Rheumatism is a term that keeps evolving with the times, from Hippocrates’ medical cases to the exploration of Western medicine about rheumatism in the mid-nineteenth century, from the rapid development of immunology to the revision of international norms for the diagnosis and treatment of rheumatism today, he is always enriching himself.
Nowadays, the development of medicine has entered a historical stage of refinement, detail and depth, and the research of various disciplines has been continuously refined and deepened. Most diseases like cardiology, respiratory medicine, nephrology and oncology have clear and standardized diagnostic and therapeutic methods and have been accepted by the majority of medical practitioners, while rheumatology has developed relatively slowly due to its complex pathogenesis and variable clinical manifestations.
However, with a series of significant developments in immunology and molecular biology in the past 50 years, especially in the past 20 years, rheumatology has developed by leaps and bounds. People have proposed to use collagen diseases and connective tissue diseases to summarize this type of diseases, but they are mostly abandoned because they are not comprehensive enough. Therefore, today’s clinical scholars advocate the use of the name rheumatic diseases, and the autoimmune diseases proposed at the end of the twentieth century only refer to a portion of rheumatic diseases.
Because rheumatism is complex, changeable, some difficult to diagnose, some treatment effect is poor, coupled with the relevant medical science education publicity is not strong, people feel doubtful and fearful about her company, from the production of some blind, vague, specious, or even wrong understanding, not only the general public, some practitioners of medicine also do. The following is a brief introduction to some aspects of misconceptions.
One of the misconceptions: rheumatism is an incurable disease
At present, most rheumatic diseases can not be cured after treatment, and people often hope that after taking drugs, injections, the disease will be eradicated, and never recur. Common rheumatic diseases such as rheumatoid arthritis, ankylosing spondylitis require long-term or even lifelong medication, and systemic lupus erythematosus, which has many diseased organs, costs more for treatment, has more chances of recurrence, and has poor quality of life.
Therefore, people think that rheumatic diseases are incurable and panic too much. In fact, most rheumatic diseases can be in long-term remission after intensive treatment in the acute stage, and as long as the medication is taken regularly and on time, it does not affect life and can be engaged in certain work.
We are familiar with diabetes, hypertension, coronary heart disease, lifelong medication, lifelong treatment seems to be accepted as a matter of course, but when it comes to rheumatism, always feel confused and fearful, in fact, now most rheumatism treatment has developed greatly, are treatable and controllable, we should treat rheumatism as calmly as hypertension, psychological relaxation, active treatment, brave face.
Myth No. 2: Rheumatism can be treated or not treated
Because most rheumatic diseases require lifelong prevention and treatment effect most will not be immediate, like rheumatoid arthritis, strong value spondylitis, dry syndrome, adult Still disease, patients may actively seek treatment at the beginning, with the treatment, often found to take more drugs, slow effect, easy to repeat, and these diseases will not soon appear heart, kidney, brain and other important organs of the lesions, people will have a People have the feeling that “even if you treat it, you can’t cure it, and if you don’t treat it, you don’t want to die”.
In fact, on the contrary, early treatment, the best time to treat is the key to successful treatment of rheumatic diseases. The best time to treat rheumatoid arthritis is in the first 2 years after the onset of the disease, and some experts even advocate that 2 months after the onset of the disease is the critical period. Over 2 years, bone destruction will occur in the joints of both hands, which is irreversible, and timely treatment can avoid joint deformity and loss of function.
Systemic lupus erythematosus emphasizes early treatment, timely control of the disease, and adherence to medication during the remission period, the prognosis is generally better. 20 years ago, the 5-year survival rate of this disease was less than 50%, but now, the 10-year survival rate can be more than 75%, but if the time for treatment is missed, once the damage to multiple organs is aggravated, the treatment will be half the effort.
Ankylosing spondylitis is a common disease occurring in the juvenile youth population, there is no cure, but if treated early and regularly, most can avoid fusion of joints and ankylosis of the spine, and does not affect life, childbirth and the performance of appropriate work. Therefore, it is wise to treat rheumatic diseases actively.
Myth No. 3: Western medical treatment for rheumatism is not as good as Chinese medical treatment
Because of the poor effect of Western medicine in the treatment of rheumatism, drug toxic side effects are obvious, more liver, kidney, blood damage, some people will listen to the change, avoid it, do not dare to use drugs, do not strictly follow the doctor’s instructions, private stop medication change.
The Chinese herbal medicine in general, non-toxic and harmless. In fact, although a number of rheumatism patients in China are currently taking Chinese medicine treatment, and achieved better results, but in the diagnosis and treatment of Western medicine is still dominant.
This is because rheumatism is a disease named after Western medicine, the diagnosis and treatment standards are formulated by Western medicine, Western medicine in the diagnosis and treatment of more targeted. Although Chinese medicine has advantages in the identification of evidence but in the identification of disease is slightly inferior, the traditional four diagnosis methods of looking, smelling, asking and cutting can not replace the laboratory laboratory indicators.
