Overview: Arthritis is an inflammatory disease of the joints caused by various reasons.
Arthritis is an inflammatory disease of the joints caused by a variety of reasons, mainly characterized by redness, swelling, heat, pain and dysfunction of the joints, and is related to joint strain, infection, trauma, and immune factors, etc. Depending on the specific circumstances, medication, physical therapy or surgery may be indicated.
Definition
Arthritis is a generalized term for inflammatory lesions that occur in one or more joints of the body.
The causes of arthritis are complex, and can be caused by joint strain, trauma, infection, autoimmune abnormalities, etc. It is characterized by localized warmth, redness, and inflammation.
The main manifestations are localized fever, redness, swelling, pressure and pain, and joint disorder.
Classification
Classification according to the number of affected joints
Polyarthritis: such as rheumatoid or rheumatoid arthritis, gout, ankylosing spondylitis, systemic lupus erythematosus and other collagen diseases.
Monoarthritis: e.g. laryngoarthritis, temporomandibular arthritis, septic knee osteoarthritis.
Classification according to location
Arthritis can occur in all joints of the body, such as foot arthritis, ankle arthritis, finger arthritis, knee arthritis, shoulder arthritis, spinal arthritis, temporomandibular joint arthritis, and so on.
Classification according to the cause
Infectious: e.g. septic arthritis.
Degenerative: e.g. osteoarthritis.
Rheumatic immunity: e.g. rheumatoid arthritis, ankylosing spondylitis, gouty arthritis.
Morbidity
There is no information on the overall incidence of arthritis. Examples of common arthritis incidence are listed below.
Osteoarthritis (OA)
The overall prevalence of osteoarthritis in people over 40 years old in China is as high as 46.3%.
There are 300 million osteoarthritis patients worldwide.
Rheumatoid Arthritis (RA)
The overall prevalence rate in China is 0.3% to 0.4%.
The prevalence rate of women is two to three times higher than that of men.
The age of 25 to 50 is the favorable age for this disease.
Ankylosing Arthritis (AS)
AS is more common in males, with a male to female ratio of 10.6:1. The disease is slower to develop in females than in males, and the symptoms are less severe.
The onset of the disease is between 15 and 30 years of age, and it is rare in children after 30 years of age and under 8 years of age.
Gouty Arthritis
The prevalence of gout in China is between 1% and 3%, and is increasing year by year.
There is an obvious difference in the prevalence of gout between men and women, with the ratio of men to women being 15:1.
Women tend to suffer from gout after menopause, and polyarthritis is more common.
Causes
Arthritis is a large group of diseases with complex causes, some of which are related to joint strain, infection, and trauma, some are related to heredity and metabolic abnormalities, and some are of unknown etiology. The causes of each disease vary and are listed below.
Causes
Osteoarthritis
The cause of the disease is still unclear, and is generally believed to be due to mechanical and biological causes.
Primary OA
The etiology is unclear and may be related to genetic and physical factors.
Genetic: e.g., Heberden’s nodes are inherited as a monogenic autosomal trait, associated with the type II procollagen gene (COL2A1) on the 12th pair of chromosomes.
Secondary OA
Mechanical or anatomical abnormalities: e.g. acute and chronic injuries, joint dysplasia.
Metabolic abnormalities: e.g. diabetes mellitus, chondrocalcinosis, gout, etc.
Endocrine abnormalities: acromegaly, hyperparathyroidism, etc.
Neurologic defects: peripheral neuritis, spinal cord cavernous disease, Charcot arthropathy.
Rheumatoid arthritis
The cause of the disease is unknown and there is a certain genetic predisposition.
Genetic factors
Human leukocyte antigen-DRB1 (HLA-DRB1) and gene locus (HLA-DQα1:160D) are strong genetic factors associated with rheumatoid arthritis.
Environmental factors
Exposure to asbestos, silica, and organic solvents at work; smoking; and exposure to pathogenic microorganisms may promote the production of autoantibodies and influence the onset and progression of rheumatoid arthritis.
