1.What is rheumatoid arthritis? The normal joint cavity has a layer of synovial membrane, which can secrete a small amount of synovial fluid to lubricate and protect the joint, but when suffering from rheumatoid arthritis, the synovial membrane produces an inflammatory response, a large number of inflammatory cells infiltrate and accumulate in the synovial membrane, causing significant thickening and congestion of the synovial membrane, and secrete a large amount of fluid, the joint swelling, pain and other phenomena. Rheumatoid arthritis is a chronic systemic autoimmune system disease mainly arthritic lesions, because it is a difficult chronic disease, often recurrent, although the disease itself is not enough to kill, but will lead to deformation of the patient’s limbs and joints, and affect the patient’s ability to work and live, and some patients are even rejected by marriage or society. 2.Who is prone to rheumatoid arthritis? According to epidemiological surveys, the prevalence rate of Chinese people is about 0.4%, which is slightly less than the 1% of Caucasians. It is estimated that there are about 5 million people suffering from rheumatoid arthritis, the ratio of men to women is about 1:3, and it occurs in the age of 40-60. That is, the number of women affected is three times that of men, middle-aged women are more likely to develop, but any age may develop. 3. Why do I get rheumatoid arthritis? The medical community still has a limited understanding of the cause of this disease, only known to be related to abnormalities in the body’s immune system, and its causative factors may be related to genetics, the environment (possibly bacterial or viral infections), emotions and endocrine. That is, people with certain genetic traits begin to develop the disease in response to environmental triggers. The disease is caused by problems with the body’s “defenders” (called the immune system), which not only kill germs, but also produce many unnecessary antibodies (autoantibodies), such as rheumatoid factor, anti-cyclic citrullinated peptide antibodies, anti-keratin antibodies, etc., which destroy the normal structure of the body. 4.What are the symptoms of rheumatoid arthritis? It varies from person to person. Usually, at the beginning, there is only slight local discomfort, such as joint pain, stiffness and swelling. Later, the pain increases and movement becomes more difficult. The most common sites of attack are the small joints of the extremities, most often the proximal fingers, between the fingers and palms, and the wrists; the toes and between the feet; the knees, ankles, shoulders, temporomandibular joints, and other areas of the joints may also be affected. In addition, there is often a “symmetrical” pattern of invasion, i.e., the symptoms appear on the same part of the body on both the left and right sides. More than 80% of patients do not heal well, with gradual joint distortion, deformity, and even interstitial lung fibrosis. Inflammation also causes fatigue, impatience and discomfort, mild sweating at night, anemia, and possible weight loss. 5.How to prevent rheumatoid arthritis? There are no effective preventive measures. Early detection and early treatment can better prevent the occurrence of joint deformities. Once you find yourself with the signs of the disease, you should be alert, and promptly find a rheumatologist to do diagnosis and treatment. 6.What are the risk factors for poor prognosis of rheumatoid arthritis? The following risk factors have a poor prognosis (i.e., prone to joint disability): 1) young onset (i.e., young age of onset); 2) more than four swollen joints; 3) high sedimentation and CRP; 4) morning stiffness of more than one hour; 5) particularly high rheumatoid factor and anti-CCP antibody titers; 6) poor results of low-dose hormone therapy; 7) imaging within two years after onset of disease, joint bone There is destruction; 8) HLA-DR4 positive. 7. How is rheumatoid arthritis treated? The goal of treatment is to relieve pain and stiffness, prevent deformity, and help maintain normal motor function. Drug therapy is a core part of the treatment plan for this disease. There are three major categories of therapeutic drugs – NSAIDs, disease-modifying antirheumatic drugs, and glucocorticoids. 1) NSAIDs: These are anti-inflammatory pain medications that help relieve pain and stiffness, allowing you to exercise to maintain good joint function and continue normal activities. However, anti-inflammatory painkillers do not stop the progression of the disease or affect its outcome. 