I. Rheumatoid arthritis diagnosis and treatment routine Clinical manifestations: 20 to 60 years old, most common at the age of 45, the incidence of women is 2 to 3 times that of men; most of the disease starts slowly, there is a period of weakness, general malaise, fever, poor performance and other symptoms before the emergence of obvious joint symptoms. Joint manifestations: morning stiffness, pain and pressure, joint swelling, joint deformity, joint dysfunction Extra-articular manifestations: rheumatoid nodules, rheumatoid vasculitis, pulmonary changes (interstitial changes, nodular changes, pleurisy), pericarditis, gastrointestinal discomfort (epigastric discomfort, stomach pain, nausea, poor appetite, even black stool, mostly due to anti-rheumatic drugs), anemia, dry syndrome. Laboratory tests: RF (+), elevated ESR in the acute phase, elevated complement X-rays: X-rays of the fingers and wrist joints are the most valuable. Diagnostic criteria: 1. Morning stiffness lasting at least 1 hour (per day) with a duration of at least 6 weeks; 2. Having three or more arthrogryposis for at least 6 weeks; 3. Wrist, metacarpophalangeal, and proximal phalangeal arthrogryposis for at least 6 weeks; 4. Symmetrical arthrogryposis for at least 6 weeks; 5. Having subcutaneous nodules; 6. Hand radiographic changes (at least osteoporosis and joint space narrowing); 7. Positive rheumatoid factor (titer >1:20) (four of the above) (Four of the above seven items can be diagnosed as rheumatoid arthritis) Differential diagnosis: 1. Ankylosing crestitis: Mostly seen in young men, with asymmetrical large arthritis of the lower extremities. RF (-), HLA-B27 (+). 2, osteoarthritis: mostly seen in older people over 50 years old, arthralgia is not as obvious as rheumatoid arthritis, mainly involving weight-bearing joints such as the knee and hip joints. The increase in blood sedimentation is not obvious, and the serum RF (-). 3. Systemic lupus erythematosus: The joint lesions of this disease are lighter than those of rheumatoid arthritis and the systemic symptoms outside the joints, such as pteroidal erythema, hair loss and proteinuria, are more prominent. Serum anti-nuclear antibodies and anti-double-stranded DNA antibodies are more positive, while complement is more low. 4.Rheumatoid arthritis: Mostly seen in adolescents, its arthritis is characterized by wandering swelling and pain in the large joints of the extremities, and joint deformity rarely occurs. Extra-articular symptoms include fever, sore throat, cardiac inflammation, subcutaneous nodules, annular erythema, etc. ASO (+). Treatment: 1. General treatment: appropriate rest, joint braking during the acute period, functional joint exercises during the recovery period, etc. 2. (2) Tid gold combination: gold sodium thiomalate, injected intramuscularly once a week, starting from the smallest dose, gradually increase to 50mg each time, the injection time can be extended after effective; Jinuofen 3mg, Po, Bid Liuzoxapyridine 2g/day, divided into 3~4 times orally, starting from small dose Other are penicillamine, azathioprine, cyclophosphamide, cyclosporine A, etc. (3) Biological agents: gamma interferon, anti-TNFa antibody, monoclonal antibodies against T lymphocytes and their receptors (4) Chinese medicine rheumatism Xandan series, 顽痹康胶囊, etc. for internal use, rheumatism Kang rub for external use (5) adrenal cortical hormone, only after other therapies are ineffective, with many adverse reactions 3, electroacupuncture therapy, acupuncture point burial, physiotherapy, etc. 4, pain point block treatment 5, for those with joint deformities or adhesions available The treatment of small needle knife 6, medicinal bath, once a day Second, ankylosing crestitis diagnosis and treatment routine Clinical manifestations: the onset of the disease is slow and insidious, the onset of age 15 to 30 years old, the onset of 40 years old is rare. The prevalence is at least five times higher in men than in women, and the symptoms are often heavier in men than in women; the early symptoms are often low back pain, located at the sacroiliac joint or at the hip, which gradually worsens and affects lumbar activities. Eventually the crest develops deformities such as hunchback and neck strength. About half of the patients seek treatment for lower extremity peripheral arthritis as the first symptom. Especially in young patients, it presents as asymmetric swelling and pain in the large joints of the hip, knee and ankle, with recurrent episodes and remission, and often left with impaired mobility. Diagnostic criteria: 1. restricted three-way movement of lumbar forward bending, backward bending and lateral bending; 2. low back or lumbar spine pain; 3. thoracic dilatation <62.5px; 4. X-ray grading of sacroiliac arthritis: grade 0 is normal; grade 1 is suspicious; grade 2 is micro lesion; grade 3 is moderate, i.e. erosion, sclerosis, joint narrowing or widening of the joint surface; grade 4 is severe, i.e. joint ankylosis. The diagnosis of ankylosing crestitis can be confirmed by bilateral sacroiliac arthritis of grade 3 to 4 on X-ray with any of the above symptoms; or unilateral sacroiliac arthritis of grade 3 to 4 or bilateral sacroiliac arthritis of grade 2 with symptoms 1 or both 2 and 3; bilateral sacroiliac arthritis without clinical symptoms is a possible patient with ankylosing crestitis. Differential diagnosis: 1, rheumatoid arthritis: see rheumatoid arthritis diagnosis and treatment routine; 2, diffuse unexplained skeletal hyperplasia: crestal ankylosis appears in the elderly, with lesions predominantly in the thoracic spine, without sacroiliac arthritis. 