In the early, acute stage of most rheumatic diseases, in order to control the disease as soon as possible and slow down the damage to joints and organs, Western medicine should be the main focus, standardized medication, stable disease and laboratory indicators are basically normal, can be supplemented by Chinese medicine adjustment, long-term use of Chinese medicine can consolidate the efficacy and prevent the relapse of the disease.
Myth No. 4: Joint pain + high anti-O = rheumatoid arthritis
People have long been accustomed to the concept that high anti-O means streptococcal infection, and streptococcal infection can lead to arthritis. Therefore, whenever there is joint pain, especially in young people, they will remember to go to the hospital to check the anti-O, and if they find a high level, they will conclude that they have rheumatoid arthritis and rush to the doctor or buy their own medicine to treat it.
In fact, at present, rheumatoid arthritis is an outdated and controversial term. In the past, when the standard of living was low, there were many opportunities for streptococcal infections, and medical conditions were poor, the incidence of rheumatic fever was high, and combined arthritis was common, so rheumatoid arthritis was used in medicine to refer specifically to arthritis associated with rheumatic fever.
Nowadays, the incidence of rheumatic fever is very rare, and people tend to take the term literally, calling all joint pains and aches caused by cold, wind chill, freezing and humidity as rheumatoid arthritis, while joint pains may be spondyloarthropathies, rheumatoid arthritis, systemic lupus erythematosus, dry syndrome, or even osteoarthritis and ligament damage. Therefore, this term is seriously misunderstood and ambiguous between doctors and the general public, causing a certain degree of confusion, which is not conducive to doctor-patient communication.
Therefore, some experts recommend abandoning it. Anti-O is essentially an antibody, which is produced by the body to fight against the streptococcal O antigen. It is elevated in two ways, first, by a significant increase in titer measurement, indicating a possible recent streptococcal infection, commonly in the respiratory tract, skin mucosa, and soft tissues. In a few people, this can lead to arthritis and nephritis, which is generally called reactive arthritis.
In another case, the titer is higher than normal, but the titer is not high, which means that the streptococcus infection has been infected before and not thoroughly treated, or there is a hidden focal point of infection in the body chronic stimulation of the body, the body retains a small amount of antibodies. In general, low titers of anti-O do not cause damage to the body, and, some normal elderly people and tumor patients will have high anti-O. Therefore, high anti-O is not terrible, and should be actively sought for its cause and treated correctly; joint pain does not mean rheumatoid arthritis, and should be analyzed specifically to find the root cause.
Myth No. 5: Joint pain + high rheumatoid factor = rheumatoid arthritis or positive rheumatoid factor = rheumatoid arthritis
For the general public, rheumatoid arthritis is the most familiar rheumatic disease, rheumatoid factor is the most familiar laboratory indicators, the general doctors are referred to as RF, joint pain, will think of going to the laboratory three samples; blood sedimentation, anti-O, rheumatoid factor.
If you see a positive rheumatoid factor, you will think you have rheumatoid arthritis. In fact, this is very wrong due to the misunderstanding of rheumatoid factor. RF is essentially an autoantibody, produced by lymphocytes, which binds to autoimmunoglobulin and participates in the formation of immune complexes. It has a positive rate of about 80% in rheumatoid arthritis, and is an important diagnostic reference, but not a specific diagnostic criterion, because 5% of normal elderly people can be positive, and the positive rate can increase with age, and the positive rate can be more than 20% in elderly people over 75 years old.
And in other immune diseases such as systemic lupus erythematosus, dry syndrome, systemic sclerosis, myositis, mixed connective tissue, IgA nephropathy, RF positive rate can be 5% to 90%, in some common diseases such as infection, liver disease, interstitial lung fibrosis, tuberculosis, etc. RF can be positive or detection titer increased. Therefore, RF high does not mean rheumatoid arthritis, must be objective analysis, it is best to consult a professional doctor.
Myth #6: Women don’t get ankylosing spondylitis
For most of us, this seems to be an ironclad rule, and even when we want to give an example of the relationship between the occurrence of disease and gender, we tend to come up with this example, saying that ankylosing spondylitis is predominantly male, with a male to female ratio of about 8 to 9:1.
Indeed, traditional, classic textbooks and medical readings emphasize that women have a very low chance and likelihood of getting ankylosing spondylitis, so doctors are often accustomed to excluding ankylosing spondylitis when young women suffer from joint pain and low back pain.
However, in the past 20 years, with the development of rheumatism, rheumatologists found that women with ankylosing spondylitis is not uncommon, the ratio of male to female incidence of about 4 to 5:1, in recent years, rheumatologists in Europe and the United States even proposed that there is no significant difference between the incidence of men and women, they found that many chronic arthralgia, lumbosacral pain most female patients can be classified as spondyloarthropathy, which is not uncommon in patients with ankylosing spondylitis, given slow-acting The drugs have a significant effect.
However, female patients have a later onset and milder symptoms, and the prognosis is generally better. If not treated in a timely manner, it can also affect the workforce and even cause disability. Therefore, we should change old concepts and establish new thinking to avoid misdiagnosis caused by this.