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Abstract: Rheumatoid arthritis is an autoimmune disease with a focus on erosive arthritis, which can cause joint swelling, pain, morning stiffness and other uncomfortable manifestations, as well as joint deformity of varying degrees if not treated promptly, and even complete loss of joint function. The patient in this case, who started more than 10 years ago without targeted treatment, was admitted to the hospital due to worsening symptoms. After treatment with ibuprofen extended-release tablets, diclofenac sodium extended-release tablets, methotrexate tablets, and salazosulfapyridine tablets, the symptoms improved and the disease stabilized, but the wrist joint remained slightly deformed.
Basic information】Male, 39 years old
Disease Type】Rheumatoid arthritis
Hospital】The First Hospital of China Medical University
Date of consultation】September 2019
Treatment plan】Medication (ibuprofen extended-release tablets, diclofenac sodium extended-release tablets, methotrexate tablets, liubizine tablets)
Treatment period】1 week of inpatient treatment, 1 month of outpatient follow-up
Treatment effect] The symptoms improved and the disease was stable, but the wrist joint remained slightly deformed.
I. Initial consultation
More than 10 years ago, the patient developed swelling and pain in the proximal interphalangeal joints of both hands and both wrist joints without any obvious cause, with limited movement, no fever, no dry mouth or dry eyes. Six months ago, the patient’s joint swelling and pain worsened, mainly involving the metacarpophalangeal joints, proximal interphalangeal joints, bilateral wrist joints, bilateral elbow joints, bilateral shoulder joints, bilateral temporomandibular joints, bilateral knee joints pain, limited movement, accompanied by dry mouth, no fever, no skin rash, self-medication at home with Duyiwei capsule treatment, the effect is not good, to our hospital outpatient check anti-cyclic citrullinated peptide antibody are positive, now for further treatment admitted to the hospital, given The patient was admitted to the hospital for further treatment and was given three rheumatic tests, the results of which showed that C-reactive protein was 97.7 mg/L. He was initially diagnosed with rheumatoid arthritis. Since the onset of rheumatoid arthritis, the patient has been clear, mentally competent, able to eat, and has normal bowel and stool.
Treatment history
The results showed that the bone density of the right wrist joint was reduced, the bone trabeculae were sparse, the wrist joint space was narrowed, the bone structure of the wrist was disturbed, and the distal bone of the ulnar radius was not continuous, which was consistent with the manifestation of rheumatoid arthritis. Combined with the patient’s complaints of increased joint swelling and pain, the patient was judged to be in the active stage of rheumatoid arthritis. The patient was advised to take anti-inflammatory drugs ibuprofen extended-release tablets and diclofenac sodium extended-release tablets to control the development of inflammation and relieve pain. Anti-rheumatic therapy was administered with methotrexate tablets and salazosulfapyridine tablets. After one week of treatment, the patient can be discharged only when the symptoms improve and the condition is stable, and he still needs to insist on taking anti-rheumatic drugs after discharge.
III. Treatment effect
After giving the patient medication, the symptoms were significantly reduced. By using anti-inflammatory drugs ibuprofen extended-release tablets and diclofenac sodium extended-release tablets, the development of inflammation was effectively controlled and the patient’s joint swelling and pain were improved. After using the anti-rheumatic drugs methotrexate tablets and salazosulfapyridine tablets, the progression of the disease was effectively stopped, and the degree and extent of the patient’s joint swelling and pain were controlled, but for the narrowing of the right wrist joint space that had formed before treatment, a mild right wrist joint deformity would remain after treatment. The patient was discharged from the hospital after one week with no other discomfort.
IV. Notes
After the patient’s condition improved, while I was happy for the patient, I did not forget to advise the patient that the following points should be noted in life after discharge.
1, after discharge from the hospital should be reasonable diet, active weight control, avoid overweight, obesity and other increased joint load, which can reduce the risk of rheumatoid arthritis.
2, patients should adhere to regular follow-up visits to the hospital after discharge, once a month for the first three months, and once every 3-6 months thereafter, and if symptoms such as joint swelling and pain worsen during this period, they should seek medical attention promptly.
3. Patients should pay attention to strengthening the protection of their joints on a daily basis, increase clothing in time, and avoid cold stimulation. When exercising, pay attention to moderate intensity, not strenuous exercise.
V. Personal insights
Rheumatoid arthritis is insidious, mainly manifested as joint swelling, pain, morning stiffness, etc. Serious cases may also appear joint deformity, mobility disorders, etc.. Therefore, once the above-mentioned symptoms appear, timely consultation and early anti-rheumatic treatment are more effective, and patients can regain normal mobility and inhibit the progression of osteoarthrosis, reducing the risk of disability. In the patient in this case, if timely consultation is made after the onset of the disease, the increase in the extent of joint lesions can be prevented, and the more severe degree of joint deformity will not be left behind after treatment.