Ankylosing spondylitis
Genetic
The rate of HLA-B27 positivity in immediate family members is as high as 58%, compared to only 4% in the general population.
Infection
May be associated with enteropathogenic infections of the genitourinary tract.
Autoimmunity
60% of patients with AS have increased complement in the blood, with increased levels of IgA, IgG, IgM and C4.
Gouty arthritis
Metabolism
When uric acid is synthesized in excess, or when it is not normally excreted from the body, it leads to a large accumulation of uric acid in the blood and deposits in the joints, kidneys, and subcutaneous areas, which attracts a large number of leukocytes and causes an inflammatory response, leading to gouty arthritis.
Genetics
There are about 30 genes associated with the development of gouty arthritis that increase the production or decrease the elimination of uric acid.
Symptoms
Symptoms vary between the different types of arthritis.
Main Symptoms
Osteoarthritis
Joint pain, stiffness, swelling, and limited range of motion are the most predominant manifestations of osteoarthritis, and symptoms of osteoarthritis vary in different parts of the body.
Osteoarthritis of the hand: Most common in the distal interphalangeal joints. The interphalangeal joints show bony nodules, which are called Bouchard’s and Heberden’s nodules when they are located in the proximal and distal interphalangeal joints, respectively. The joints bend horizontally to form a serpentine deformity.
Osteoarthritis of the knee: pain and stiffness in the early stages. As the disease progresses, there are symptoms such as walking imbalance, squatting weakness and inability to hold weight.
Osteoarthritis of the hip joint: pain occurs insidiously and radiates to the outer hip and inner thigh, and the patient suffers from activity limitation and claudication (pain occurs when walking and has to stop and continue walking after a break).
Osteoarthritis of the foot: redness, swelling, heat and pain in the joints between the toes, similar to gout, but less painful.
Rheumatoid arthritis
Clinical manifestations vary widely among individuals, and most of them have a chronic onset.
Joint pain and swelling
Soreness at the beginning, with obvious joint swelling and aggravation of pain in the later stages. Localized fluid accumulation and temperature increase. After repeated attacks, muscle atrophy of the affected limbs and pike-shaped swelling of the joints.
Morning stiffness
Stiffness in the morning, the symptoms will be relieved or disappear after a period of activity, mostly more than 30 minutes.
Multiple joint involvement
Mostly occurs in metacarpophalangeal joints or interphalangeal joints, often involves 1 to 3 joints, the affected joints are symmetrical.
Restricted joint movement or joint deformity
In the late stage, joint movement is limited, joint deformity occurs, and the wrist joint is tilted to the side of the little finger. The knee joint is turned to the inside and outside of the body.
Extra-articular manifestations
Manifestations include carpal tunnel syndrome, rheumatoid nodules, polyneuritis and vasculitis.
Ankylosing spondylitis
Most of the disease starts slowly and insidiously, and the clinical manifestations are often atypical. Different parts of the lesion have different symptoms.
Sacroiliac joint
Lower back pain and stiffness, often involving the buttocks and thighs.
Lumbar spine joints
Lower back pain and limitation of movement, early diffuse muscle pain. Activities such as forward flexion and backward extension of the low back are limited. In later stages, there may be atrophy of the lumbar back muscles and lumbar deformity.
Thorax, thoracic spine joints
There may be thoracic dorsal pain, anterior and lateral chest pain, and limited chest expansion.
Cervical spine joints
In early stages, there may be cervical spondylitis and cervical deformity occurs. Cervical motion may be limited and the head is often fixed in a forward flexed position.
Extra-articular lesions
Cardiac lesions: aortic atresia, heart enlargement and atrioventricular block.
Ocular lesions: conjunctivitis and iritis.
Pulmonary lesions: symptoms of cough, sputum and shortness of breath are often present.
Chronic prostatitis: symptoms such as frequent urination, urgency and dysuria.
Renal lesions: often lead to primary glomerular and tubulointerstitial nephritis, with symptoms such as proteinuria.
