I. Non-steroidal anti-inflammatory drugs (NSAIDs) are generally used in the acute phase of RA when joint pain is obvious, and the dosage forms include oral drugs and topical drugs. These drugs have a rapid anti-inflammatory and analgesic effect, but cannot stop the development of the disease, and often need to be taken together with anti-rheumatic drugs to improve the condition. Common oral drugs include diclofenac preparations, ibuprofen, loxoprofen sodium tablets, meloxicam, celecoxib, etc. Topical drugs such as diclofenac emulsion. When applying, please note: 1. In the acute attack of joint redness, swelling and pain of RA, you should choose from the stronger drugs, such as diclofenac preparations, loxoprofen, etc. The strong anti-inflammatory and analgesic effects are accompanied by more adverse reactions, so you can switch to weaker but relatively safer drugs, such as celecoxib and meloxicam, when the joint redness and swelling improve, and stop the drug after complete relief. In the course of treatment, if there is no obvious effect after 1-2 weeks of applying a full dose of NSAIDs, you can switch to another NSAIDs drug; 2, NSAIDs have irritation to the gastric mucosa, and cannot be used at the same time, if the patient himself has gastric disease, and the joint inflammation is heavy, it is necessary to add NSAIDs on top of the drugs to protect the gastric mucosa; 3, to master the application of The contraindications and safety of NSAIDs. In the application of NSAIDs drugs, patients with abnormal liver and kidney function, reduced platelets, gastrointestinal system diseases and a history of allergies should be used with caution. It is advisable to check the blood routine and liver and kidney function before applying such drugs and about 2 weeks after application. Elderly people with a history of bleeding gastric ulcers can take selective COX-2 inhibitors such as celecoxib to reduce gastrointestinal reactions. The earlier the rheumatoid arthritis is treated with DMARDs, the better. Because of its ability to improve the pathological process of RA, slow down or even stop the progression of bone destruction. These drugs are commonly used clinically as methotrexate, leflunomide, salazosulfapyridine enteric tablets, hydroxychloroquine, etc. The following are some descriptions of the above single drugs: 1. Methotrexate: As the gold standard drug for the treatment of rheumatoid arthritis, it is generally used as the first choice, both in terms of efficacy and cost. To reduce adverse reactions, you can start with a small dose, such as 7, 5mg/week, once a week. To reduce its adverse reactions, you can add the same dose of folic acid tablets on the second day of methotrexate, common adverse reactions are nausea, stomatitis, diarrhea, hair loss, rash, etc. A few appear bone marrow suppression, hearing impairment and interstitial lung changes. It can also cause miscarriage, malformations and affect fertility. Clinically, if a patient presents with interstitial lung lesions, the addition of methotrexate is generally not recommended. Routine blood and liver function should be checked regularly while taking the drug. For patients with pregnancy needs, the drug needs to be discontinued for at least 3 months before conception, and folic acid should be continued after discontinuation until the end of delivery. 2. Leflunomide: Generally, it takes 4-8 weeks after taking the drug to take effect, and the dose is 10-20mg/day. Common adverse reactions are diarrhea, itching, hypertension, increased liver enzymes, rash, hair loss and transient white blood cell drop, etc. Liver function and white blood cell should be checked regularly at the early stage of taking the drug. It takes about 2 years for the drug to be completely cleared from the body. Patients who are planning to become pregnant should take colesevelam until the drug is not measurable in peripheral blood after discontinuation of the drug to promote excretion of leflunomide. Methotrexate and leflunomide have synergistic effects and can be used together to treat RA, but monitor blood work and changes in liver and kidney function. 3. Salicyclovir enteric coated tablets: the general onset of action is also 4-8 weeks, taking a maximum dose of 2g/day, can start with small doses, such as 250mg/time, twice a day; common adverse reactions include vomiting, nausea, dyspepsia, anorexia, abdominal pain, diarrhea, rash, asymptomatic aminotransferase increase and reversible spermatozoa reduction, etc. Occasionally, white blood cells and thrombocytopenia, should be prohibited for those who are allergic to sulfonamide. The drug does not affect female fertility. Men need to stop taking the drug for more than 3 months when considering fertility. Regular blood tests and liver and kidney functions should also be performed during the drug administration. 4, hydroxychloroquine: the drug is slow to take effect, usually 2-4 months, the dose is 0,2g-0,4g/day, the drug has an accumulative effect in the body, easy to cause retinal degeneration and blindness, about six months after taking the drug should check the fundus of the eye. Other adverse reactions include dizziness, headache, skin rash, itching and tinnitus. There is no report on the effect of hydroxychloroquine on the fertility of male and female patients. Glucocorticosteroids are generally used in patients with severe attacks during the acute phase of RA, where the application of adequate NSAIDs is not effective, or in patients with severe involvement of liver and kidney function, heart and lung systems. Generally, long-acting compound betamethasone injection, medium-acting prednisone acetate, methylprednisolone, etc. are chosen. The EULAR 2013 RA treatment guidelines also state that the addition of a low-dose glucocorticoid may be considered as part of the initial treatment. as part of initial therapy for up to 6 months; the dose should be reduced as quickly as clinically feasible. The so-called “low-dose” clinical application is generally 2-3 tablets/day, with methylprednisolone tablets preferred in patients with poor liver function. During the application process, attention should be paid to vitamin D and calcium supplementation, and long-term application is required to prevent femoral head necrosis. Clinically, joint cavity injections of hormones can also be seen to reduce arthritic symptoms and improve joint function, but they should not be applied more than three times in a year. And too many joint cavity punctures increase the chance of infection, and some can also occur steroid crystal arthritis. Fourth, botanical preparations Currently, botanical preparations commonly used in clinical practice are Leigongteng multi-glucoside tablets and white peony total glucoside capsules. 1, Leigongduan polysaccharide tablets: the general dose of 30-60mg / day, taken after meals, faster onset of action, similar to anti-inflammatory and immunosuppressive effects, the main adverse effects are gonadal suppression, resulting in reduced sperm production male sterility and female amenorrhea. Other adverse reactions include poor appetite, nausea, vomiting, abdominal pain, diarrhea, elevated liver enzymes, skin rash, etc. There may be bone marrow suppression with anemia, leukocytopenia and thrombocytopenia. It is generally not recommended for patients of childbearing age. Pay attention to the monitoring of liver and kidney function and blood routine changes. 2, white peony total glucoside capsule: generally used in doses of 0.6g / day, divided into three times after meals, the role of relatively weak, adverse reactions are also small, mainly the number of stools, poor performance, etc. Clinically, according to the different characteristics of each patient to choose the drug, in general, the treatment of rheumatoid drugs have certain adverse effects of liver and kidney function damage, but because of individual differences, in the monitoring of liver and kidney function and blood routine However, because of the great differences between individuals, it is still necessary to apply drugs to stop the development of the disease under the premise of monitoring liver and kidney function and blood tests.