How should rheumatoid arthritis be treated? In fact, to treat this disease, the first thing to do is to first understand the causes of this disease and by what means to check this disease, only by grasping these two aspects, you can treat rheumatoid arthritis very well.
Rheumatoid arthritis is a chronic, inflammatory synovitis-based systemic disease of unknown etiology. It is characterized by polyarticular, symmetric, aggressive joint inflammation of the small joints of the hands and feet, often accompanied by extra-articular organ involvement and positive serum rheumatoid factor, which can lead to joint deformity and loss of function.
1.Etiology
(1) The onset of RA may be related to genetics, infection, sex hormones, etc.
(2) The pathology of rheumatoid arthritis mainly includes: proliferation of synovial cells, massive inflammatory cell infiltration, microvascular neovascularization, formation of vascular opacities and destruction of cartilage and bone tissue.
2.Signs and symptoms: may be accompanied by weight loss, low fever and fatigue and other systemic symptoms.
(1) Morning stiffness The duration is proportional to the severity of inflammation.
(2) manifestations of joint involvement
(1) Multi-joint involvement
(2) Joint deformity
(3) Other manifestations: Carpal tunnel M tarsal tunnel syndrome, N fossa cyst (Baker cyst), atlantoaxial subluxation due to cervical spine involvement, corresponding to spinal cord compression and insufficient blood supply to the basilar artery.
(3) Extra-articular manifestations
(1) General manifestations Fever, rheumatoid nodules, rheumatoid vasculitis and lymph node enlargement may be present.
②Heart involvement
(3) Respiratory system involvement
④Renal manifestations
⑤Nervous system
⑥Anemia
(7) Digestive system
(4) RA of elderly onset often starts at the age of >65 years, with small gender differences, mostly with acute onset and rapid development (some with OA as the initial manifestation, with typical RA manifestations appearing a few years later).
3.Examination
Laboratory tests
(1) General examination Blood, urine routine, blood sedimentation, C-reactive protein, biochemistry (liver and kidney function, A/G), immunoglobulin, protein electrophoresis, complement, etc.
(2) Autoantibodies Rheumatoid factor (RF-IgM), anti-cyclic citrulline (CCP) antibody, rheumatoid factor IgG and IgA, anti perinuclear factor, anti-keratin antibody, as well as anti-nuclear antibody and anti-ENA antibody, etc.
(3) Genetic markers HLA-DR4 and HLA-DR1 subtypes.
Imaging tests
(1) X-ray radiographs Joint radiographs show soft tissue swelling, osteoporosis and progressive cystic changes of the joint surface, aggressive bone destruction, blurring of the joint surface, joint space narrowing, joint fusion and dislocation.
① Stage Ⅰ Normal or osteoporotic.
② Stage II osteoporosis with mild subarticular surface bone invasion or destruction and mild joint space narrowing.
③ Stage III Significant subsurface bone erosion and destruction, significant joint space narrowing, and joint subluxation deformity.
Stage IV The above changes are combined with fibrous or bony ankylosis of the joint. Interstitial lung lesions and pleural effusion can be seen on chest X-ray.
(2) CT examination
(3) MRI examination MRI examination of hand and wrist joints can indicate early synovitis lesions, which is useful for detecting early joint destruction in patients with rheumatoid arthritis.
(4) Ultrasound Ultrasound of the joints is a simple, non-invasive test that can be useful in identifying synovitis, joint effusion and joint destruction. Studies have concluded that it has good agreement with MRI.
3.Special examination
(1) Arthrocentesis For joints with joint effusion, the examination of joint fluid includes: joint fluid culture, rheumatoid factor test, anti-CCP antibody test, anti-nuclear antibody, etc., and polarized light test to identify urate crystals in gout.
(2) Arthroscopy and synovial biopsy are valuable for the diagnosis and differential diagnosis of RA, and have an auxiliary therapeutic effect on single joint refractory RA.
4.Activity indicators are
①Joint pain ≥ 4.
②Morning stiffness > 30 minutes.
③ESR≥30mm/h.
④Higher CRP.
⑤ Increased platelets (PLT).
⑥Anemia.
⑦RF (+) 1:20 or more.
(8) Extra-articular manifestations (fever, anemia, vasculitis, etc.).
6, treatment of rheumatoid arthritis treatment of the main purpose: to reduce the inflammatory response of joints, inhibit the development of lesions and irreversible bone destruction, as far as possible to protect the function of joints and muscles, and ultimately achieve the goal of complete remission or reduce disease activity.
The principles of treatment include patient education, early treatment, combined medication, individualized treatment plan and functional exercise.
(1) Education: To make patients understand the disease correctly, build up confidence and patience, and be able to cooperate with doctors in treatment.
(2) General treatment: rest and joint braking should be emphasized for those with significant joint swelling and pain, while attention should be paid to the early start of functional exercises for joint stiffness after the joint swelling and pain have subsided. In addition, physical therapy, topical medicine and other adjuvant treatments can quickly relieve joint symptoms.
7.Medication
(1) Non-steroidal anti-inflammatory drugs: Fotarine, Fenbid, etc.
(2) Anti-rheumatic drugs (DMARDs): methotrexate; salazosulfapyridine; hydroxychloroquine; leflunomide; cyclosporine; jinnovine; total glucosamine, etc.
(3) Glucocorticoids
(4) Human recombinant TNF receptor fusion protein, currently there are two kinds of domestic Enzyme and Ixepro.
( 5) Botanical drugs: There are many kinds of botanical drugs used for rheumatoid arthritis, such as Lei Gong Tang, Bai Shao total glucoside, Qing Teng Lin, etc.
4.Surgical treatment
(1) In the early stage of rheumatoid arthritis, if the drug control is not good, arthroscopic surgery can be considered to remove the synovial membrane in the joint to remove the disease-causing factors, which can protect the joint cartilage from further erosion.
(2) For patients with advanced disease, joint cartilage is completely eroded away and the function of the joint space is severely limited by narrowing, artificial joint replacement surgery can be considered to relieve pain and improve joint function.
5.Immune purification
6, functional exercise: functional exercise is an important method to restore and maintain joint function in patients with rheumatoid arthritis. In the acute phase of obvious joint swelling and pain, joint activities should be appropriately restricted. However, if the swelling and pain improve, functional activities should be performed without increasing the patient’s pain.