Professor Yi Dong emphasizes that
Rheumatic diseases cannot be cured, and symptoms and conditions can be improved through active treatment
There is no specific drug
Methotrexate for rheumatoid arthritis, which is low cost and effective, should be promoted at the grassroots level.
Prof. Dong Yi: I am a professor of internal medicine at Peking Union Medical College Hospital, specializing in rheumatology, and have some experience and interest in the diagnosis and treatment of clinical rheumatism. I am glad to communicate with the netizens today, and I hope I can take this platform to try to solve many of their problems, and I thank them for their support!
Primary care doctors have misconceptions about treatment
Question: We say we need early treatment, so what stage of disease do patients admitted to the Department of Rheumatology and Immunology at the Union usually develop?
Prof. Yi Dong: A few are in the early stage, but most of them are in the advanced stage and are referred to us only after outside treatment has failed. For example, rheumatoid arthritis is no longer a disease that can be treated, and only then are they referred to us. The same is true for lupus erythematosus, which is almost incurable before it is referred to us. Why are we now desperately trying to promote it? We hope that patients can get the right treatment at an early stage. Not only here in our area, but also in the general primary hospitals.
Question: The timing of treatment seems to be very critical, so how can patients determine when and where to seek treatment?
Prof. Dong Yi: Patients cannot judge themselves, for example, when a joint hurts, he cannot tell whether he has arthritis or lupus erythematosus.
Question: Can you give the patient some simple preventive guidance?
Prof. Dong Yi: Rheumatism is a multifactorial disease, and there is a top difficulty in prevention. However, gouty arthritis can be prevented if it is a little bit closely related to lifestyle habits. As long as the diet abstains from smoking and alcohol, and eats less food high in purines (seafood and animal offal, etc.), attacks can be reduced. It should be emphasized that arthritis does not only refer to rheumatoid arthritis. Nowadays, there is a misconception among the people that when they talk about rheumatism, it is rheumatoid arthritis, and when they talk about arthritis, it is also rheumatoid arthritis. In fact, rheumatoid arthritis is now rare in our country, at least in the big cities. The high incidence of rheumatoid arthritis was in the 1950’s. Nowadays, because of the availability of many effective antibiotics and the timely and early cure of suppurative tonsillitis and other predisposing diseases, rheumatic fever and rheumatoid arthritis have been reduced.
Question: You mentioned earlier that most of the rheumatism patients admitted to Xiehe are in advanced stage.
Prof. Yi Dong: Yes.
Question: What are the main aspects of these unreasonable treatments?
Prof. Dong Yi: We cannot say that primary care doctors have a completely incorrect understanding of rheumatism, but there are still many misconceptions.
Question: Can you tell us specifically?
Prof. Yi Dong: One of the misconceptions is that primary care doctors usually do not get regular continuing education to update their knowledge. Nowadays, there are many new treatments for arthritis, or nodular tissue disease in rheumatology. But sometimes we also feel that it is difficult to spread this knowledge to the very grassroots level. For example, in rheumatoid arthritis, there is now a lot of emphasis on early diagnosis and early treatment, because this can significantly improve the function of the joints so that the hands and feet do not become deformed. But now we see that in many cases this is not the case, but the use of many “native” methods, informal Chinese and Western medicines. Some of them only use hormones forever, and some of them add a lot of hormones to Chinese medicine. This makes the patient’s symptoms seem to be relieved, but the disease continues to develop. For example, the treatment of rheumatoid arthritis, both domestic and foreign, are currently using different remission drugs, the most effective of which is methotrexate. And now there are many new drugs, for example, also available in China, called Leflunomide. If these drugs can be applied early, they are very effective. There are also many biological agents that are not yet available in China, and their efficacy will be better. What we mean by “efficacy” is not only to stop pain, but also to reduce the destruction of bones and reduce the rate of disability.
Rheumatism cannot be cured
Question: Can rheumatism be cured? Is it possible to reverse the disease?
Prof. Yi Dong: It cannot be cured, but it can significantly reduce the disability rate. This is a great benefit to patients. Some patients are unable to take care of themselves, which is very sad for the patients. We recommend methotrexate, which is inexpensive and good, and this drug is domestically produced. It used to be used to treat cancer, but now we are starting to use it for arthritis, and it works very well and costs less.
Question: Do primary care doctors know about this drug?
Prof. Dong Yi: I have not gone to the grassroots to investigate, but from what I know, it still needs to be vigorously promoted.
Question: What is the cost of methotrexate treatment?
Prof. Dong Yi: It is very cheap, a bottle of methotrexate costs more than 30 yuan and can be used for half a year. However, methotrexate can only treat rheumatoid arthritis, not osteoarthritis. When we go to rural areas, we see many elderly people with osteoarthritis, and because of their financial situation, they don’t treat it at all. There is basically no good and effective medicine for this degenerative disease. But we can relieve cartilage wear and tear by improving the nutrition of the cartilage.
Question: Nowadays, there are many advertisements saying that lupus erythematosus and dryness sign can be cured, what do you think?
