When it comes to rheumatism, people think it’s just joint or muscle pain or swelling, but it’s not.
As the “guardian of people’s health”, you have to recognize some of the enemy’s “tricks”, keep a clear head, see the tricks and dismantle the tricks, advise patients and help win the final battle! Here I will tell you some of the common tricks of the rheumatism devil, as well as countermeasures.
Trick 1: Sound and fury. Trick: the bottom of the barrel!
Trick: What hurts the joints is only its small force, and the big main force is setting up ambushes everywhere.
Rheumatic disease does not only invade the joints, muscles, bones and soft tissues around the joints, such as tendons, ligaments, bursae, fascia and other parts, many systemic rheumatic diseases can cause damage to the system. In other words, it only sends a single small force to attack the joints; its main force has long since planted ambushes in various systems and may also have started messing up long ago. This is systemic damage. It should be noted that this damage is often carried out unnoticed, so it is often overlooked and eventually leads to very serious consequences.
Response method: Targeted treatment is indispensable, and it is important to take the bottom out.
First of all, it is important to recognize which systemic damage can be caused by rheumatic immune diseases.
For example, systemic lupus erythematosus, systemic sclerosis, dry syndrome, leukoarthrosis, and individual severe rheumatoid arthritis can lead to systemic damage. The manifestations are circulatory system damage – cardiac inflammation (pericarditis, myocarditis, endocarditis); urinary system – renal damage (proteinuria, hematuria, swelling, hypertension, renal failure); hematological system (leukopenia, erythrocytopenia, thrombocytopenia, hemolysis, etc.); respiratory system (interstitial pneumonia, pulmonary hypertension, pleural effusion); digestive system (liver function damage, jaundice); Nervous system damage (headache, epilepsy, cerebrovascular disease; motor disorders, such as muscle weakness, myasthenia; sensory disorders, such as limb numbness); endocrine system (electrolyte disorders, such as hypokalemia) and so on. Some rheumatic diseases can also cause damage to the reproductive system, such as leukoaraiosis can cause ulcers in the reproductive system.
Some non-systemic rheumatic diseases can also cause damage other than joints and bones. For example, gout can lead to kidney damage, which, if not treated in time, may eventually lead to kidney failure, and can also lead to cardiovascular and cerebrovascular lesions due to the deposition of gout stones locally in blood vessels. So those who eat and drink a lot of gout patients should pay attention to it!
According to my explanation above, you may understand. Many times, doctors recommend tests to detect the disease as early as possible and to avoid systemic damage.
Some patients are confused and say: I am a joint thing, why should I check my eyes, blood, liver and kidney function, urine routine, autoantibodies, anti-nuclear antibodies, anti-ds-DNA antibodies, anti-ENA antibodies, anti-platelet antibodies, anti-cardiolipin antibodies, rheumatoid factor, ultrasound, cardiac ultrasound, head CT (MRI) and other tests ah, is the doctor fooling me?
After understanding the above, you will understand that this is not the case.
Trick 2: Concealment. Trick: catch the thief!
Trick: The enemy is setting up a “bewitching array” in an attempt to confuse us.
Many times the disease will set up a “disorientation” to dazzle people with all sorts of symptoms in an attempt to conceal it from the world.
How to deal with it: Get to the core and break the spell.
To crack this trick, first you need to know which diseases and rheumatic diseases have similar or the same performance.
1, tumor. Tumor can also appear as joint and muscle pain, fever and other manifestations similar to rheumatic activities, which is called “carcinoid syndrome” and is easily misdiagnosed. This requires tumor markers, bone scan (bone imaging) and other tests to help identify.
Recently, I had a patient who had been diagnosed with rheumatoid arthritis and had breast cancer many years ago, and her condition had been stabilized by radiotherapy, but recently she was hospitalized in the cardiology department of a hospital due to pericardial effusion. The results came out 2 days later, not only did she have lumbar 3 and 4 disc lesions, but also the lumbar 2 to 4 vertebrae had a low-density area of bone destruction, so the diagnosis was clear – lumbar bone metastasis from tumors, which must be treated in oncology.