3.Reiter syndrome: pain in the crestal region may occur, HLB-A27 may be positive, the onset is acute, only less than half of patients will develop sacroiliac arthritis, and asymmetric onset, most of the peripheral joint inflammation, may be accompanied by skin or nail lesions or urethritis, etc.; 4.Psoriatic arthritis: pain in the crestal region may occur, sacroiliac arthritis is asymmetric onset, HLB-A27 may be positive. -A27 may be positive, most of them appear peripheral joint inflammation and skin psoriatic lesions; 5. Inflammatory bowel disease arthritis: slow onset, accompanied by inflammatory symptoms of the gastrointestinal tract, most of them are peripheral joint onset, a few patients with sacral arthritis have symmetrical onset. Treatment: 1. General treatment: Encourage patients to exercise properly, especially the flexion activities of the crest and hip. Sleep on a hard bed, use low pillows, avoid weight-bearing on the crest, prolonged bending and trauma. 2, drug treatment: (1) non-steroidal anti-inflammatory drugs (2) slow-acting anti-rheumatic drugs: methotrexate 10mg orally, once a week; lujiazosulfapyridine 2g/day, divided into 3 times orally; in addition, can also be taken orally Leigongteng tablets (3) Chinese medicine rheumatism Xandan series, nagging paralysis Kang capsule, etc. 3, acupuncture treatment: take Hua Tuo clip crest point electric acupuncture treatment or acupuncture point injection or acupuncture point buried wire; 4, small needle knife treatment 5, physical therapy. Diagnosis: 1. Symptoms: Wandering pain in the knees, elbows, shoulders, ankles, wrists and other large joints, acute symptoms such as redness, swelling, heat and pain in the joints; chronic symptoms such as joint pain, cold pain or pain, which is aggravated in cold weather or rainy days. Extra-articular symptoms include fever, sore throat, cardiac inflammation, subcutaneous nodules, annular erythema, etc. 2.Signs: There is usually no joint deformation. 3.X-ray film: no bone lesions or mild osteophytes, swollen shadow of soft tissue around the joint is visible. 4, laboratory tests: in the acute stage, the blood count is elevated and the blood sedimentation is increased, but generally does not exceed 80 mm/h. Check ASO (+), RF (-). Differential diagnosis: 1. rheumatoid arthritis: see related diagnosis and treatment routine; 2. osteoarthritis: see related diagnosis and treatment routine; 3. lupus arthritis: systemic symptoms outside the joints of this disease, such as pteroidal erythema, alopecia, proteinuria, etc. are more prominent. Serum antinuclear antibodies, anti-double-stranded DNA antibodies are mostly positive, complement is mostly low, and ASO (-). Treatment: 1, drug anti-rheumatism treatment: oral Aspirine, 0.3g, Tid; penicillin 8 million units IV; rheumatism Xandan capsule oral; Chinese medicine rheumatism Kang rub external rub; Chinese medicine external application, etc. 2, electroacupuncture treatment, once a day, 10 times / course; physical therapy (Chinese medicine ion introduction, microwave, ultra-short wave) 3, for patients with obvious pressure pain points feasible pain point closure or small needle knife treatment 4. 4, osteoarthritis diagnosis and treatment routine Clinical manifestations: slow onset, mostly after the age of 40, the incidence of women than men; mostly in weight-bearing joints such as knees, hips, etc., joint pain and activity, pain relief after rest; in the joint after a long period of rest and then activity localized transient stiffness, lasting no more than 30 minutes, disappear after activity, serious cases even at rest have joint pain and activity The affected joint is often associated with pressure pain, bony hypertrophy, bony grinding sound, and deformity in a few patients. The first metatarsophalangeal joint can also be affected. Tight shoes and repeated trauma are the causes of this condition, which is characterized by localized pain, bony hypertrophy and first toe valgus. Diagnosis: 1. Hand joint criteria: pain or stiffness of the hand joints with at least three of the following four conditions: (1) distal and proximal phalangeal joints of the 2nd and 3rd fingers of both hands and the 1st carpometacarpal joint, with 2 or more of these 10 joints showing stiff tissue hypertrophy; (2) at least 2 distal phalangeal joints showing stiff tissue hypertrophy; (3) less than 3 metacarpophalangeal joints involved (swollen); (4) at least 1 of the above 10 joints (4) At least 1 of the above 10 joints is deformed. (2) Knee joint criteria: see knee osteoarthritis diagnosis and treatment routine. 