However, there are still many topics that require further research, including cancer, viral infections, and immunological diseases. Immunological research is undeniably one of the mainstays of medicine in recent years, with new discoveries being made every day. Observations range from the clinical manifestations of cowpox smallpox to the current X-ray studies of human tissue antigen HLA molecules, and research tools range from simple physical and chemical properties to the use of sophisticated molecular biotechnology. The number of articles published every day is so large that it takes a little time to catch up with the latest knowledge.
In fact, immunology is not limited to rheumatism, but many diseases of all human systems are immune pathologies, such as viral hepatitis, thyroiditis, polyneuritis, platelet hypoplasia, etc. The basic cause of these diseases is immune injury. However, they are classified as gastroenterology, metabolism, neurology, or hematology only because the lesions are confined to a single organ. Rheumatic diseases, on the other hand, are immunopathologies that affect organs throughout the body and are multi-organ immune diseases. The clinical manifestations are variable and quite complicated. In order to successfully treat rheumatic diseases, in addition to detailed physical examination, it is necessary to understand the manifestations of the disease over time and the differences in disease manifestations, so as to grasp the characteristics of rheumatic diseases and prescribe the right medicine.
Development of rheumatology
The development of rheumatology in China is unlike other traditional disciplines, which have only a history of about 20 years, and the maturity of rheumatology has occurred in the last decade. In addition to the foundation laid by the efforts of early medical predecessors, the development is mainly due to the rapid advancement of molecular biotechnology and immunological tests, which made the formerly difficult tests easier and more sensitive, and the tests that could only be performed in medical centers can now be accurately examined in local areas, which can be said to be the best example of precision medicine in the countryside. At this time, advanced medicine competed to carefully examine the clinical symptoms (Symptom and Sign) presented by patients to reach a clinical diagnosis, and at this time medicine was based on “symptom medicine”. Later, the development of imaging devices such as X-ray, ultrasound, and endoscopy gave human beings the opportunity to examine the internal structure of the human body and the tissue deformation caused by diseases through these devices. The most important developments were the invention of tomography, computer tomography, and magnetic resonance imaging (MRI). By now, computed tomography and MRI have begun to use different pathological characteristics of diseases to distinguish different diseases (e.g., computed tomography contrast and T1 and T2 imaging), which can be considered a major breakthrough in the history of examination. Another field of medicine, nuclear medicine, has also matured in the last decade. The greatest advantage of nuclear medicine is the assessment of the function of tissues and organs in addition to the shape of the image, making medical examinations a step forward to “functional medicine”. Positron Emission Tomography (PET) also has similar advantages. Another area of nuclear medicine is RadioImmune Assay (RIA), which can measure up to nano (micrograms) and pico (nano-micrograms) and is the most important key to progress in endocrinology. Recently, due to the rapid advances in molecular biotechnology and immunology, medical tests have officially entered the field of “molecular medicine”, and the range of topics addressed is very different from traditional techniques. It has the ability to assess risk factors, abnormalities in genetic structure, abnormalities in cellular signaling, and defects in important organelles on the cell surface and in the cytoplasmic nucleus. The level of discussion is from tissue and organs down to chromosomal nucleic acids, and the substances studied move from proteins to DNA and RNA, and the diagnostic stage is advanced from late pathological shape changes and mid-stage functional abnormalities to very early molecular signal defects. If you do not know the four simple steps to remove the transparent gelatinous material of human chromosomes, which can be felt and felt, it is impossible to consider the disease from this perspective. The diagnosis and treatment of rheumatic diseases require not only a complete and detailed medical history and examination, but also these sophisticated testing techniques.
Advances in rheumatology testing technology
Simply put, the development of modern testing techniques cannot be separated from computer technology, immunology and molecular biotechnology. The principle of testing, especially regarding serological examination, has evolved from the most basic physical coagulation, hemolysis, and diffusion reactions to the use of Monoclonal Antibody and Recombinant Protein to detect abnormal reactions. For example, Lymphocyte Subpopulation has evolved from a rough estimate of the time required for Roset Formation of sheep red blood cells to a flow cytometer test that can be performed in minutes. In the early days, Double Diffusion was very difficult to determine, but now we use Western Blotting to measure SSA, SSB, Jo-1, Sclero-70, Sm and RNP, and the accuracy has improved greatly. Previously, only qualitative examination (Quality Identification) was available, but now quantitative estimation is required. In the past, human vision was used to count, but now it is replaced by photoelectric signals, and the number of samples taken has increased from tens to tens of thousands, so that the error is naturally reduced. Another advancement is the change from invasive examination to non-invasive evaluation, and from radiation risk to non-radiation safety technology.
Scope of rheumatic diseases
There is a wide range of rheumatic diseases, except for organ-confined immunopathy, which can be roughly listed as follows.
I. Extensive connective tissue lesions
Systemic lupus erythematosus
Rheumatoid arthritis
Scleroderma
Polymyositis/dermatomyositis
Vasculitis
Dry syndrome
Mixed connective tissue disorders
II. Spondyloarthropathies
Degenerative arthritis
Infectious arthritis (bacterial viral mycobacterial parasites)
V. Stiff bones and cartilage tendons (osteoporosis, bone necrosis, osteomyelitis, chondromalacia, etc.)
Soft tissue disorders: myofascial pain, back pain, tendonitis, synovitis
Seven, metabolism-related rheumatic diseases
Gout
Pseudogout
Other crystalline arthritis
What are the characteristics of rheumatic diseases?
The author’s years of clinical experience can be summarized as follows.