Also, some systemic rheumatic diseases have some connection with tumors, such as dry syndrome, a small part of which may be transformed into lymphoma, and individual severe dry syndrome has some correlation with tumors.
Recently, we found some elderly patients who always have individual joint swelling and pain, and when they are hospitalized, we usually have to perfect tumor markers, bone scan and other examinations for him/her to avoid missing the diagnosis.
2. Tuberculosis. Many of you have some knowledge of tuberculosis. But did you know that tuberculosis can occur in all tissues and organs of the body, such as pulmonary tuberculosis (the most common), bone tuberculosis, kidney tuberculosis, spleen tuberculosis, etc. These tuberculosis can be seen as low fever, night sweats, wasting, joint and muscle pain, and can be easily misdiagnosed as rheumatism. Not only that, internationally, the incidence of tuberculosis in China has been relatively high, and in recent years there has been a tendency for tuberculosis to make a comeback, so screening for tuberculosis is one of the very important tasks of rheumatologists, especially for those patients with low fever, and we usually recommend that they screen for tuberculosis antibodies and or do a PPD test. Also, some rheumatic patients end up needing hormone therapy, which can be very, very dangerous if TB is not excluded.
Fever is also a common symptom of rheumatic disease. This fever can be low, moderate, or high, and often manifests as irregular fever, usually without chills, ineffective antibiotics, and fast blood sedimentation, such as systemic lupus erythematosus, adult Stihl’s disease, acute neutrophilic febrile dermatosis, and lipofuscinosis.
In contrast, TB usually also presents with fever, ranging from low to moderate to high fever, ineffective general antibiotics, rapid hematocrit, and also pain in joints and muscles. Once misdiagnosed, treatment of TB can be delayed and even life-threatening. Wouldn’t you say that it also needs to be identified?
I once came across a case in a rural hospital in a foreign country where a young patient suffered from chronic lumbosacral pain with intermittent low-grade fever (which the patient did not pay attention to) for several months, accompanied by morning stiffness, and the doctor checked a sacroiliac x-ray and found that the sacroiliac joint surface was “fuzzy” and arbitrarily judged it to be ankylosing spondylitis. The next treatment was very sad, and the patient was immediately treated with high-dose hormone shock therapy. After imaging of the lumbar spine at a major hospital in Beijing, several lumbar vertebrae were found to have been destroyed and eroded, which was clearly judged to be bone tuberculosis. The wrong treatment had led to the active spread of tuberculosis bacteria, and a young man would be in a wheelchair for the rest of his life!
There are several diagnostic and treatment misconceptions here. If we had not done x-rays and performed sacroiliac CT, we would not have been misled by intestinal artifacts and misinterpreted as blurred sacroiliac joint surfaces. If it had not been misdiagnosed by an arbitrary lay doctor and wrongly applied hormones, it would not have led to the spread of TB bacteria.
The above are only some key diseases that need to be identified in rheumatism, which are not very comprehensive, for example, dry syndrome also needs to be identified with common endocrine diseases (such as diabetes); different rheumatism diseases also need to be identified clearly among each other, such as rheumatoid and lupus erythematosus identification, gout and reactive arthritis identification, and so on and so forth, and the contents are very complicated. Therefore, it is necessary for doctors and patients to cooperate well and diagnose correctly!
Knowing the above, you may understand why doctors sometimes ask you to do some seemingly unrelated tests.
Medicine is a practical discipline, and doctors are the ones who keep improving and learning through lessons learned time and time again, and every patient is our teacher.
I told many of my patient friends that doctors always think more than patients and think carefully, because doctors see too many patients, each clinical is “as deep as the abyss, like walking on thin ice”, try to act carefully. Because, we deeply know what it means if the doctor misdiagnosis, missed diagnosis, it will mean delaying the correct treatment of patients, and even endanger the life and health of patients!
I like this motto – I wish people were always healthy, why should I be alone in poverty. This is a couplet at the entrance of the ancient medicine heir, reflecting the fact that the doctor is not a profession that pursues personal gain first, his ultimate goal is to destroy himself. If one day we can diagnose ourselves without a doctor, it will be a great progress for humanity.