Prof. Dong Yi: You absolutely can’t believe in any package cure, and you can be cured by taking medicine. This kind is absolutely fraudulent. People must not be fooled. Sometimes the medicine seems to have some effect, but in fact, hormones are added, and even some of the medicine put morphine, why put morphine? The joints have to hurt, so morphine is put in for relief. I think the government should strengthen the management of this area.
Question: What you mean is that these fake drugs only temporarily relieve the patient’s symptoms, and the disease is still developing.
Prof. Dong Yi: Yes, patients still often go to buy them. Why do they still go to buy them? Because he has no choice, because there is no good treatment plan for him locally. So he believes in this medicine.
Question: Is there usually a better solution?
Prof. Yi Dong: Analgesia is absolutely necessary because if the patient’s pain is not relieved, his quality of life will be poor. But analgesia should be accompanied by treatment of the cause of the disease. We agree with etiological treatment and analgesia in parallel with etiological treatment. Nowadays, there are several levels of analgesia, such as cancer, which requires morphine. However, rheumatism is a benign lesion (does not cause death), so non-morphine painkillers should be used. Patients with benign lesions are treated with treatments that are not too damaging to the body.
The use of medication needs to be weighed against the pros and cons
Question: You mean that treatment has to be a trade-off between adverse drug reactions and therapeutic effects.
Prof. Yi Dong: There is a choice to be made between the efficacy of the treatment and the risk. NSAIDs used in rheumatology for pain relief. It used to be considered as a least toxic drug, but recently many problems have been found. The biggest problem is that it has gastrointestinal reactions and if applied for too long, it can cause a lot of damage to internal organs. But the patient is sick and it is impossible not to use it. Another example is lupus erythematosus patients, the first choice is hormone, is there any side effect of hormone? But if hormones are not used to treat the patient, the patient with lupus may die soon. But on the other hand, there are risks to consider. The quack doctors we mentioned above use a lot of unreasonable medication in order to temporarily relieve the patient’s symptoms, which causes serious damage to the patient’s body and also does not achieve actual efficacy, and the disease is still developing.
Prof. Dong Yi: When it comes to analgesics, there is a lot of concern about the safety of Vanor and Xilab at present. And the US FDA expert advisory committee has conducted a collective vote on this. If you were to vote, what would your attitude be?
Prof. Yi Dong: I may be more conservative on Vanox, but I will definitely vote for Cilazao.
Question: Some experts have commented that COX-2 drugs such as Vanno and Cilobal have no meaningful existence.
Prof. Yi Dong: COX-2 drugs are relatively new drugs. A large number of clinical evaluations are conducted after marketing. And although traditional NSAIDs have been on the market for a long time, there have been no long-term, large-dose retrospective studies done. So it cannot be stated that such cardiovascular problems do not occur with NSAIDs (e.g., naproxen). In fairness, both classes of drugs should be evaluated equally before we talk about trade-offs.
Question: “A drug is toxic in three ways”, so how can the risk of drug toxicity be minimized during treatment?
Prof. Yi Dong: Some people feel good about ibuprofen, some feel good about Nebulizer. You can see that maybe 70% of patients do not feel good about the efficacy of this drug, and 30% of patients feel good about the efficacy of this drug, and you can exclude this drug. So, we have to ask the patient, what is the previous medication used. Some people tell you that taking Fotarine is not good. Then you don’t have to prescribe Fotaralin. It’s all about having interaction with the patient. The patient needs to actively feed this information back to the physician and actively participate in the treatment throughout the course of the disease.
Q: In what groups of people do rheumatic diseases usually develop?
Prof. Yi Dong: The high-risk groups are different in different rheumatic diseases. For example, lupus erythematosus is mostly seen in women aged 20-40. Rheumatoid arthritis, 40-60 years old in women. Osteoarthritis, 55-70 years old. Dry syndrome, 45-60 years old in women. So, the high risk group is related to age gender. Some diseases are related to lifestyle habits, such as gout, which is mostly seen in 35-year-old men, mostly after a beautiful meal or mental stress. Like ankylosing spondylitis, which is mostly seen in men and develops at the age of 15-20.
Question: Let’s summarize your talk again. You recommended methotrexate for rheumatoid arthritis.
Prof. Yi Dong: Yes, methotrexate is the preferred palliative drug and is inexpensive. Those who have symptoms of joint swelling and pain should add a non-steroidal anti-inflammatory drug.
Question: You corrected some misconceptions that the reference to rheumatic diseases being curable is inaccurate.
Prof. Dong Yi: Rheumatism is a treatable disease, and with reasonable treatment, it can significantly improve the patient’s symptoms and quality of life. However, the reference to a radical cure is incorrect.
Question: Are there any specific drugs for rheumatism?
Prof. Dong Yi: Anti-rheumatic drugs are effective, and they can definitely improve the symptoms, condition and course of rheumatic diseases. However, there is no special medicine for the so-called root cause.
Question: What advice do you have for the majority of rheumatism patients?
Prof. Dong Yi: Patients should not go to trust wandering doctors and do not believe in advertisements, but should believe in scientific cure. If you want to take Chinese medicine, go to a regular Chinese medicine hospital, and if you want to take Western medicine, go to a Western medicine department. The most terrible thing is the specialist hospital that is not approved by the state, therefore, you must go to the regular hospital approved by the state.