Rheumatology includes hundreds of diseases, and those with high incidence include rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, desiccation syndrome, polymyositis/dermatomyositis, systemic sclerosis, mixed connective tissue disease, and vasculitis. The prognosis and regression of various diseases vary greatly depending on their pathogenesis.
I. Rheumatoid arthritis
What will happen if you have rheumatoid arthritis? Does it require long-term medication and what are the most serious consequences? The course of rheumatoid arthritis is variable, with some patients progressing toward severe disease; others are able to remit naturally; and most patients have recurrent episodes of progressive disease. There is individual variability in the prognosis of rheumatoid arthritis. A large number of statistics show that the prognosis of patients with rheumatoid arthritis is roughly as follows: 15% to 20% of patients have an attack and then remit for at least one year or no longer; another 10% to 15% of patients have rapidly progressing disease, with destruction and deformity occurring within two years, and according to foreign statistics, complete loss of labor force within a few years of onset is about 10%. The remaining 70% of patients have recurrent, periodic episodes of polyarthritis, and with reasonable treatment, the inflammation can be gradually reduced.
There are several factors that affect the prognosis as follows.
1, female patients generally have a poorer prognosis than male patients.
2. Older patients are worse than younger patients.
3. Acute onset is worse.
4.Patients with symmetrical, multi-joint invasion are worse.
5. Poor prognosis in patients with early polyarticular effusion.
6.Patients with systemic symptoms are worse.
7.Patients with early rheumatoid nodules are poor.
8.Poor with extra-articular lesions, such as rheumatoid vasculitis and neuropathy.
9, early bone erosion is poor.
10.Poor early rheumatoid factor titer increase.
11.Poor for those who delay treatment.
12.Poor for those with persistent increased blood sedimentation, high C-reactive protein, and increased blood eosinophils.
13, early hormone therapy (short-term) symptoms
Second, ankylosing spondylitis
Ankylosing spondylitis is more common in men, the age of onset is younger, often mistaken for “lumbar strain”, many patients seeking treatment can not be diagnosed, delaying treatment. The name ankylosing spondylitis literally leads to two misconceptions: on the one hand, the overly optimistic belief that the disease only affects the spinal joints and does not cause damage to the heart, lungs, and other important organs; on the other hand, the pessimistic belief that the disease will inevitably lead to the end of spinal ankylosis. Under the influence of these two attitudes, the patient is bound to believe that there is no need for treatment and that there is no difference between treatment and no treatment, thus delaying treatment and causing irreversible consequences.
Now, a large amount of clinical data has proved that in addition to spine and joint involvement, ankylosing spondylitis can have heart, lung, eye, kidney and nervous system damage, although the incidence is very low, but the serious condition of the heart and kidney failure can occur.
The development of ankylosing spondylitis does not always develop into spinal ankylosis, especially with the improvement of modern medical care, so that doctors can diagnose and treat the disease early, thus playing a – certain role in delaying and postponing the development of the disease, greatly reducing the occurrence of spinal ankylosis. Therefore, patients suffering from ankylosing spondylitis should pay enough attention to the disease, full of confidence, under the guidance of doctors long-term medication, some patients are in remission, self-medication, often leading to aggravation of the disease.
Systemic lupus erythematosus
In the 1950s before hormones were used to treat SLE, the 5-year survival rate of SLE was 5%, i.e. 95% of patients survived for less than 5 years. Of course, the length of survival in SLE is related to early diagnosis and early treatment. With the development of medical immunology in the last 40 years, early diagnosis of this autoimmune disease can be made by means of some immunological tests, such as the aforementioned tests for various specific antibodies, and many patients are diagnosed before visceral damage. Only after an early and correct diagnosis is early treatment possible, which is the key to a good or bad prognosis. If the diagnosis is not made until there is severe damage to important organs throughout the body or even a decline in function, then no matter how vigorous the treatment measures are, they often do not help. Secondly, after the diagnosis, proper and reasonable treatment is necessary.
When to use hormones? What is the appropriate dose of hormones? This is also a factor that directly affects the prognosis. Hormones and immunosuppressants must be used under the guidance of a specialist, in order to maximize the effectiveness of the drugs and not to cause adverse reactions, which requires close cooperation from the patient and regular review at the hospital. The prognosis also depends on the attitude towards the disease. Some people are pessimistic and disappointed since the disease, some are full of care, some are reluctant to take hormones, some are biased and look for “secret remedies”, all these are extremely unfavorable to the treatment of the disease. At present, the five-year survival rate of SLE in China is more than 85%, and the good or bad prognosis is closely related to the patient’s compliance.
The main cause of death in SLE is infection, followed by renal failure. Infections often occur when hormones and immunosuppressants are not used correctly during recurrent disease episodes, leading to viral, bacterial, and mycobacterial infections. In the advanced stages of the disease, due to various contradictions in treatment, death often occurs due to multi-organ failure. The occurrence of renal failure and uremia is a serious complication of SLE and is the second cause of death from SLE. However, with the development of modern science, hemodialysis and kidney transplantation can be performed to save patients’ lives.