The tip of the iceberg: the symptoms that appear clinically may only be a small part of the symptoms, and most of them may still be latent, just like the tip of the iceberg, faintly appearing and disappearing after appearing, and the latent symptoms may appear from time to time in the future. The lack of sensitivity of the instrument is one of the reasons, another reason is the lack of detailed examination and physical examination.
Variable: No disease has ever been as diverse and heterogeneous as rheumatic diseases. Lupus erythematosus can attack any organ or tissue in the body, and the variety of symptoms can be imagined. The pathological changes are a good tool to speculate on the interpretation of clinical changes.
Episodic: Some conditions appear occasionally and reappear only after several years of appearance. Questioning is the best way to go besides experience, vantage point.
Favors all in one: Yang Guifei set three thousand favors in one rheumatic patient is not lucky. Rheumatic diseases can attack many organs, so many lesions will appear in the same patient, if you ignore this characteristic of rheumatic diseases, not only the patient suffering, treating physicians are also busy in and out of nothing. Physicians must be especially careful to consider the possibility of rheumatic disease when two systems are affected at the same time. Syphilis was considered in the nineteenth century when there were multiple systemic lesions; tuberculosis in the early twentieth century; systemic lupus erythematosus in the mid-twentieth century; and Lyme disease and AIDS in the late twentieth century.
It is not that there are no clues to the variety and diversity of changes mentioned above. There is only one place for a piece of clothing to be organized and hung smoothly. The same applies to the treatment of rheumatic diseases. It is important to grasp the focus and the pathological changes so that all treatment can be on track.
The origin is long: as mentioned above, mastering the longitudinal side of time is a very important diagnostic skill. A minor and insignificant condition may have appeared years ago. It is very important to synthesize the information to make the relevant conclusions, and it is difficult to make a correct diagnosis with incomplete information.
The onset of rheumatic diseases is fierce: many patients with rheumatic diseases are very serious when discovered, such as cerebral hemorrhage, pulmonary hemorrhage or heart failure. Especially those patients who delay the course of treatment or stop the medication without permission.
Euphemistic about people: On the contrary, many patients’ symptoms are really hard to detect. It may be as simple as a few small red dots on the face. These unnoticeable symptoms can persist for many years without being noticed until the disease worsens and the signs have been there for years.
Recurrence: Another characteristic of rheumatic diseases is that they come and go, and they come and go. It is like waves after waves, with intervals of reprieve of varying duration. It is important to recognize this characteristic so that there is no rush to reduce medication when the disease is stable and no chaos when the disease intensifies.
Why are rheumatic diseases increasing?
In fact, it is not that there are more and more rheumatic diseases, but that these patients already exist. It is only because of the increasingly sophisticated testing technology, the earlier we can diagnose the cause of the disease that could not be found before, especially the great progress in molecular biology, so that clinical rheumatologists have greater ability. Secondly, the economic development, modern people are more and more concerned about the problems that were previously ignored. When you can’t even eat enough, you have time to pay attention to the early subtle symptoms of rheumatism.
Is there a specific medicine for rheumatism?
There are definitely, immunosuppressants and immunomodulatory drugs have made great progress such as MTX, the experience and safety of using them is increasingly improved, and the combination of drugs and plague evaluation (combination therapy) not only reduces the side effects but also makes the efficacy of the treatment to produce an additive response is a great blessing for patients. Nowadays, rheumatology treatment is not only about relieving painful symptoms, but also about fundamentally changing the course of the disease and bringing it into remission.
Is rheumatism a genetic disease?
It is not a genetic disease. However, rheumatism is associated with certain abnormalities in gene regulation. Body specificity can be given to the next generation, but it does not mean that the next generation will definitely get the disease, so it is not a genetic disease.
Diagnosis of rheumatic diseases
Due to the multi-organ lesions and the long course of the disease, the ARA diagnostic criteria are usually used. It is a common mistake for physicians to think that they must have all the diagnostic points before making a diagnosis, knowing that the patient has already passed the prime time for treatment and lost the opportunity for treatment. It is important to understand that the course of rheumatic disease is a dynamic disease process, and too much of the old-fashioned approach will miss many early cases.
Treatment of rheumatic diseases
The treatment of rheumatic diseases is still based on the steroid Prednisolone, but the most appropriate prescription must be tailored to each patient. The treatment of high risk has progressed to early use of second-line immunosuppressants (Immune Suppressor) or immune modulators (Immune Modulator), Combined Therapy, Pulse Therapy, the Golden Period, and the introduction of a sophisticated Disease Activity Index instead of clinical observation. As for Cytokine Therapy, T cell Therapy, Peptide Therapy, or Vaccine Treatment, there have been first successful cases but they are still a long way from the clinic. However, special care should be taken to prevent patients from irreparable damage due to over-promotion and fear of steroid side effects, serious side effects caused by ignorant use of steroids, and serious injury to the gastrointestinal tract caused by frequent drug changes due to poor efficacy of NSAIDs or improper use.
In addition to medical therapy, appropriate surgical and rehabilitative treatment can really add to the effectiveness of treatment. For example, joint immobilization for patients with rheumatoid arthritis with severe joint destruction; osteoarthroplasty or decompression surgery for pain caused by ischemic bone necrosis; swimming rehabilitation and brace stretching for stiff crestitis; and home activity guidance and auxiliary mold work for rheumatoid arthritis can all be of great help to patients. Rheumatology treatment is a group work, to get the best treatment must integrate the views of rheumatology, orthopedics, rehabilitation, functional therapists and even psychological rehabilitation experts. An over-emphasis on medical treatment is not only ineffective in controlling the disease, but the side effects of medication can be considerable. The use of interdisciplinary integration techniques to enhance the effectiveness of rheumatology treatment and reduce unnecessary side effects is exactly what is known as “the power of the force to attack is unbreakable”.