2) disease-modifying anti-rheumatic drugs: can be used to reduce the activity of the disease and slow down the damage to the joints, as well as to make the patient himself feel much better and help stop the progression of the disease. Drugs of this type include Methotrexate (MTX, methotrexate), Leflunomide (LEF, leflunomide), Sulfasalazine (SSZ, sulphasalazine), Hydroxychloroquin (HCQ, hydroxychloroquine sulfate), and the herbal medicine Lei Gong Tang (TwHF, Tripterygium wilfordii Hook F) and others that can suppress or modulate the immune response. All of these drugs require weeks or even months of use before their effects appear and have some side effects. Patients respond to these drugs with variable efficacy, but there are no measurements to predict the effect in advance, and they have some effect in most patients. The mechanism of action of these drugs is not clear, but the disease continues to improve during continued use, showing a good overall effect on the control of the disease. During the application of these drugs, blood tests and liver functions need to be checked for early detection of possible side effects. Biologic agents: They can be considered as “special drugs”, which can selectively block specific factors in the development of the disease, rapidly reduce inflammation, eliminate joint pain, and effectively prevent joint deformities. These drugs include blockers of tumor necrosis factor, blockers of interleukin-6, B-cell scavengers, and antagonists of the co-stimulatory factor CTLA-4. At present, blockers of tumor necrosis factor are more frequently used in China, and there are several varieties of imported and domestic supply. Its main disadvantage is the expensive price. 3) Glucocorticoid: It can rapidly inhibit inflammatory response, reduce joint pain, and help stop the development of the disease. For those with severe disease, small doses of hormones such as prednisone (prednisone) ≤10mg/day can be given, with fewer and milder adverse effects. Calcium may be added to prevent osteoporosis. For intractable joint swelling, intra-articular injection of hormones is also possible. 8.What are the daily precautions for patients with rheumatoid arthritis? 1) When the joint is in acute inflammation, rest properly because it will be very painful. 2) Do not massage the inflamed joints, because it will make the inflammation more serious. 3) Keep your body and joints warm by adding clothes and socks, because the cold will cause muscles to contract, making joints more likely to become painful and stiff. 4) When the acute inflammation of the joints has passed, heat therapy can be used to increase the flexibility of the joints. 5) When you wake up in the morning, move your joints in bed first, and then get out of bed to reduce pain. 6) If the joints are immobilized for a long time, it will increase the pain and muscle weakness, so moderate exercise can be used to strengthen the loose muscles and improve joint mobility. The specific amount of daily exercise depends on the individual’s actual ability. Activities such as walking, swimming, running, cycling, etc. are suitable, while intense sports such as weight lifting, basketball, soccer, etc. are not. ①Swimming in a warm pool, in addition to using the buoyancy of the water to reduce the burden on the joints, can also use the warm water to achieve the purpose of increasing the flexibility of the joints, so that the whole body joints and muscles are fully active, can reduce joint pain and promote muscle relaxation, is a very good exercise. ②The balance between rest and exercise is quite difficult to achieve just right, and it is different for each person. In general, rest is good for inflammation and flare-ups that have relief, and activity helps keep joints moving. The right principle for exercise is “small and regular”. And, in general, more activity is better than less. 7) Avoid finger flexion (e.g., holding a rubber ball tightly or cutting vegetables with a knife), as this may cause the arthritic hand to become more deformed. It is appropriate to do finger stretching exercises, such as opening the palm of the hand. 8) When resting or sleeping, take a flat supine posture, with the palms of your hands facing upward and your arms straight, and do not put pillows at your knees to avoid contractures and flexion deformities of the lower limb joints. 9) Choose comfortable and suitable shoes: the upper must be soft, the front of the shoe should be wider and deeper than the average person wears, in order to adapt to the irregular inflammation and deformation of the joints. Do not wear soft slippers, and the heel should not be too high. 10) Avoid overexertion, sleep at least 8 hours a night, preferably with a nap during the day. In the daily activities or work, there should be a short 10-minute break every hour. 11) Patients with dry eyes should not wear contact lenses and can order artificial tears to improve the symptoms. To reduce the discomfort caused by dry eyes, close your eyes and rest after watching TV or computer screen for a period of time. 12) Follow your physician’s instructions and do not stop or reduce the dose because you feel that your condition has decreased or because you are concerned about the toxicity of the medication. Continued outpatient follow-up visits on a regular basis, accurate assessment of the condition, and timely adjustment of the treatment plan will help prevent joint deformation and reduce the medical burden.