Rheumatology and Immunology Rheumatologic diseases are a group of difficult diseases with complex clinical manifestations that involve all systems of the body, including the eyes and otorhinolaryngology. The specialty of our rheumatology department is rheumatic eye disease and otorhinolaryngological disease. The most common eye diseases related to this include: uveitis, iritis, retinal vasculitis, ischemia, optic neuritis, sclerositis, keratitis, dry eye, etc.; rheumatic diseases related to this include: ankylosing spondylitis, leukoarthrosis, dry syndrome, systemic small vessel vasculitis, rheumatoid arthritis, systemic lupus erythematosus, aortitis, temporal arteritis, etc.. Related otolaryngological diseases include: ulcers in the throat, hoarseness, dry cough, tracheal stenosis, ear redness, nasal congestion, nasal bridge pain, deformation, hearing loss; related rheumatic diseases are mostly seen in: recurrent polychondritis, Wey’s granulomatosis, leukoaraiosis several various vasculitis diseases, etc.; II. Leukoaraiosis Leukoaraiosis is common in young people and is characterized by recurrent oral ulcers, pubic ulcers, various skin rashes and ocular involvement. The ocular manifestations of the disease are varied, with uveitis being the most common, and in severe cases, bilateral total uveitis, as well as optic neuritis and scleritis. It can also involve the nerves and gastrointestinal tract; another characteristic of the disease is that it is recurrent. Sometimes, when the ocular manifestations appear, the posterior chamber ulcers are instead alleviated; therefore, they are easily overlooked. Recurrent attacks of uveitis and optic neuritis will lead to blindness. For treatment, in addition to local treatment of ophthalmology, it is more important to provide systemic treatment to prevent recurrence. Third, ankylosing spondylitis Ankylosing spondylitis is common in young people and is characterized by low back pain, lower extremity pain, and heel pain, which is heavier in the morning and can be relieved after activity. The most common manifestation of the disease involving the eyes is iridocyclitis, but there can also be optic neuritis, retinitis, and sclerenitis. The disease is mostly acute and although it may improve in 1 to 2 weeks, repeated attacks will lead to a variety of ocular sequelae, with iridocyclitis being one manifestation of the disease. Sometimes, the ocular symptoms are obvious while the systemic manifestations are hidden, and Ying and enough to exclude. Treatment should be systemic and systematic to prevent recurrent eye disease. Fourth, recurrent polychondritis Recurrent polychondritis is a systemic disease, mostly involving the eyes, nose, ears, throat, hearing, etc. It can be seen as red, swollen and painful nose, collapsed deformity, red, swollen and painful ears, narrow trachea, breathing difficulties, red eyes (conjunctivitis, sclerositis, scleritis), etc. There can also be arthralgia, etc. The disease is rare, but delayed diagnosis is more frequent. Once the diagnosis is clear, the disease is mostly seen in severe ears losing the best time for treatment. In addition, it can be life-threatening due to tracheal collapse, difficulty in breathing and hoarseness caused by tracheal involvement. Once the trachea is involved, its lesions are difficult to reverse with drugs. Therefore, this disease should be treated actively. V. Granulomatosis Welch The disease is an inflammatory disease of blood vessels, mainly involving the upper and lower respiratory tracts and kidneys, manifesting as nasal polyps and sinusitis, lung shadows, fibrosis, dyspnea, kalemia, proteinuria, renal insufficiency, hypertension, and swelling of the lower limbs. The disease can also involve the eye and may manifest as sclerositis, proptosis, and corneal ulceration. Pathological biopsy of the involved area and laboratory tests for ANCA (+) are important for diagnosis. The disease is sometimes severe, and mortality is high with delayed treatment. Appropriate aggressive treatment can protect organ function and improve prognosis. Dry syndrome This disease is a kind of ductal epithelial inflammatory disease, common in middle-aged and elderly people, mainly manifested as dry mouth (dry food needs water), dry eyes, optic neuritis, blackened teeth, lamellar loss, parotid enlargement, etc. In serious cases, there may be hepatitis, renal tubular lesions, pulmonary fibrosis and masses, shadows, etc. Laboratory tests may show SSA (+), SSB (+), ANA (+), and RF (+). The disease is easily associated with lymphoma. The diagnosis of the disease requires the cooperation of ophthalmology, dentistry and