Neurologic lesions: hip pain with sensory and motor dysfunction.
Gouty arthritis
Acute gouty arthritis
Initial sudden attack with joint swelling and severe pain, peaking within 1 to 2 days, with redness, swelling, heat and pain in the affected joints, and severe pain that is intolerable.
Chronic Gouty Arthritis
As the number of affected joints gradually increases, it becomes chronic inflammation and eventually develops joint deformity.
The affected joints are stiff and asymmetric, with persistent pain and large subcutaneous nodules, resulting in deformity and loss of function.
Gouty nodules
Gouty nodules are most common in the ear and opposite ear whorls, followed by the ulnar hump, knee joint capsule and tendons.
The main manifestation is a yellowish or white round or oval nodule that protrudes from the skin surface, and there may be several of them.
Consultation
Department of Medicine
Orthopedics
Orthopedics is consulted for joint pain, stiffness and unfavorable movement.
Rheumatology
If you have the above symptoms, you can also consult the Department of Rheumatology and Immunology.
Preparation
Consultation: Registration, Preparation of documents, Frequently Asked Questions
Tips for Consultation
If you have many clinical symptoms, you should try to record the symptoms you have experienced and the frequency of episodes, etc., so as to give the doctor more reference.
For those with limited mobility, it is recommended that their family members accompany them to the doctor, and the patient can move around with the help of a wheelchair or crutches in order to prevent falls or accidents.
Avoid applying painkillers on your own before going to the doctor to avoid aggravating or masking the condition.
Preparation List
Symptom list
Pay particular attention to the time of onset of symptoms, special manifestations, etc.
Which joints are found to be abnormal and what are the specific manifestations?
How long has the condition lasted?
What factors caused it or under what circumstances was it aggravated?
Medical history checklist
Has anyone in the family experienced symptoms such as joint pressure, swelling or deformity?
Has there been any autoimmune disease (e.g., rheumatism) or other systemic disease (e.g., gout)?
Has there ever been a traumatic injury and how was it sustained?
Does the person usually drink alcohol and what is the daily amount of alcohol consumed?
Checklist
Test results of the last six months, which can be brought to the doctor’s office
Laboratory tests: blood test, liver and kidney function, joint fluid test, etc.
Imaging tests: X-ray, CT, MRI
Drug List
Non-steroidal drugs: Ibuprofen, Indomethacin
Cytotoxic drugs: methotrexate
Antimalarials: hydroxychloroquine, chloroquine
Glucocorticoid: Prednisone
Diagnosis
Arthritis is characterized by pain, swelling, and limited movement of the joints, and the diagnostic criteria vary from disease to disease.
Diagnosis is based on
medical history
Osteoarthritis
Recurrent joint pain in the last month.
Age is mostly above 50 years old.
Comorbidity with primary pathologies such as infection, trauma, joint instability, metabolic disorders, etc.
Rheumatoid arthritis
Family members have suffered from similar diseases.
The person has experienced symptoms such as joint pressure, swelling and pain.
Ankylosing spondylitis
I have a family history of ankylosing spondylitis.
I have had symptoms of infection, followed by progressive restriction of spinal movement.
Gouty arthritis
Have a long history of drinking alcohol.
I have a long history of taking medication to promote uric acid excretion.
I have a history of trauma.
Clinical manifestations
Osteoarthritis: pain, tenderness, stiffness, swelling and dysfunction of the affected joints.
Rheumatoid arthritis: joint pain and swelling, morning stiffness, multiple joint involvement, limited joint movement or deformity.
Ankylosing arthritis: lower back pain, stiffness, muscle pain, limited spinal movement, etc.
Gouty arthritis: swelling and severe pain in the joints, redness, fever, and joint deformities.
Laboratory Tests
Blood sedimentation, C-reactive protein: valuable in the diagnosis of osteoarthritis.
