1.What is rheumatoid arthritis?
(1) Rheumatoid arthritis (RA) is a chronic, systemic disease of unknown etiology, mainly inflammatory synovitis, and is one of the most common rheumatic immune diseases. It is characterized by symmetric, aggressive arthritis of the wrist, metacarpophalangeal joints, proximal interphalangeal joints and small joints of the foot, and may be accompanied by extra-articular organ damage such as interstitial lung lesions, peripheral nerve damage, etc. Most patients with RA have positive serum rheumatoid factor and anti-CCP antibodies, and RA can lead to joint deformity and loss of function.
(2) The onset of RA may be related to genetics, infection, sex hormones, etc. RA can occur at any age, with more middle-aged women, the high incidence of age 40 to 60 years, the incidence of women is 2 to 3 times that of men.
2, the clinical characteristics of rheumatoid arthritis
(1) rheumatoid arthritis patients may be accompanied by weight loss, low-grade fever and fatigue and other systemic symptoms.
(2) morning stiffness: morning joint stickiness, the subjective feeling of inflexible joint movement when waking up in the morning, is a non-specific manifestation of arthritis, and the time of morning stiffness reflects the severity of arthritis.
(3) Typical manifestations of arthritis: symmetrical, multi-joint swelling and pain: the wrist, metacarpophalangeal joints, proximal interphalangeal joints and other small joints are mainly involved; joint deformities: pike swelling, ulnar deviation, swan neck-like deformity, button flower-like deformity, etc.; if the joint swelling or deformity compresses the median nerve, it may cause carpal tunnel syndrome, cervical spine involvement may have neck pain and weakness, atlantoaxial joint subluxation, there may be spinal cord compression manifestations.
(4) Extra-articular manifestations.
(1) high titers of rheumatoid factor, long-term RA activity patients can appear rheumatoid nodules, which are commonly found in the elbow, joint eminence and other joint bulges and often under pressure; rheumatoid vasculitis (necrotizing small arteritis that mainly involves small arteries, which can manifest as necrosis of finger and toe ends, skin ulcers, etc.).
(ii) cardiac involvement, respiratory involvement: may include coronary arteritis, interstitial lung lesions, etc.
(iii) renal damage: mainly primary glomerulonephritis and tubulointerstitial nephritis, renal amyloidosis and renal damage secondary to drug therapy (penicillamine and NSAIDs).
(iv) Neurological: in addition to symptoms of peripheral nerve compression, there may be ischemic neuropathy secondary to vasculitis.
⑤ anemia: the most common extra-articular manifestation of RA, which is chronic disease anemia, often mild to moderate.
(vi) Digestive system: mostly due to side effects of glucocorticoids and painkillers.
(7) Eye: some patients may have uveitis and sclerositis, which may be caused by vasculitis; there may also be secondary dry conjunctival keratitis, etc.
3, rheumatoid arthritis treatment principles
Rheumatoid arthritis treatment principles include patient education, early treatment, combined medication, individualized treatment. Drug treatment program should be individualized, mainly including non-steroidal anti-inflammatory analgesics, slow-acting drugs to improve the condition, glucocorticoids, biological agents and botanicals.
(1) Non-steroidal anti-inflammatory analgesics (NSAIDs) have anti-inflammatory and analgesic effects and are the most commonly used drugs in the treatment of rheumatoid arthritis, which cannot inhibit the progression of bone destruction in RA and can only improve the symptoms of joint swelling and pain.
(2) slow-acting drugs to improve disease (DMARDs): the current first-line drugs for RA treatment are methotrexate, leflunomide, salazosulfapyridine, hydroxychloroquine, etc. These drugs have a slow onset of action, but can inhibit bone destruction in RA.
(3) Glucocorticoids: they are not the first choice and must be used for the treatment of rheumatoid arthritis. They can be considered in the following cases.
(1) rheumatoid vasculitis including peripheral neuropathy, interstitial lung lesions, iritis, etc.
(ii) Transitional treatment: patients with severe rheumatoid arthritis may use small doses of hormones for rapid relief, and once the disease is controlled, hormones should first be reduced or slowly discontinued.
③Patients whose regular improvement of the condition by slow-acting drug therapy is ineffective may be treated with additional small doses of hormones.
(iv) Local application: such as intra-articular injection can effectively relieve the inflammation of local joints. The principle of hormone use is short-term small dose (prednisone ≤ 10mg/d) application, while paying attention to stomach protection and prevention of osteoporosis and other complications.
(4) Biological agents: currently more commonly used are TNF-α inhibitors and IL-6 antagonists, which play an important role in refractory severe rheumatoid arthritis.
(5) botanicals: such as Leigongjiang polyglucoside tablets, total glucoside of peony, etc.
4, RA patients need to strengthen functional exercise
Functional exercise is an important way to restore and maintain joint function in patients with rheumatoid arthritis. Generally speaking, in the acute phase of rheumatoid arthritis, joint swelling and pain should be appropriate to limit joint activities. When the disease is stable, that is, after the pain and swelling of the joint is relieved, appropriate functional exercises should be gradually performed without increasing the pain of the patient. For those who do not have obvious joint swelling and pain but have reversible joint movement limitation, they should be encouraged to perform formal functional exercises. In hospitals with conditions, this should be done under the guidance of rheumatologists and rehabilitation specialists.