Physical and chemical examination of rheumatism
If you find that you have the main symptoms of rheumatism, the next step is to conduct further physical and chemical examinations. Rheumatism is an autoimmune disease, its hematological examination is mostly antigen antibody examination, and because it includes more types of diseases, the clinical need to select targeted physical and chemical examination items according to the patient’s own situation and disease characteristics to assist in diagnosis. The more commonly used ones are blood sedimentation and C-reactive protein, both of which are acute phase indicators and are not specific, but are mostly used as indicators of disease progression and evaluation of treatment effects, such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, etc. Blood sedimentation and C-reactive protein can be significantly increased in the acute phase, indicating disease progression. If they decrease in different degrees after treatment, it indicates that the treatment is effective and the disease is in a stable stage. In addition to sedimentation and C-reactive protein, there are also many antibody indicators with strong specificity, such as rheumatoid factor and anti-cyclic citrulline antibodies in rheumatoid arthritis; ANA and anti-ds-DNA antibodies in systemic lupus erythematosus; anti-SSA and anti-SSB antibodies in dry syndrome; anti-Jo-1 antibodies are the signature antibodies of dermatomyositis; anti-ANCA is a variety of vasculitis antibodies.
In addition, rheumatic diseases that mainly manifest with arthropathy need further joint radiological examination, such as osteoarthritis, joint X-ray, lumbar spine, cervical spine CT or nuclear magnetic examination, ankylosing spondylitis, sacroiliac joint CT examination; rheumatoid arthritis needs to be carried out on both hands X-ray examination, etc.
Fourth, the self-diagnosis of common rheumatic diseases
In daily life rheumatism is more than other system diseases are not understood, people often think that the incidence of rheumatism is low, the symptoms are not heavy, less harmful, in fact, this is a very wrong concept, clinical incidence of certain rheumatism is not lower than the incidence of respiratory, cardiovascular system diseases, such as not timely treatment, its harmfulness is also greater, such as the whole body multi-joint deformity, irreversible, seriously affect daily life and work. However, due to the diversity of rheumatic disease symptoms, involving multiple systemic lesions, coupled with the lack of understanding of its nature, it is easy to cause misdiagnosis, the following introduces several common rheumatic disease self-diagnosis and identification, to help you better understand rheumatic disease, to facilitate timely diagnosis of rheumatic disease patients, to avoid misdiagnosis. 1, joint pain as the main manifestation of rheumatic disease
(1) Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic autoimmune disease with symmetrical, polyarthritis as the main manifestation, and its condition varies greatly among individuals, from transient, mild oligoarthritis to acute, progressive polyarthritis, and in severe cases, multi-system damage can occur.
① The onset is mostly seen in women, with 35-60 years of age being the preferred age.
② The main manifestation is pain in the proximal interphalangeal joints of both hands, which is symmetrical arthritis, mostly accompanied by redness, swelling and morning stiffness (time greater than 1 hour), and can also invade the metacarpophalangeal joints, wrist joints, knee joints, shoulder joints, etc.
③ Joint pain is mostly persistent, progressively aggravated, and not relieved after rest.
④ Rheumatoid arthritis patients with rheumatoid factor positive rate of 75%, anti-cyclic citrulline antibody positive, blood sedimentation, C-reactive protein can be increased.
⑤ X-ray examination is dominated by articular cartilage destruction.
(2) Osteoarthritis
Osteoarthritis, also known as osteoarthrosis, degenerative arthritis, proliferative arthritis, senile arthritis, etc., is a common disease of the middle-aged and elderly due to degenerative changes in joint cartilage causing joint pain and joint dysfunction (including joint deformity), and belongs to a common rheumatic disease. What we call bone spurs, osteophytes, cervical spondylosis, patellar tenderness, and herniated discs in the lumbar spine all fall under the category of osteoarthritis. Whether or not you have osteoarthritis requires attention to the following points.
① Osteoarthritis is more prevalent in women after the age of 50, and the age of onset can be advanced in patients with a history of previous thyroid, uterine, or ovarian surgery.
The main lesions are joint cartilage degeneration and hyperplasia, with joint pain as the main symptom and less joint redness and swelling.
The joint pain is not continuous and can be relieved after rest.
④ Patients with osteoarthritis have negative rheumatoid factor, normal blood sedimentation and C-reactive protein in general, and osteophytes are predominant on X-ray examination.
⑤ In the case of osteoarthritis, Heberden’s nodes are seen, mostly on the dorsal side of the distal interphalangeal joints of the hand, showing chondrogenic and bony hypertrophy and flexion deformity, mostly in menopausal women.
(3) Gouty arthritis
Gouty arthritis is an inflammation of the joints caused by the deposition of uric acid crystals in the joint cavity due to the increase of uric acid in the blood due to the disorder of purine metabolism. This disease is a type of abnormal metabolic disease, whether or not suffering from osteoarthritis need to pay attention to the following points.
(i) It is more common in middle-aged and elderly men, and can also be seen in a small number of postmenopausal women, most of whom have a recent history of eating a high purine diet before the onset of the disease.
② mainly invade the first metatarsophalangeal joint, the onset of the disease is rapid, nocturnal attacks are common, the main symptom is redness, swelling, heat and pain of the joint, pain like a knife, restricted movement, but also invade the dorsal foot, ankle, knee and other joints, generally no morning stiffness, a few patients may appear fever, headache, fatigue, etc..
③ The lesioned joints are mostly asymmetrical single joints, prone to recurrent attacks, with significant relief by drinking a lot of water and taking oral painkillers.
④ negative rheumatoid factor, increased blood sedimentation, C-reactive protein, and in severe cases, increased leukocytes, and chisel-like joint damage on x-ray.
⑤ Gout stone crystals may be seen.
(4) Ankylosing spondylitis
Ankylosing spondylitis is a chronic inflammatory disease of unknown origin, mainly involving the sacroiliac joints, with insidious onset and atypical symptoms.
① prevalence in young and middle-aged males aged 10-40 years, with significant family heritability.
② mainly invade the sacroiliac joint, pain and discomfort in the low back as the main symptom, painful points located in the sacroiliac joint or hip, gradually worsening and affecting lumbar activities, accompanied by a feeling of stiffness, obvious when rising in the morning or after sitting for a long time, relieved after activity.
(iii) Peripheral single joint pain may occur, mainly in the large joints of the hip, knee and ankle lesions of the lower limbs, and may also be accompanied by ocular uveitis and other manifestations.
④ negative rheumatoid factor, increased blood sedimentation, C-reactive protein and positive HLA-B27.
⑤ X-ray examination can show that the joint surface of sacroiliac joint is rough and the joint space is narrow.