IgM rheumatoid factor (RF), anti-keratin antibody, anti-perinuclear factor, anti-cyclic citrullinated polypeptide, etc.: diagnostic value for rheumatoid arthritis.
HLA-B27: has diagnostic value for ankylosing spondylitis.
Blood and urine uric acid test: has diagnostic value for gouty arthritis.
Imaging examination
X-ray examination
Osteoarthritis: is the “gold standard” for diagnosis and is the preferred imaging test.
Rheumatoid arthritis: bone and joint changes can be observed and the disease can be staged.
Ankylosing spondylitis: sacroiliac joint X-ray can diagnose sacroiliac arthritis, is the main diagnostic method, the operation is simple and low cost.
Gouty arthritis: can determine the severity of the disease. It shows the damage caused by urate crystals to the soft tissues of the joints and excludes other causes of joint inflammation.
CT examination
Osteoarthritis: CT of the joints can diagnose osteoarthritis. It can improve the diagnosis and differentiate it from other diseases.
Ankylosing spondylitis: sacroiliac joint CT can improve the early diagnosis rate of this disease. Overcome the defect of X-ray overlap, better observation of sacroiliac joint lesions.
Magnetic resonance examination
Observe the lesions of articular cartilage, intra-articular and surrounding soft tissues. It is valuable for the diagnosis of early osteoarthritis.
Examination precautions: whether the patient has a pacemaker installed or wears metal objects.
Arthroscopy
To visualize the damage within the joint. Tissue specimens can be taken under the arthroscope for pathological examination.
Precautions: Arthroscopy is invasive and expensive, so it is generally not the first choice.
Diagnostic Criteria
Osteoarthritis
Osteoarthritis is generally diagnosed on the basis of clinical manifestations and X-ray examination, and excluding other inflammatory joint diseases. The American Rheumatism Association has proposed classification criteria for hand, knee and hip OA.
Hand OA classification criteria
Hand OA is diagnosed by having hand pain, tenderness and morning stiffness with at least 3 of the following 4 items:
Hard tissue hypertrophy in ≥2 of 10 specified joints.
Hard tissue hypertrophy in ≥2 distal interphalangeal joints.
Metacarpophalangeal joint swelling in fewer than 3.
Articular deformity in ≥1 of 10 specified joints.
(The 10 designated joints are the bilateral distal and proximal interphalangeal joints of the 2nd and 3rd fingers and the 1st carpometacarpal joint.)
Criteria for classification of knee OA
Clinical criteria: Knee OA is diagnosed by clinical presentation of knee pain and at least 3 of the following 6 items.
年龄≥50岁
晨僵＜30分钟
骨摩擦感
骨压痛
骨性肥大
膝触之不热
Clinical and radiologic criteria: Clinical manifestation of knee pain, X-ray showing bony encumbrances and at least 1 of the following 3 items are diagnostic of knee OA.
年龄≥40岁
晨僵＜30分钟
骨摩擦感
Criteria for classification of hip OA
Clinical plus radiologic criteria: Clinical manifestation of hip pain and at least 2 of the following 3 items can be diagnosed as hip OA.
Blood sedimentation ≤20mm/h
Radiographic evidence of femoral head and acetabular bone capillary
X-ray shows narrowing of the hip joint space (upper, axial, medial).
Rheumatoid arthritis
X-ray staging
Stage X-ray
Stage Ⅰ (early) X-ray examination without destructive changes can be seen osteoporosis
Stage I (early stage)
Osteoporosis can be seen without destructive changes on X-ray.
