I. What is rheumatoid arthritis?
A normal joint cavity has a synovial membrane that secretes a small amount of synovial fluid to lubricate and protect the joint, but when rheumatoid arthritis develops, the synovial membrane becomes inflamed and a large number of inflammatory cells infiltrate and accumulate in the synovial membrane, causing the synovial membrane to become significantly thickened and congested and secrete a large amount of fluid, resulting in swelling and pain in the joint.
Rheumatoid arthritis is a chronic systemic autoimmune system disease with 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.
Second, who is prone to rheumatoid arthritis?
According to epidemiological surveys, the prevalence of rheumatoid arthritis among Chinese is about 0.4%, which is slightly less than the 1% among Caucasians. It is estimated that there are about 5 million people suffering from rheumatoid arthritis nationwide, with a male to female ratio of about 1:3, with a prevalence of 40 to 60 years old. That is, the number of women affected is three times that of men, middle-aged women are more likely to develop, but people of any age may develop.
Why do I get rheumatoid arthritis?
The cause of rheumatoid arthritis is still limited, and is only known to be related to abnormalities in the immune system, and its causative factors may be related to genetics, environment (possibly bacterial or viral infection), emotions and endocrine.
That is, people with certain genetic traits begin to develop the disease in response to environmental triggers. The disease starts when the body’s “defenders” against germs (called the immune system) have problems, not only killing the germs, but also producing many unnecessary antibodies (autoantibodies) such as rheumatoid factor (RF), anti-cyclic citrullinated peptide antibodies (anti-CCP), anti-keratin antibodies (AKA), etc., which destroy the body’s normal structure.
What are the symptoms of rheumatoid arthritis?
It varies from person to person. Usually, the initial symptoms are only minor 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.
V. 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.
What are the risk factors for poor prognosis of rheumatoid arthritis?
The following risk factors have a poor prognosis (i.e., easy to complicate joint disability): 1.
1, young onset (i.e., young age of onset).
2. more than 4 swollen joints.
3, very high blood sedimentation and CRP.
4, duration of morning stiffness greater than 1 hour.
5, particularly high rheumatoid factor and anti-CCP antibody titers.
6, poor effect of small dose hormone therapy.
7.Destruction of joint bones detected by imaging within 2 years of the onset of the disease.
8, HLA-DR4 positive.
VII. How is rheumatoid arthritis treated?
Treatment goals focus on relieving joint pain and stiffness, preventing deformity, and helping to maintain normal motor function. Drug therapy is a core part of the treatment program for this disease. There are three major categories of therapeutic drugs – NSAIDs, disease-modifying antirheumatic drugs, and glucocorticoids.
1. NSAIDs: i.e., anti-inflammatory painkillers, 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, but also to make the patient himself feel much better and help stop the disease from progressing. Drugs of this type include methotrexate, leflunomide, salazosulfapyridine, hydroxychloroquine sulfate and the Chinese herbal medicine rehmannia, which can suppress or regulate the immune response. All of these drugs require weeks or even months of use before their effects appear and have some side effects. Patient response to these drugs has been variable, 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 (IL-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 supplied, including imported and domestic ones. 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 lighter adverse effects. Calcium may be added to prevent osteoporosis. For intractable joint swelling, intra-articular injection of hormones is also possible.
What are the daily precautions for patients with rheumatoid arthritis?
1.When the joint is in acute inflammation period, it is necessary to rest properly because it will be very painful.
2, do not massage the inflamed joints, because it will make the inflammation more serious.
Remember to add clothes and socks because the cold will cause the muscles to contract and the joints will become more painful and stiff.
4.When the acute inflammation of the joints has passed, you can use heat therapy to increase the flexibility of the joints.
5.After waking up in the morning, move your joints in bed first, and then get out of bed to reduce pain.
6.If the joint is fixed for a long time, it will increase pain and muscle weakness, so moderate exercise can be used to strengthen loose muscles and improve joint mobility. The specific amount of daily exercise, depending on the actual ability of the individual. Activities suitable for walking, swimming, running, cycling, etc., intense sports such as weightlifting, basketball, soccer, etc. are not suitable.
7, to avoid doing finger flexion movements (such as clutching a rubber ball, holding a knife to cut vegetables), because this will make the arthritic hand 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 position, hands palm side up, arms should be straight, two knees can not put pillows, so as not to cause contracture of the lower limb joints, flexion deformity.
9, to 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, the heel should not be too high.
10. Avoid overexertion, sleep at least 8 hours every night, and preferably take a nap during the day. In the daily activities or work, there should be a short ten-minute break every hour.
11, dry eyes patients, should not wear contact lenses, you can point artificial tears to improve the symptoms. In order to reduce the discomfort caused by dry eyes, after watching TV or computer screen for a period of time, you should close your eyes and rest.
12.Follow the physician’s instruction to take medication, do not stop or reduce the dose because you feel that your condition is reduced or you are worried about the toxicity of the medication. Continue to follow up with your doctor on a regular basis. Accurate assessment of your condition and timely adjustment of your treatment plan can help prevent joint deformation and reduce the burden of medical treatment.