Rheumatoid arthritis (RA) is a common acute or chronic inflammatory disease of the connective tissue. It can have recurrent attacks and involve the heart. It is characterized clinically by wandering pain in the joints and muscles and is an allergic disease. It is one of the main manifestations of rheumatic fever, mostly starting with acute fever and joint pain.
The typical manifestation of rheumatoid arthritis is mild or moderate fever, wandering polyarthritis, involving mostly large joints such as knees, ankles and shoulders. The lesions are locally red, swollen, burning and painful. In some patients, several joints may develop at the same time. In atypical patients, only joint pain is present without other inflammatory manifestations, and acute inflammation usually subsides in 2-4 weeks without sequelae, but often recurs. If rheumatic activity affects the heart, myocarditis and even heart valve lesions may occur.
I. Etiology and pathology
The etiology of rheumatoid arthritis is unknown. The common pathology is a disease involving the joints and surrounding soft tissues, including muscles, ligaments, bursae, and fascia. As a result of poor blood circulation, the muscles or tissues are unable to deliver the nutrients they need through blood circulation, resulting in a lack of nutrients and accelerated aging and stiffness of the muscles, which can lead to muscle and vascular atrophy in severe cases.
Clinical manifestations
Rheumatoid arthritis is a manifestation of rheumatic fever. Rheumatic fever is a systemic metabolic disease caused by group A, type B, hemolytic streptococcal infection, often with a history of infection such as dengue at the beginning of the disease. The onset of rheumatic fever is rapid, and it is most often seen in adolescents. Rheumatoid arthritis can invade the heart and cause rheumatic heart disease with fever, subcutaneous nodules and rash.
Rheumatoid arthritis has two characteristics: First, the joints are red, swollen, hot, painful and can not move, the onset of the site is often the knee, hip, ankle and other large joints of the lower limbs, followed by the shoulder, elbow, wrist joints, the small joints of the hands and feet are rare; second, the pain is wandering, a period of time is this joint attack, a period of time is that joint discomfort, but the pain does not last long, a few days can subside. The blood sedimentation is accelerated, the anti-“0” titer is increased, and the rheumatoid factor is negative. Cured rarely relapses, the joints do not remain deformed, some patients may be left with cardiac lesions.
1.Joint pain.
2.Morning stiffness
After waking up in the morning or resting for a long time, the joints become stiff and can only be relieved or disappear after activity.
3.Joint swelling and pressure pain
It is a sign of synovitis or peripheral soft tissue inflammation, and its degree varies depending on the severity of the inflammation. It can be caused by fluid accumulation in the joint cavity or synovial hypertrophy.
4.Joint deformity and dysfunction
This refers to the loss of the normal shape of the joint and limitation of the range of motion, such as inability to fully straighten the knee, ulnar deviation of the metacarpophalangeal joint of the hand, and joint subluxation. These changes are associated with damage to cartilage and bone. They are common in rheumatoid arthritis.
Diagnosis
1. Autoantibodies
Autoantibodies that should be used clinically in the context of rheumatic diseases are divided into the following four categories: anti-nuclear anti-spectrum, rheumatoid factor, anti-neutrophil plasma antibody, and antiphospholipid antibody. They have a lot to do with the diagnosis of diffuse connective tissue disease.
2.Synovial fluid examination
To some extent, it reflects the synovial inflammation.
3.Joint imaging examination
X-ray examination helps in the diagnosis and differential diagnosis of joint lesions. It is currently the most commonly used imaging diagnostic method, other still have joint CT, MRI, homoeopathy and other tests.
4. Pathological changes seen in pathological biopsy, such as lupus bands for systemic lupus erythematosus, rheumatoid nodules for rheumatoid arthritis, labyrinthitis for dry syndrome, and synovial lesions for arthritis due to different etiologies, are of great significance.
IV. Treatment
Rheumatic disease is a disease with diverse etiology and complex pathology. Clinically, it is difficult to achieve satisfactory results with a single treatment method. Comprehensive treatment should be used, in the selection of treatment methods should grasp the combination of symptoms, prevention and treatment, medical treatment and prevention combined with other principles.