Stage II (middle stage) Osteoporosis may be seen with mild cartilage destruction. With or without mild subchondral bone destruction Limited joint movement but no deformity Adjacent muscle atrophy with soft tissue lesions such as tenosynovitis
Stage II (Intermediate)
Osteoporosis with or without mild subchondral bone destruction. With or without mild subchondral bone destructionLimited joint motion but no deformityAdjacent muscle atrophySoft tissue lesions such as tenosynovitis
Stage III (severe) Osteoporosis plus cartilage or bone destructionDeformities such as subluxation, ulnar deviation, no fibrous or bony ankylosisExtensive muscular atrophyExtra-articular soft tissue lesions such as nodules or tenosynovitis
Stage III (severe stage)
Osteoporosis plus cartilage or bone destruction joint deformities, such as subluxation, ulnar deviation, no fibrous or bony ankylosis extensive myasthenia with extra-articular soft tissue lesions, such as nodules or tenosynovitis
Stage IV (terminal) fibrous or osseous ankylosis Stage III Criteria Content Articles
Stage IV (terminal)
Fibrous or bony ankylosis, stage III, each criterion
Rheumatoid arthritis is diagnosed when at least 4 of the following 7 criteria are met.
Criteria Notes
Morning stiffness Stiffness in and around the joints for at least 1 hour (disease duration ≥ 6 weeks)
Morning stiffness
Stiffness in and around joints lasting at least 1 hour (disease duration ≥ 6 weeks)
Arthritis of 3 or more regional joint sites Physician observation of involvement of 3 of the following 14 regions (left or right proximal interphalangeal joints, metacarpophalangeal joints, wrists, elbows, knees, ankles, and metatarsophalangeal joints) with concomitant soft-tissue swelling or effusion (not just bone augmentation) (duration of disease ≥ 6 weeks)
Arthritis in 3 or more areas of the joints
Physician-observed involvement of 3 of the following 14 regions (left or right proximal interphalangeal joints, metacarpophalangeal joints, wrists, elbows, knees, ankles, and metatarsophalangeal joints) with concomitant soft-tissue swelling or effusion (not simply bone augmentation) (duration of disease ≥ 6 weeks)
Arthritis of the hand wrist, metacarpophalangeal, or proximal interphalangeal joints; swelling of at least 1 joint (disease duration ≥6 weeks)
Arthritis of the hand
Arthritis of wrist, metacarpophalangeal, or proximal interphalangeal joints; swelling of at least 1 joint (disease duration ≥6 weeks)
Symmetric arthritis with simultaneous involvement of both joints (not necessarily absolutely symmetric when bilateral proximal interphalangeal joints, metacarpophalangeal joints, and metatarsophalangeal joints are involved) (disease duration ≥6 weeks)
急性关节炎发作1次以上。
炎症表现在1天内达高峰。
单关节炎发作。
患病关节皮肤呈暗红色。
第1跖趾关节疼痛或肿胀。
单侧发作累及第1跖趾关节。
单侧发作累及附骨关节。
有可疑的痛风结石。
高尿酸血症。
X线显示关节非对称性肿胀。
X线摄片示骨皮质囊肿不伴骨质侵蚀。
关节炎症发作期间关节液细菌培养阴性。
Symmetric arthritis
Simultaneous involvement of both joints (bilateral proximal interphalangeal joints, metacarpophalangeal joints and metatarsophalangeal joints, not necessarily absolutely symmetrical) (disease duration ≥6 weeks)
Rheumatoid nodules with subcutaneous nodules on bony prominences
Rheumatoid nodules
Subcutaneous nodules on bony prominences
Positive rheumatoid factor Abnormal rheumatoid factor levels, with a <5% positivity rate for this method in the normal population.
Rheumatoid factor positive
Abnormal rheumatoid factor levels, but the method is <5% positive in the normal population.
Radiologic changes typical of the hand and wrist: must include bone erosion or significant bone decalcification
Radiologic changes
Typical radiographic changes in the hand and wrist: must include bone erosion or significant bone decalcification
Ankylosing spondylitis
Confirmed by radiographs with the addition of 1 or more of the following clinical manifestations.
Restriction of spinal motion in three directions (forward flexion, lateral flexion, and posterior extension).
History of low back pain.
Limited thoracic extension, measuring less than 2.5 cm at the 4th intercostal space.
Or the patient has radiographic confirmation with 1 or more of the following clinical manifestations.
Lumbar pain and morning stiffness for more than 3 months, which is relieved by activity.