rheumatology. Treatment should also take into account the systemic situation and systemic treatment. Rheumatoid arthritis This disease is a synovitis of small joints. Its arthritis is characterized by symmetry, small joints, mainly finger joints; the disease can involve the whole body, including: lungs, kidneys, nerves, skin, etc. The test RF (+) is of diagnostic importance. The greatest danger of the disease is the deformity of the joints, resulting in lifelong disability. The disease can involve the eyes and manifest as dry ophthalmia; it can also involve the sclera and cornea. Aggressive anti-rheumatic treatment can stop the progression of the disease and alleviate the ocular changes. Without systematic treatment, surgery of the cornea is difficult to succeed. Systemic lupus erythematosus is a typical immune disease with multi-organ damage, multiple auto-antibodies, and aggressive disease. Ocular manifestations include fundus hemorrhage, retinal vasculitis and optic neuritis. Clinical manifestations include skin lesions, neurological diseases, pleural effusion, pericardial effusion, blood changes, and renal changes; laboratory tests include ANA (+), ds-DNA (+), decreased complement, and anti-cardiolipin antibodies (+). Some patients are critically ill, which can lead to death. The treatment of the disease mainly relies on hormones, and as the systemic disease improves, the eye disease improves with it. IX. Temporal arteritis and rheumatic polymyalgia This is a common disease in the elderly and is more common in women. It is characterized by a new migraine or a change in the nature of a previous headache and may be accompanied by a transient loss of vision, which is a precursor to imminent permanent blindness of the eye. It should be treated aggressively and with urgency. The disease may also be characterized by generalized muscle pain, chewing pain, anguish of the temporal vessels in the head, scalp tenderness, and fever. Significant increase in blood sedimentation and CRP is a characteristic feature. Timely and adequate dose of hormone therapy is the key to success. X. Systemic vasculitis Vasculitis is a general term for a group of diseases that involve large and small vessels. Both arteries and veins can be involved. The pathology is characterized by inflammatory changes in the small vessels at the site of involvement, which can result in thickening, narrowing, occlusion of the vessel wall, as well as destruction of the vessel wall and bleeding. The clinical manifestations are site-specific. Cutaneous vasculitis is the most easily detected and manifests as various rashes, ulcers, blackening, necrosis, florid spots, Raynaud’s phenomenon, intermittent claudication, etc. Visceral vasculitis may manifest as pain, infarction or bleeding, such as heart attack, cerebrovascular disease, hemiplegia, limb numbness, etc. It should be actively treated to prevent the lesion from continuing to worsen. XI. Myositis and dermatomyositis These diseases are lesions of skeletal muscles caused by autoimmune abnormalities, which manifest as pain and weakness of the muscles of the limbs, and when the muscles of the pharynx are involved, they manifest as hoarseness and difficulty in swallowing. There may also be involvement of the heart muscle and smooth muscle (gastrointestinal tract). Laboratory tests: myoenzymes are increased and abnormal muscle changes are seen on electromyography. A rash appearing on the extensor side of the joints and a purplish rash on the upper eyelids are diagnostic. Pulmonary lesions may manifest as interstitial lung lesions and fibrosis. This disease requires exclusion of neoplastic diseases and long-term and systematic treatment. XII. Abnormalities of tests related to rheumatic diseases Blood: leukopenia, anemia, thrombocytopenia; Urine: proteinuria, hematuria, tubular urine, low specific gravity urine, leukocyturia; Serum: increased ESR, increased CRP, decreased complement, increased immunoglobulin, increased uric acid, abnormal liver and kidney function, etc.; Antibodies: ANA, anti-ds-DNA, anti-ENA RF, CCP, AKA, APF, ACL, HLA-B27, ANCA, TgAb, TmAb; Imaging: pericardial effusion, pleural effusion, interstitial lung lesions, vascular stenosis, joint destruction, osteoporosis and hyperplasia, etc.; Summary: No matter what clinical signs and symptoms appear, as long as more than 2 sites or organs are involved, do not Forget —- this may be the result of rheumatic immune disease. A positive test for autoantibodies is likely to be a rheumatic immune disease. The eye, otorhinolaryngology and throat symptoms associated with this are rheumatic eye disease and rheumatic otorhinolaryngology disease.