I. What is rheumatoid arthritis?
Rheumatoid arthritis is a systemic autoimmune disease characterized by chronic, progressive, destructive joint inflammatory lesions, mainly manifesting as symmetric polyarthritis, characterized by pain, swelling and morning stiffness in the joints of the hands, wrists, elbows, ankles and feet. Patients may present with extra-articular manifestations such as fever, anemia, subcutaneous nodules, vasculitis, pericarditis, pulmonary damage and lymph node enlargement, and various autoantibodies such as rheumatoid factor, antiperinuclear factor, keratin antibodies and anti-cyclic citrullinated peptide antibodies can be detected in the serum. Without proper treatment, RA can be prolonged for many years, eventually leading to joint deformity and loss of function.
What are the indications of rheumatoid arthritis disease activity?
The signs of active rheumatoid arthritis include: joint pain, pressure and swelling, prolonged morning stiffness, extra-articular manifestations (such as rheumatoid nodules, vasculitis, pluritis, etc.); laboratory tests include positive rheumatoid factor with high titer, increased sedimentation, positive C-reactive protein, increased platelets, increased immunoglobulins, increased circulating immune complexes, etc. X-rays show aggravation of joint lesions.
What are the principles of rheumatoid arthritis treatment?
The principles of rheumatoid arthritis treatment include: 1. early treatment, early application of disease-modifying anti-rheumatic drugs (DMARDs) or slow-acting anti-rheumatic drugs to control the progression of rheumatoid arthritis lesions. 2. combination of drugs, the combined application of two or more disease-modifying anti-rheumatic drugs can inhibit different aspects of immune or inflammatory damage, to play a better therapeutic role. 3. individualization of the program, according to the patient’s disease 4, functional exercise, in the systemic treatment at the same time, should emphasize the functional activities of the joints.
How are the drugs used to treat rheumatoid arthritis classified?
The main drugs for the treatment of rheumatoid arthritis are non-steroidal anti-inflammatory drugs (NSAIDs, the first-line drugs), disease-modifying anti-rheumatic drugs (DMARDs, including biological agents, the second-line drugs), glucocorticoids, traditional Chinese medicine and antibiotics and other major categories. Among them, disease-modifying antirheumatic drugs include chemically synthesized drugs and biological agents (including tumor necrosis factor-alpha antagonists, etc.), and antibiotics such as memantin, which can delay, stop or even reverse the early rheumatoid arthritic lesions in some patients and have clear therapeutic effects.
V. What are DMARDs and what is the combination therapy of DMARDs?
DMARDs stands for Disease Modifying Anti-Rheumatic Drugs, which also refers to slow-acting anti-rheumatic drugs, including a group of anti-rheumatic drugs with slow onset of action and long duration of treatment, which can control the disease, delay radiological progression, improve and maintain joint function, and change the course of the disease. These drugs have a “curative” effect. The combination of DMARDs refers to the simultaneous application of two or more DMARDs for the treatment of rheumatoid arthritis. Combination therapy with DMARDs has been shown to be significantly more effective than monotherapy without a significant increase in adverse effects. Therefore, most patients should be treated with a combination of DMARDs in adequate doses and courses. When the disease is in complete remission, a DMARDs can be used for maintenance treatment.
VI. What is a biologic agent?
Biologics refer to protein or nucleic acid drugs developed by modern biotechnology using DNA recombinant technology or other new biological technologies. Biologics currently used in clinical practice for rheumatoid arthritis include tumor necrosis factor-alpha antagonists, monoclonal antibodies to CD-20, cytotoxic T-lymphocyte-associated antigen-4 fusion protein (CTLA-4Ig), interleukin 6 antagonists, JAK3 enzyme inhibitors, etc. In addition, there are many new agents in clinical or laboratory research. ACR) made the latest recommendations for the treatment of DMARDs, defining them as biologic DMARDs according to their characteristics and suggesting the timing of the application of novel biologic DMARDs. Among them, TNF-α antagonists are widely used in clinical practice, with significant efficacy in relieving symptoms, delaying and stopping bone destruction, and preventing joint deformity; monoclonal antibodies to CD-20 and cytotoxic T-lymphocyte-associated antigen-4 fusion protein (CTLA-4Ig) have also been used in patients with moderate to severe refractory rheumatoid arthritis, and have shown good clinical application prospects. The application of new biological agents has greatly improved the condition of rheumatoid arthritis patients, improved the prognosis and improved the quality of life.
Seven, what is the significance of immunopurification therapy in the treatment of rheumatoid arthritis?
For patients with stubborn severe rheumatoid arthritis, the effect of regular drug treatment is not satisfactory. If the patient has high titers of antibodies and a large number of circulating immune complexes, fast blood sedimentation, and no obvious decline in white blood cells, no damage to important organs, no infection and no coagulation disorder, this therapy can be applied. It can quickly remove the abnormal immunoglobulins and other harmful substances in the plasma, and at the same time, apply slow-acting anti-rheumatic drugs to control the further development of lesions. As long as the indications are well chosen, this therapy can often make patients with severe rheumatoid arthritis quickly relieve their condition.
Eight, rheumatoid arthritis patients can be treated with glucocorticoids?
Rheumatoid arthritis patients can be treated with glucocorticoids if necessary, but must master the indications. Otherwise, it can cause adverse reactions. The indications include.
1. Rheumatoid arthritis with systemic damage.
2.When the symptoms are severe and cannot tolerate NSAIDs or the effect of NSAIDs is poor, small doses of hormones can be applied before the effect of slow-acting anti-rheumatic drugs.
3.Refractory rheumatoid arthritis in which multiple second-line drugs are ineffective.
4.For recalcitrant individual joint lesions, especially large joints, intra-articular injection of hormone therapy can be considered.
What is the standardized treatment of rheumatoid arthritis?
Standardized treatment includes early treatment, individualized treatment, early application of palliative drugs, and for those with heavy symptoms and high antibody titers, combined treatment with palliative drugs.
X. What is the significance of functional exercise in the treatment of rheumatoid arthritis?
Functional exercise plays an important role in the recovery of joint function and prevention of muscle atrophy in rheumatoid arthritis patients. This can not be replaced by drug therapy. In many RA patients, after regular medication, the swelling and pain of the joints are obviously relieved or even disappeared, but if no attention is paid to functional exercise, the normal function of the joints will be lost and the muscles will be atrophied. Therefore, appropriate joint functional exercises should be selected as early as possible according to the condition.
XI. Can rheumatoid arthritis be completely relieved?
As long as patients can be diagnosed early, undergo regular and individualized systemic treatment as soon as possible, and be closely monitored under the guidance of a specialist, the disease can go into complete remission.