Restricted lumbar frontal or sagittal plane motion.
Reduced thoracic mobility compared to normal individuals of the same age.
Gouty arthritis
Those who have the following clinical, laboratory, and x-ray signs, with 6 of 12 matching.
Treatment
Aims of treatment: to relieve symptoms, control the progression of the disease and improve the quality of life.
Treatment principle: Early diagnosis and early treatment, according to the different causes of the disease, using a combination of general treatment, drugs, surgery and other methods of treatment.
General treatment
Local braking
When the pain is severe, timely braking is needed to relieve muscle spasm, reduce pain and prevent deformity. The braking is done with plaster casts or braces, and the time and method of immobilization need to be decided according to the condition.
Puncture and fluid extraction
Infected joints and fluid accumulation may require puncture and aspiration of joint fluid, and cleaning of the joint cavity with saline if necessary.
Functional exercise
Functional exercises may be used in the non-acute phase to slow down the progression of the disease. Suitable for autoimmune diseases and degenerative arthritis.
Exercises targeting the spine and thorax are beneficial for maintaining the position of the spinal joints.
For hip and knee joint pathology, arch or heel tendonitis, running, punching and contact sports (e.g. judo, soccer, basketball, etc.) should be avoided.
Dietary management
Patients with gout or high uric acid need to limit the intake of alcohol, foods high in sugar, and foods high in purines (e.g., animal liver and kidney, seafood, etc.). Use drugs that inhibit uric acid excretion, such as thiazide diuretics, with caution.
Drink more than 2000 ml of water per day to increase the excretion of uric acid.
Medication
Non-steroidal anti-inflammatory drugs
Commonly used drugs include ibuprofen, meloxicam, celecoxib and so on.
The role of drugs: analgesic and anti-inflammatory, relieve the symptoms of arthritis, but in the control of the disease has a limited role in the control of the disease, only to relieve pain, redness and swelling symptoms, can not control or stop the progress of the disease.
Medication precautions: pay attention to gastrointestinal reactions and other side effects, avoid taking two or more at the same time; can increase the occurrence of cardiovascular events, need to be careful with the drug.
Anti-rheumatic drugs
Commonly used drugs include Liuzasulfapyridine, Methotrexate, Cyclophosphamide and so on.
The role of drugs: does not have obvious analgesic and anti-inflammatory effects, but can relieve and control the progress of the disease. It is suitable for autoimmune diseases such as rheumatoid arthritis.
Medication precautions: while taking methotrexate, folic acid should be supplemented under the guidance of a doctor. If the patient himself has liver function or kidney function impairment need to reduce the dosage.
Colchicine
It is suitable for patients with gouty arthritis, and the treatment is most effective when the drug is started within 12 hours of the acute attack of gout.
Precautions: There may be gastrointestinal adverse reactions such as nausea and vomiting; regular monitoring of liver and renal function and blood routine is required.
Glucocorticosteroids
Commonly used drugs include prednisone, hydrocortisone, methylprednisolone and so on.
The effect of drugs: there is a powerful anti-inflammatory effect, can quickly relieve the symptoms of joint swelling and pain and systemic inflammation. It can rapidly improve the symptoms of joint swelling and pain and systemic symptoms. It is suitable for the active period of severe disease.
Precautions for the use of the drug: the principle of using the drug when a small dose, a short course of treatment. It is only used as a “bridge therapy” for anti-rheumatic drugs. In the course of glucocorticoid treatment, attention should be paid to the prevention of osteoporosis and infection.
Uric acid lowering treatment
Inhibit uric acid production drugs: such as allopurinol, febuxostat. Use with caution in renal insufficiency.
Promote uric acid excretion drugs: such as benzbromarone, probenecid. Adverse effects include gastrointestinal symptoms, skin rash, etc. Regular testing is required.
Antibiotics
Commonly used drugs include cefixime, azithromycin and erythromycin.
Drug action is to reduce joint symptoms and systemic symptoms caused by infection.
