Arthritis refers to inflammatory diseases that occur in the joints and surrounding tissues of the body and can be divided into dozens of types. There are more than 100 million patients with arthritis in China and the number is increasing. The clinical manifestations are redness, swelling, heat, pain, dysfunction and joint deformity of the joints, which in severe cases lead to joint disability and affect the quality of life of patients.
The causes are complex, mainly related to inflammation, autoimmune reaction, infection, metabolic disorders, trauma, degenerative disease and other factors.
The main clinical manifestations: pain; swelling; dysfunction; signs: different types of arthritis have different signs, including erythema, deformity, soft tissue swelling, joint erythema, exudate, bony swelling, bone rubbing sound, pressure pain, muscle atrophy or muscle weakness, restricted joint range of motion and nerve root compression.
Common diseases associated with arthritis.
1, rheumatoid arthritis
This disease is one of the most common types of chronic arthritis. It is associated with genetics, bacterial and viral infections, and environmental factors including smoking. It can occur at any age, but is more common in women between the ages of 40 and 60. The diagnostic criteria of the American College of Rheumatology’s 1987 revised classification of rheumatoid arthritis (≥4 can confirm the diagnosis) are.
(1) Morning stiffness lasting at least 1 hour (≥ 6 weeks).
(2) Involvement of 3 or more joints (≥ 6 weeks).
(3) Involvement of hand joints (wrist, metacarpophalangeal or proximal interphalangeal joints) (≥ 6 weeks).
(4) Symmetrical arthritis (≥ 6 weeks).
(5) With rheumatoid subcutaneous nodules.
(6) Altered hand joint radiographs (showing osteoporosis or marked decalcification of the joint and its adjacent bones, narrowing of the joint space).
(7) Positive serum rheumatoid factor (titer > 1:32).
2.Osteoarthritis
Also known as degenerative joint disease, osteoarthrosis, mostly seen in middle-aged and elderly people, the process of disease is mostly slow. Hand, knee, hip and spine joints are easily involved, while the metacarpophalangeal, wrist and other joints are less involved. The disease usually worsens with activity or decreases with rest. The duration of morning stiffness is usually less than half an hour. Heberden and Bouchard nodes are seen on examination when both hands are involved, and friction is palpable in the knee joints. There are no extra-articular manifestations such as subcutaneous nodules or vasculitis. The rheumatoid factor is mostly negative, and a few elderly patients may have low titer positivity.
3.Gouty arthritis
With the improvement of people’s living standard, the incidence and consultation rate of gout are gradually increasing. Gout is a metabolic disease caused by an increase in uric acid synthesis due to abnormal purine metabolism. Uric acid levels may also rise due to a decrease in uric acid clearance by the kidneys in cases of abnormal kidney function. The saturation of plasma with uric acid leads to the deposition of monosodium urate crystals in the relatively unvascularized tissues surrounding the distal joints. The presence of such crystals can lead to acute inflammatory synovitis in single or multiple joints. Gout is more common in men, with the bunion being the most commonly affected area, with 50% to 70% of first episodes occurring here. 90% of people with gout will experience involvement of the first metatarsophalangeal joint at some point in their lives. Other areas of the foot that may be involved are the back of the foot, the heel, and the ankle.
4. Ankylosing spondylitis
It is more prevalent in young men and has a clear tendency to run in families. The involvement of the central joints, such as the sacroiliac and spinal joints, is predominant, but peripheral joints may also be involved, mostly in the large joints of the lower extremities, with asymmetric swelling and pain, often accompanied by pain in the tendons and ligamentous attachments of the spinous process, greater trochanter, Achilles tendon, and spinal rib joints. In severe cases, the spine may become stiff and the movement of the cervical, lumbar and thoracic vertebrae may be restricted, resulting in a “hunchback”, which seriously affects the patient’s daily life. The extra-articular manifestations are mostly iridocyclitis, heart block disorders and aortic valve atresia, etc. X-rays can show sacroiliac joint invasion, destruction or fusion. 90% of patients appear to be HLA-B27 positive, while rheumatoid factor negative.
5.Reactive arthritis
The disease has an acute onset and is often preceded by a history of intestinal or urinary tract infection. Asymmetric involvement of large joints (especially lower extremity joints) is the main cause, and there is usually no symmetric involvement of small joints such as proximal interphalangeal joints and wrist joints. It may be accompanied by ophthalmia, urethritis, glansitis and fever, etc. HLA-B27 may be positive and rheumatoid factor negative, and patients may have asymmetric sacroiliac arthritis x-ray changes.
6.Infectious arthritis
Associated with bacterial infection. Common pathogens include Staphylococcus aureus, S. pneumoniae, S. meningitidis, gonococcus, streptococcus, and Mycobacterium tuberculosis. The pathogenesis includes direct bacterial infection and the release of toxins or metabolites by bacteria during the infection process, including subacute bacterial endocarditis and post-scarlet fever arthritis. Arthritis due to direct bacterial infection is characterized by red, swollen, and painful joints and joint dysfunction. The weight-bearing joints of the lower extremities are asymmetrically involved. Large joint involvement is common, such as hip and knee joints. The joint cavity puncture fluid often shows purulent changes. Bacteria may be found on smear or culture. Arthritis with Mycobacterium tuberculosis infection occurs in young adults with evidence of tuberculosis at other sites including the lungs or lymph nodes. There may be erythema nodosum and a negative serum rheumatoid factor. A tuberculin test is positive. Arthritis due to bacterial metabolites or toxins can heal spontaneously in 1 to 2 weeks, and joint symptoms are wandering.
7.Rheumatic fever
Most of the disease starts with acute fever and joint pain. Typical manifestations are mild or moderate fever, wandering polyarthritis, involving mostly large joints such as the knee, ankle, shoulder, elbow, wrist, etc., commonly transferred from one joint to another, the lesions show local redness, swelling, burning, severe pain, some patients also have several joints at the same time. In atypical patients, there is only joint pain without other inflammatory manifestations. Acute inflammation usually subsides in 2 to 4 weeks, leaving no sequelae, but it often recurs. If rheumatic activity affects the heart, myocarditis may occur and even heart valve lesions may be left behind.
8.Other
Such as traumatic arthritis, psoriatic arthritis, enteropathic arthritis, etc. Autoimmune diseases such as systemic lupus erythematosus, dry syndrome, scleroderma and tumors also often show arthritic manifestations during the occurrence and development of the disease.