Rheumatologic diseases are a group of systemic diseases that affect multiple systems and organs, including systemic rheumatologic diseases, various types of arthritis, and many rare and uncommon diseases.
Rheumatologic diseases are the most common type of difficult diseases in hospital internal medicine.
Rheumatologic diseases are often misdiagnosed and underdiagnosed, and should be brought to the attention of physicians and patients.
Focus on systemic prevention and treatment of osteoarthritis
Osteoarthritis is a chronic, degenerative joint disease, mostly manifested as pain in the finger joints, knees, hips, and cervical and lumbar joints, with restricted movement and joint deformation. In China, there are currently about 30 million middle-aged and elderly people with osteoarthritis, which is almost equivalent to the population of two Beijing cities. This shows how important it is to prevent and treat osteoarthritis.
Understanding the causes of osteoarthritis
Age Factors
As the population ages, the prevalence of osteoarthritis increases significantly, and the older the person, the higher the prevalence; the prevalence is about 10% for people over the age of 45, and up to 40% to 60% for people over the age of 60.
Weight factors
Osteoarthritis is also closely related to weight, and the fatter a person is, the more likely he or she is to develop the disease.
Weight bearing factors
Certain occupational tasks and long-term joint weight imbalance may trigger osteoarthritis.
Endocrine factors
A decrease in estrogen levels in women during menopause is also an important factor in the development of the disease.
How to detect patients with osteoarthritis?
Symptoms
1. Patients are mostly middle-aged and elderly people over 45 years old, and osteoarthritis occurs more commonly in the knee and hip joints.
2. Joint pain is characterized by mild to moderate intermittent dull pain in the early stages, which is aggravated by activity and can be relieved after rest. Patients may suffer from transient synovitis resulting in joint swelling, short morning stiffness, hand numbness, sciatica, dizziness and other signs of nerve and blood vessel compression. Later, the pain may develop into persistent, or even tearing or pinprick-like pain. In severe cases, the pain cannot be relieved even after rest, and the pain increases at night. In the morning or after sitting for a long time, the joints often feel uncomfortable and stiff, as if they are stuck together, and can recover quickly after activity, usually within 30 minutes.
Physical signs
Bony hypertrophy (such as Hebden’s nodes, Bouchard’s nodes, etc.), impaired joint movement and deformity, audible bone rubbing sounds and palpable bone rubbing sensation can be seen.
Mastering the key points of prevention and treatment
1.Educate and guide residents and patients to reduce weight to reduce the burden on the joints.
2.Educate and guide the patients to avoid excessive activities and joint weight-bearing. Because excessive exercise can aggravate joint damage, patients should: ① Reduce walking appropriately to the extent that there is no painful discomfort after the activity. Those with significant joint pain should reduce the intensity of exercise and shorten the duration of exercise. ② Pay attention to joint warmth.
3, treatment needs to be different from person to person. (1) For milder symptoms, you can use topical medication and receive physical therapy to eliminate pain and restore joint function. ②In addition to physical therapy and massage for those with more severe symptoms, medication can be used (mainly divided into two categories: symptom control and condition improvement medication). ③For those who have obvious joint function disorder and obvious joint deformity, if they cannot improve after standardized and correct medical treatment, surgical treatment can be adopted.
Three points of managing dry syndrome
Misconceptions that need to be corrected
At present, the main misconception of domestic and foreign physicians about dry syndrome is that this disease cannot be treated or does not need to be treated. In fact, dry syndrome is not untreatable, and treatment with scientific methods can achieve long-term remission, prevent or reduce the involvement of liver, lung and kidney, and stop the occurrence of complications such as extra-glandular organs. However, due to sitting and waiting for the development of the disease for a long time, the condition of many patients becomes more and more serious, so that interstitial lung fibrosis, hyperglobulinemia, whole blood cell reduction and impaired liver and kidney function eventually appear. Therefore, doctors should correct the above-mentioned misconceptions and provide active management and treatment to patients with dry syndrome.
Grasp the main manifestations of patients
When community residents show the following manifestations, community doctors should highly suspect them of dry syndrome and actively suggest them to go to higher level hospitals for timely treatment.
Dry mouth
Dry mouth, dry tongue, dry and cracked tongue and mirror tongue, the need to drink water when speaking and eating solid food, recurrent oral ulcers and swelling of parotid and submaxillary glands, etc.
Dry eyes
Dry eyes, photophobia, few tears, foreign body sensation, or even no tears, and often filiform secretions in the inner canthus of the eyes. Ophthalmia often occurs.
Other manifestations
Dryness of nose, throat and trachea; decreased gastric acid, atrophic gastritis, subclinical pancreatitis; dry skin and vagina.
Supervise the patient for proper treatment
Treatment points
The pathological basis of dry syndrome is B-cell hyperfunction, which leads to excessive antibody production, causing lymphocyte infiltration of various exocrine glands (such as lacrimal gland, sublingual gland, submandibular gland, etc.), damage to lung and liver, and even lymphoma. Therefore, in addition to symptomatic treatment, the key is to suppress the overly hyperactive immune response.
Principles of drug administration
That is, following the principle of individualized treatment.
1. For mild patients, strong chloroquine, total peony glycosides and other mild botanicals can be used for treatment.
2, moderate to severe patients should be given azathioprine, cyclosporine, leflunomide, etc. Cyclophosphamide can be considered for severe visceral involvement.
3.Regulate the use of hormones. Those with obvious symptoms can be given small doses of hormones (but attention should be paid to timely dose reduction), and add an appropriate amount of immunosuppressants.
4, symptomatic treatment, such as the use of sodium glassate eye drops, not only to relieve eye discomfort, but also to prevent dry keratoconjunctivitis, etc. For those with many autoantibodies and poor response to medical treatment, immunosorbent plasma replacement can be considered.