Drug precautions: antibiotics should be applied early and in sufficient quantity, and antibiotics should be changed promptly according to the results of bacterial culture of drainage fluid and drug sensitivity test.
Immunosuppressive drugs
Drug effect: help to relieve joint swelling and pain, morning stiffness and other symptoms.
Commonly used drugs are Lei Gongteng, total white peony glycosides, Qingfengteng and so on.
Drug precautions: Adverse effects include gonadal suppression, bone marrow suppression, liver damage, etc. Close monitoring is required during drug administration.
Chondroprotective agents
Oral medications include aminoglucose sulfate or hydrochloride, bisacodyl ryanin, etc. Sodium hyaluronate can also be injected into the joint cavity.
It can lubricate the joints and protect the articular cartilage, which in turn can partially relieve pain. It has the effect of slowing down the progression of osteoarthritis.
Surgery
If the condition cannot be controlled after regular treatment, surgery can be considered to correct the deformity and improve the quality of life.
Synovectomy
It is suitable for rheumatoid arthritis.
Indications for surgery include: large amount of exudate in the joints, ineffective non-surgical treatment for up to 3 months, bone destruction and limited joint movement.
It can reduce the exudation of joint fluid, protect cartilage and subchondral bone tissue, and improve joint function.
Spinal Orthopedic Surgery
It is suitable for ankylosing spondylitis with severe disability deformity.
Surgery carries the risk of damaging the spinal cord, nerve roots, and large blood vessels, so it should be chosen carefully with the advice of your doctor.
Osteotomy
Indications: For osteoarthritis combined with internal and external joint deformity. It is used to maximize joint preservation.
Methods include proximal tibial osteotomy, proximal fibular osteotomy, and distal femoral osteotomy.
It is suitable for young and middle-aged patients with high activity level and good joint mobility.
Arthrodesis
Suitable for arthritis pain that is not treated by conservative treatment, such as joint infection.
For patients who are engaged in manual labor with severely damaged joints, fusion is feasible in order to maintain the stability of the limbs.
Arthroplasty
Applicable to ankylosing spondylitis, rheumatoid arthritis, osteoarthritis, etc.
Patients whose disease seriously affects their daily life and for whom non-surgical treatment is ineffective may consider this procedure. Early surgery is beneficial to improve joint function and enhance the quality of life of patients.
This procedure is not suitable for patients with infectious diseases of the knee joint and neurological diseases.
Arthrocentesis
Indications: Gouty arthritis patients who are ineffective in general treatment and medication need to choose surgical treatment.
Arthroscopic cleaning of gout stones has the advantages of small wound, short time, low infection rate and few complications.
Biological therapy
Drug effect: It can inhibit bone destruction, and has significant effect on both central axis and peripheral symptoms, and is suitable for autoimmune diseases such as ankylosing spondylitis.
The main drugs include tumor necrosis factor-alpha, infliximab, adalimumab, etc.
Precautions: blood routine, urine routine, liver function, renal function and so on should be regularly rechecked during the medication. If the combination of drugs reaches the standard, the dosage can be gradually reduced, and the process of reducing the dosage should be closely monitored to prevent recurrence.
Rehabilitation
Includes physical therapy, rehabilitation and other treatments.
Physical therapy
It can reduce inflammation and pain, relieve muscle spasm and improve blood circulation.
It mainly includes: direct current therapy and drug ion introduction, low-frequency pulse electrotherapy, medium-frequency current therapy, high-frequency electrotherapy, magnetic field therapy, ultrasound therapy, acupuncture, light therapy (e.g., infrared and ultraviolet rays), and cold therapy.
Functional Exercises
Increase joint mobility exercises. Perform 2 to 3 repetitions per day for each affected joint.
Increase the strength of the muscles near the joints, such as straight leg lifts, ankle pump exercises, and static squatting exercises.
Prognosis
Cure
Infectious factors
Infectious diseases such as septic arthritis are usually curable if treated in time.
