What is rheumatoid arthritis?
Rheumatoid arthritis, referred to as rheumatoid arthritis or RA, is an autoimmune disease of unknown etiology characterized by chronic inflammation of the joints. It may be related to genetics, infection, immune regulation and autoimmunity. When the immune system is disturbed, certain normal cells in the body are targeted, causing an immune inflammatory response and erosion of the articular cartilage. The prevalence of RA in China is 0.32%-0.36%, with the peak age of onset being 35-50 years old and the prevalence in women being 2-3 times that of men.
What are the dangers of rheumatoid arthritis?
Rheumatoid arthritis is an autoimmune disease that poses a serious health risk and has a high disability rate. As the disease progresses, it eventually affects joints throughout the body, resulting in fibrous or bony joint ankylosis and subsequent muscle atrophy. The disease is generally not life-threatening, but it does have a serious impact on the patient’s life by causing loss of self-care and ability to work, followed by loss of economic resources. In addition, serious complications of rheumatoid arthritis, such as vasculitis and coronary artery disease, may occur if the extra-articular parts are invaded, which may be life-threatening. Therefore, early diagnosis and treatment are of great significance.
How is rheumatoid arthritis diagnosed?
The diagnosis of rheumatoid arthritis is mainly based on clinical manifestations, autoantibody tests and X-ray examinations.
1. Morning stiffness lasting 1 hour per day for more than 6 weeks.
2. having 3 or more swollen joints lasting for more than 6 weeks
3, arthritis of the hand (swelling of at least 1 joint in wrist, metacarpal, and proximal interphalangeal arthritis), lasting for more than 6 weeks.
4. symmetrical arthritis lasting more than 6 weeks.
5, with subcutaneous nodules.
6, with positive rheumatoid factor.
7, radiological imaging changes (osteoporosis, joint space narrowing).
If four of the above seven items are met, rheumatoid arthritis is diagnosed. However, for some atypical rheumatoid arthritis or early rheumatoid arthritis, the diagnosis may be missed or misdiagnosed. For such patients, in addition to routine blood, urine, blood sedimentation, C-reactive protein, rheumatoid factor and other tests, MRI may be done for early diagnosis. For patients with suspected rheumatoid arthritis, regular review and close follow-up are necessary.
Common therapeutic drugs for rheumatoid arthritis
NSAIDs, or non-steroidal anti-inflammatory drugs (also known as antipyretics and analgesics). They act as anti-inflammatory, analgesic, antipyretic, and anti-swelling agents by reducing peripheral prostaglandin synthesis. They are generally used in patients with first-episode or mild disease. The common antipyretic and analgesic drugs used to treat rheumatoid arthritis are: ibuprofen, aspirin, indomethacin, etc. NSAIDs need to be individualized and cannot be combined with two drugs of the same type to avoid an increase in adverse reactions. although NSAIDs can reduce the symptoms of rheumatoid arthritis, they cannot stop the natural process of rheumatoid arthritis lesions, i.e. they cannot inhibit joint destruction. Therefore, they need to be used in combination with disease-modifying anti-rheumatic drugs (DMARDs). Common adverse reactions include: gastrointestinal irritation, renal adverse reactions, coagulation disorders, hepatic impairment, and a few NSAIDs have allergic reactions.
DMARDs, called antirheumatic drugs. These drugs are slower acting than NSAIDs, taking about 1-6 months to significantly improve clinical symptoms, and are slow acting drugs. Although they do not provide immediate pain relief and anti-inflammation, they have the ability to improve and control disease progression, i.e., they can inhibit joint destruction. Commonly used DMARDs: methotrexate, salbutamol, leflunomide, hydroxychloroquine, etc. Methotrexate is the most commonly used and is the basic drug in the combination therapy of DMARDs, and there are many types of DMARDs and adverse effects depend on the specific drug. The common ones are: rash, gastrointestinal symptoms, bone marrow suppression, etc.
Glucocorticoid drugs can rapidly reduce pain and swelling in joints, but the effect is not long-lasting and relapses within a short period of time once the drug is stopped. Glucocorticoid drugs also do not inhibit the disease process. They can provide rapid relief of inflammatory symptoms during acute attacks of arthritis and when symptoms are severe, but long-term use can lead to serious side effects, so they should only be used for a short period of time and not as a long-term treatment. The dose of glucocorticoids should be gradually reduced (<10mg/day) after the symptoms are controlled until they are finally discontinued. Glucocorticosteroids are generally not used alone in the treatment of rheumatoid arthritis, but in combination with DMARDs. During treatment, attention should be paid to calcium and vitamin D3 supplementation to prevent and treat osteoporosis.
Why rheumatoid arthritis needs early and standardized treatment?
Rheumatoid arthritis is a progressive, teratogenic disease. As the disease progresses, it can develop from early arthritis to irreversible joint deformity, loss of function, and even disability, greatly affecting the quality of life. It may also lead to life-threatening complications of rheumatoid arthritis, such as vasculitis and coronary heart disease. Therefore, early and standardized treatment is necessary to control the progression of the disease and reduce joint damage, so as to maintain a normal life. In China, there are still some patients who do not undergo regular treatment, resulting in delays.