3. Hip joint criteria: hip pain with at least two of the following three conditions: (1) blood sedimentation <20mm >50 years old; (2) knee stiffness <30 minutes; (3) bone grinding sound; Treatment: 1. acupuncture, fire cupping, physiotherapy, etc. 2. painful point closure, intra-articular joint block, etc. 3. 5.Non-steroidal anti-inflammatory drug treatment 6.Treatment of bracket fixation 7.Other treatments: fluid can be pumped under aseptic conditions and bandaged with gauze bandages. 8.For those who do not work with the above methods, they can be referred to surgery for arthroscopic treatment or surgical treatment. Clinical manifestations: The clinical symptoms of lumbar disc herniation are various, and the main clinical manifestations are: Symptoms: 1. lower back pain 2. radiating neuralgia of lower limbs 3. numbness Signs: 1. general signs: such as low back pain, limp body leaning forward, etc. 2. 2. Crestal deviation: one of the characteristics of lumbar disc herniation. 3.Limited crestal movement 4.Lumbar pressure point 5.Sciatica 6.Straight leg raise test 7.Flexion neck test 8.Thumb extension test 9.Nociceptive examination of lower limbs 10.Knee tendon and Achilles tendon reflex 11.Disorder of urination and defecation and extensive sensorimotor effects 12.Femoral nerve pull test Auxiliary examination: 1.X-ray examination 2.CT examination 3.MRI examination Diagnosis: Usually based on the pattern of low back pain in the medical history, and The diagnosis can be confirmed by X-ray or CT or MRI, combined with radiological pain in the lower limbs, scoliosis, positive rate of straight leg raising test, pressure points in the lumbar spine, significant weakening of the extensor muscles, reduced nociceptive sensation in the lower limbs, and weakening or disappearance of the Achilles tendon reflex. Local diagnosis: 1, lumbar 3-4 intervertebral disc herniation (compression of lumbar 5 nerve): (1) pain in the sacroiliac joint, hip joint posterior lateral, and radiates to the front of the thigh and calf anterior medial (2) numbness of the calf anterior medial (3) weak or absent knee reflex (4) pressure points at the lumbar spinous process equivalent to the intervertebral space (5) weak knee extension (6) positive hip hyperextension test or femoral nerve pull test 2. Lumbar 4-5 disc herniation (compression of the lumbar 5 nerve): (1) pain in the sacroiliac joint, hip joint and posterior lateral aspect of the thigh and calf, radiating to the anterolateral dorsum of the calf (2) numbness in the lateral aspect of the leg or dorsum of the foot (3) reduced toe dorsiflexion (4) no change or weakening of the Achilles tendon reflex (5) significant pressure pain next to the spinous process of the 4th lumbar vertebra 3. Lumbar 5-sacral 1 disc herniation (compression of the sacral 1 nerve): (1) (1) pain over the sacroiliac joint, hip thigh and posterior lateral calf or foot (2) numbness of the lateral calf foot including the lateral three toes (3) weakness of the foot and toe plantarflexion (4) weakness or atrophy of the calf triceps (5) weakness or loss of the Achilles tendon reflex (6) obvious pressure pain next to the spinous process of the 5th lumbar vertebra (4) herniated lumbar disc with multiple crestal spaces: the diagnosis of herniated lumbar disc at 2 or more crestal spaces. Clinical signs should be considered together, and CT or MRI should be performed to confirm the diagnosis. Differential diagnosis 1, lumbar spinal stenosis: with a history of lumbar pain, but with intermittent claudication as the main manifestation, especially heavier during walking and relieved at rest, with limited posterior extension of the patient. 2, cauda equina nerve tumor: characterized by progressive lumbar pain, which is worse at night and relieved after getting up and moving. 3.Crestal spondylolisthesis: sciatica is mostly bilateral. 4.Lumbar spine tuberculosis: low back pain is persistent. Most of them do not have sciatica. There is low fever in the afternoon and night sweating. 5.Sacroiliac arthritis: Sacroiliac joint mostly has obvious pressure pain, positive "4" test and positive pelvic squeeze test. 6.Proliferative lesions of the lumbar spine (including ligamentous joint capsule and osteophytes): lumbago can be present in various positions. 7, pear-shaped muscle injury syndrome: mostly due to rough movements such as lower limb abduction, external rotation or internal rotation, the patient mostly has no lumbar pain and crestal oblique signs, and the pear-shaped muscle has obvious local pressure pain. Treatment: 1, lumbar epidural block therapy 2, sacral block and placement drip therapy and other blocks 3, analgesic sedative application 4, collagenase lysis disc 5, small needle knife therapy 6, other therapies: bed rest, traction therapy, tui-na therapy, acupuncture therapy, etc.