If treatment is not timely, or the treatment method is not standardized, it may lead to prolonged inflammation of the joints and the formation of chronic inflammation. Chronic pain and fluid accumulation occur, affecting the quality of life.
Other factors
Arthritis caused by degenerative diseases and autoimmune diseases is usually difficult to cure. Aggressive treatment can alleviate symptoms without affecting daily work and life, slowing the progression of arthropathy and improving quality of life.
Related diseases include osteoarthritis, rheumatoid arthritis, ankylosing spondylitis and gouty arthritis.
If not treated aggressively, there can be a risk of teratogenicity. Damage to other organs (e.g., heart, lungs, brain, kidneys, eyes, etc.) may occur in autoimmune diseases, further affecting health and daily life.
If gouty arthritis is combined with high blood pressure, diabetes, and other kidney diseases, renal insufficiency is likely to occur and can be life-threatening.
Prognostic factors
Timing of treatment: Early treatment has a better prognosis. Early diagnosis, conservative treatment can be carried out to minimize the aggravation of the disease in the late stage and the impact of joint deformity on life.
Self-existing conditions: If there are existing joint deformities, surgical treatment may be required.
Physical fitness: If the patient is suffering from chronic diseases, the recovery will be slower.
Medical condition: It is related to the level of local doctors and surgical conditions.
Socio-family factors: Patients with good financial situation and easy occupation will be conducive to recovery.
Harmfulness
Arthritis of different etiology has different hazards.
Osteoarthritis: If not effectively treated, severe joint destruction, limited joint movement and finally joint deformity can occur, seriously affecting daily life.
Rheumatoid arthritis: most patients with rheumatoid arthritis have a delayed condition, with a high disability rate in the first 2 to 3 years. If not treated early, joint destruction reaches 70% within 3 years.
Ankylosing spondylitis: If the condition is prolonged, there is a risk of teratogenicity.
Gouty arthritis: if not controlled in time, it can lead to joint pain and deformity, affecting normal working life.
Daily
Daily Management
Dietary management
Choose foods rich in protein and vitamins, such as lean meat, milk, beans, fresh vegetables and fruits.
Appropriately reduce the intake of foods high in oil and sugar, such as drinks, candies and snacks. Eat less high cholesterol foods such as animal offal, crab roe, shrimp, fish roe, etc. Animal meat should be eaten without skin.
The intake of omega-3 polyunsaturated fatty acids and vitamin D foods, such as deep-sea fish, nuts, cauliflower, etc., can be moderately increased, but should not be excessive.
Reduce the intake of refined carbohydrates (e.g. white flour, white rice, sucrose, etc.) and increase the intake of whole grains appropriately.
If taking glucocorticosteroids for a long period of time, it is recommended to use calcium-rich foods at the same time, such as milk (300 ml per day), tofu, shrimp skin, etc., but should be avoided at the same time with dark green vegetables. Get plenty of sunshine and take vitamin D supplements under doctor’s supervision.
Gout patients are forbidden to drink alcohol and eat less meat, seafood and animal offal; drink more water; supplement sufficient amount of fresh vegetables daily, which should reach 500 grams (about 5 large cupped cups); and eat more fruits rich in potassium and vitamin C, such as bananas, cherries and strawberries.
Avoid spicy and stimulating foods, such as alcohol, strong tea, coffee, raw garlic, ginger, chili peppers and curry.
Exercise management
During the acute active stage of arthritis (when severe pain occurs), proper rest and braking of joint parts should be taken. After the symptoms are basically controlled, early functional exercises can be performed.
Train the flexibility and coordination of the joints under the guidance of the doctor, and strengthen the training of daily life activities (e.g. holding chopsticks to hold things) to improve the proficiency and skill.
Exercises such as groping, stretching, kicking and other full-body stretching exercises, as well as aerobic exercises such as bicycling, exercise bikes, swimming, and short-distance walking can be performed. The frequency of exercise should not be too much, such as swimming and cycling, generally 2 to 3 times a week is appropriate.