I. Concept
Rheumatism in medical terms refers to chronic pain of unknown origin in joints and their surrounding soft tissues. Rheumatic diseases refer to a large group of diseases with different etiologies but with a common denominator of involving joints and surrounding soft tissues, including muscles, ligaments, bursae and fascia. In addition to pain, joint lesions are accompanied by swelling and impaired movement, and have a chronic course of alternating episodes and remissions.
At present, most scholars believe that rheumatism is actually a systemic disease, mainly involving connective tissue, and most patients have joint and muscle lesions, which are related to immunological abnormalities of the body and belong to autoimmune diseases. It is a kind of disease with high incidence, wide range of lesions, and heavy danger.
The World Health Organization classifies rheumatic diseases into ten categories, including more than 100 kinds of diseases. The common rheumatic diseases are.
1, diffuse connective tissue diseases including rheumatoid arthritis, juvenile rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis, polymyositis and dermatomyositis, adult still disease, necrotizing vasculitis and other vascular diseases, dry syndrome, overlap syndrome, lipofuscinosis, etc.
2, seronegative spondyloarthropathies including ankylosing spondylitis, Ritter syndrome, psoriatic arthritis, enteropathic arthritis, undifferentiated spondyloarthropathy, etc.
3, degenerative arthritis (osteoarthritis, osteoarthrosis)
4.Arthritis, tendon sheath and synovitis related to infectious factors
5.Metabolic and endocrine diseases with rheumatic manifestations including gout, pseudogout and chondrocalcinosis, amyloidosis, hepatomegaly (Wilson’s disease), arthrosis caused by diabetes, arthrosis caused by thyroid and parathyroid glands, acromegaly, etc.
6.Others include tumors, neurodegenerative diseases, chronic strain and injury of joints, osteoporosis, osteochondrosis, etc.
Second, the etiology
The etiology of rheumatism is complex according to the western medical explanation, and the exact cause is not yet fully understood. At present, it is believed that the disease is closely related to infection, genetics, metabolic disorders, environment, degenerative changes, trauma and strain, etc. Rheumatic diseases belong to the category of “paralysis” in Chinese medicine. At present, it is customary to classify rheumatism into actual paralysis and deficiency paralysis according to the newness of the disease, the deficiency of the evidence, and the severity of the evil.
The actual paralysis: including walking paralysis, pain paralysis, paralysis, heat paralysis, persistent paralysis, etc.; deficiency paralysis: including qi and blood deficiency paralysis, yin deficiency paralysis, yang deficiency paralysis, etc. According to the five main organs, they are divided into tendon paralysis, pulse paralysis, muscle paralysis, skin paralysis, bone paralysis, etc. Chinese medicine emphasizes the internal factors of the human body as the cause of disease, i.e., “where evil is present, its qi must be deficient”.
Similarly, the cause of rheumatism is also mainly internal. As the Nei Jing says: “wind and rain, cold and heat, not to deficiency of evil, not to hurt people alone. The “Jisheng formula” more clearly pointed out: “are due to body weakness, the couples are empty, by wind, cold and dampness and into paralysis.” In other words, due to the weakness of the human body, the lack of qi and blood, or overwork, the skin pores loose, the camp is not solid, external evil take advantage of the weakness and enter, flowing into the meridians, muscles, joints, resulting in qi and blood stagnation, blockage, not through the pain and joint pain, soreness, wood numbness, unfavorable activities.
As for the external causes are related to climatic conditions and living environment, mainly wind, cold, dampness, evil invasion. The Nei Jing says: “Wind, cold and dampness come together and become paralysis. This explains the unpredictable climate, hot and cold, or living in a humid, cold or wading, rain, blowing air conditioners and fans, wind, cold and damp evil, take advantage of the body’s low resistance to invade the body, injected in the meridians, stay in the joints, muscles, so that the qi and blood paralysis obstruction and paralysis.
However, because each person’s physique is different, each type of disease has its own prevalence, so the “Nei Jing” also said: “its wind wins for walking paralysis, cold wins for pain paralysis, damp wins for paralysis.” If the wind-cold damp paralysis does not heal over a long period of time, the disease may turn into heat for a long time, or the evil of wind-heat, or the Yang of the body or the Yin of the body may have heat. This means that the external evil stays in the body and accumulates over time, and the disease is caused by the meridians and internal organs, which can produce the corresponding symptoms of internal organs paralysis (such as heart paralysis with palpitations, shortness of breath, chest pain, etc.).
Three, common clinical manifestations
1. Fever Most patients have irregular mild or moderate fever, but some have flaccid fever or persistent low fever. The pulse rate is accelerated and sweating is profuse, often out of proportion to body temperature.
The typical manifestation of arthritis is wandering polyarthritis, often symmetrically involving the knee, ankle, shoulder, wrist, elbow, hip and other large joints; local inflammatory manifestations of redness, swelling, heat and pain, but not septic. In some patients, several joints are affected at the same time, and small joints of hands and feet or spinal joints can also be involved. The attack usually occurs within one month after streptococcal infection, and anti-streptococcal antibody titers may often increase.
After the acute inflammation subsides, the joint function is completely restored and no joint ankylosis or deformity remains, but recurrent attacks are often seen. Typical cases have been rare in recent years. The degree of local inflammation of the joint is not significantly related to the presence or absence of cardiac inflammation or heart valve lesions.
3. Cardiac inflammation is the most important clinical manifestation, and 65% to 80% of pediatric patients have cardiac lesions. Acute rheumatic heart inflammation is the most common cause of congestive heart failure in childhood.
4. Skin changes can be urticaria, maculopapular rash, erythema multiforme, erythema nodosum and erythema annulare, with erythema annulare being more common and diagnostic. It is common in the inner limbs and trunk, and is a light red ring-shaped erythema, which is small when it first appears, and then expands rapidly to the surrounding area, with mildly straight edges and normal skin color inside the ring. Sometimes it fuses into a wreath. The erythema is sometimes hidden, not itchy, not hard, and the color fades when pressed, which can last for several months.
5, chorea often occurs in children with rheumatism between 5 and 12 years old, more women than men. Most in the streptococcal infection 2 to 6 months after the onset. It is a manifestation of rheumatic fever inflammation invading the central nervous system, including the basal ganglia, cerebral cortex, cerebellum and striatum, with a slow onset. Clinical manifestations include: mental abnormalities at the onset, often with emotional restlessness, agitation, comprehension and memory loss; involuntary movements; muscle weakness and ataxia.
6, other manifestations in addition to the above typical manifestations, rheumatism may occasionally involve other parts and cause rheumatic pleurisy, peritonitis, vasculitis, should be noted.
IV. Laboratory diagnosis
1, erythrocyte sedimentation rate (ESR) This is an older test, although not specific in the diagnosis of rheumatic diseases, but it is still considered the most simple and inexpensive laboratory indicators to distinguish between inflammatory and non-inflammatory diseases.
2, C-reactive protein (CRP) is an acute time-dependent reactive protein, rheumatic disease (RA, SLE, etc.) active, infection, inflammation, high fever, malignant tumors, surgery, radiation sickness, etc. CRP level rises rapidly, 48 to 72 hours can reach the peak, the condition improves when the rapid decline to normal. The level of CRP in joint fluid has some significance in distinguishing septic, tuberculous and rheumatoid arthritis.
It has diagnostic significance for infectious and crystal-induced arthritis, and is also of great significance for differentiating inflammatory and non-inflammatory exudates.
4, specific antibodies anti-hemolytic streptococcal lyso, rheumatoid factor, anti-cyclic citrullinated peptide anti-body test, anti-nuclear antibody, HLA-B27 and other tests.