Factors that commonly affect the prognosis of lupus include.
1. Early diagnosis is the key to good or bad prognosis. If the diagnosis is not confirmed until the important organs of the whole body are severely damaged or even their functions are reduced, then no matter how strong the treatment measures are, they often do not help.
2. Early correct and reasonable treatment is the key to good or bad prognosis of lupus, such as correct selection of hormones, including the time, dose and method of drug administration. The application of immunosuppressants has greatly improved the prognosis of lupus, especially for lupus nephritis.
The presence or absence of large amounts of proteinuria, pathological changes in renal biopsy, renal function and response to treatment all have an impact on the prognosis of lupus.
4. Multi-system damage, such as pulmonary hypertension, pulmonary fibrosis, encephalopathy, and cardiac involvement, are also factors of poor prognosis.
5. Application of hormones and immunosuppressants. Lupus patients themselves have immune dysfunction and are prone to complications of infection, and the application of hormones and immunosuppressants makes the chance of infection greatly increase. Infection is the most common complication of lupus, so how to control infection can also affect the prognosis of lupus.
IV. Dryness syndrome
If the clinical manifestation is only dry mouth, dry eyes and other mucous membrane damage, it is generally better. Most of those with visceral damage can be relieved after proper treatment, and there are few deaths; some patients involve the lungs and cause interstitial pneumonia, and sometimes the progress is faster. Dry syndrome is easy to be complicated by malignant lymphoma, which needs high attention.
The prognosis is mainly related to the following factors.
1, timely control and treatment of severe visceral damage.
2.Prevention and active treatment of all kinds of infections.
3.Avoidance of mistreatment, failure to treat, strengthening vigilance, and striving for early diagnosis.
4.Patients cooperate with doctors and use hormones and immunosuppressants under the guidance of doctors.
V. Polymyositis/dermatomyositis (PM/DM)
The overall 5-year survival rate of PM/DM patients is about 80%. Most cases are chronic and progressive, with gradual recovery after 2 to 3 years. It is generally accepted that death from this disease is rare in those with a disease duration of more than 7 years. The majority of patients with acute attacks, such as those with significant muscle weakness, even respiratory muscle weakness, combined acute interstitial pneumonia, and severe cardiac damage, have a poor prognosis. Patients with dysphagia have a poor prognosis because they are prone to aspiration pneumonia.
The causes of death include respiratory failure due to dyspnea, intercostal muscle lesions of the diaphragm, or respiratory failure due to interstitial pneumonia, heart failure due to myocardial involvement, aspiration pneumonia due to lesions of the pharynx and upper esophagus, and death due to subarachnoid hemorrhage, and death due to malignant tumors or tumor metastases affecting important organs. In addition, death can often be caused by complications such as pneumonia, fungal meningitis, gastrointestinal bleeding due to long-term application of corticosteroids and gastrointestinal perforation. The most common causes of death are pulmonary and cardiac involvement, tumors, and infections.
Factors affecting prognosis.
The prognosis is poor in those who are older, have dysphagia, have an acute onset, and are treated late. Inclusion body myositis has a poor prognosis, DM has a better prognosis than PM, and those with overlapping SLE have a better prognosis than those with overlapping scleroderma. In terms of autoantibodies, those with anti-SRP antibodies have a poor prognosis, and those with positive anti-Mi-2 antibodies have a better prognosis than those with positive anti-JO-1 antibodies. Children generally have a better prognosis than adults.
Complicating tumors.
The percentage of concurrent tumors varies from 9% to 52%, generally after the age of 40 years, and the older the age of onset, the greater the chance of concurrent tumors. The incidence of malignant tumors far exceeds that of patients with polymyositis.
VI. Systemic sclerosis
The natural course of systemic sclerosis is highly variable, with many patients having progressive sclerosis of the fingers, flexion contracture and disability, and almost all patients eventually having visceral involvement. Those with early manifestations of kidney, heart and lung involvement suggest a poor prognosis. The 10-year survival rate after first diagnosis is 65%, and early death and disability are more common in diffuse sclerosis, while pulmonary hypertension and intestinal malabsorption are common causes of death in patients with limited sclerosis.
VII. Mixed connective tissue disease (MCTD)
Mixed connective tissue disease was initially considered to be a “good glucocorticoid response with a good prognosis”, but now, 20 years later, it is clear that this recognition needs to be re-evaluated. Currently, clear high titers of anti-U1-RNP antibodies are generally associated with a low incidence of severe renal damage, but with potentially life-threatening neurological involvement. Therefore, not all MCTD have a good prognosis. patients with MCTD may die from pulmonary hypertension and cardiac comorbidities. Pulmonary hypertension can sometimes progress rapidly, leading to death within weeks.