Rheumatoid arthritis is a common acute or chronic inflammatory disease of the connective tissue. It can have recurrent attacks and involve the heart. It is characterized clinically by wandering joint and muscle soreness, heaviness, and pain. It is an allergic disease. It is one of the main manifestations of rheumatic fever, mostly starting with acute fever and joint pain.
The typical manifestations are mild or moderate fever, wandering polyarthritis, involving mostly large joints such as knee, ankle, shoulder, elbow, wrist, etc. It is common that the disease is transferred from one joint to another, with localized redness, swelling, burning and severe pain. In atypical patients, there is only joint pain without other inflammatory manifestations. Acute inflammation usually subsides in 2 to 4 weeks, leaving no sequelae, but it often recurs. If rheumatic activity affects the heart, myocarditis may occur and even heart valve lesions may remain.
Rheumatoid arthritis is a common acute or chronic inflammatory disease of connective tissue. It can have recurrent attacks and involve the heart. It is characterized clinically by wandering joint and muscle soreness, heaviness, and pain. It is an allergic disease. It is one of the main manifestations of rheumatic fever, mostly starting with acute fever and joint pain.
The typical manifestations are mild or moderate fever, wandering polyarthritis, involving mostly large joints such as knee, ankle, shoulder, elbow, wrist, etc. It is common that the disease is transferred from one joint to another, with localized redness, swelling, burning and severe pain. In atypical patients, there is only joint pain without other inflammatory manifestations. Acute inflammation usually subsides in 2 to 4 weeks, leaving no sequelae, but it often recurs. If rheumatic activity affects the heart, myocarditis may occur and even heart valve lesions may be left behind.
1.Etiology
The etiology of rheumatoid arthritis is not fully understood. According to the analysis of symptoms, epidemiology and immunology, it is believed that it is closely related to human hemolytic streptococcal infection, and it is now noted that viral infection is also related to the disease.
2.Clinical manifestations
(1) Pain
Joint pain is the most common symptom of rheumatism, pain may occur in joints all over the body, but pain in the limbs and trunk area and may cause lesions of internal organs and nervous system.
(2) Muscle pain
Painful symptoms may also occur in muscles, and muscle weakness, elevated muscle enzymes, and myogenic damage may also occur, such as systemic lupus erythematosus, mixed connective tissue disease, and dermatomyositis.
(3) Irregular fever
Irregular fever will appear before the appearance of rheumatism, and chills will not appear, and treatment with antibiotics is ineffective, and fast blood sedimentation will also appear.
(4) Skin and mucous membrane symptoms
Dermatomyositis, dry syndrome, leukodystrophy, and seborrhea may present with rash, oral ulcers, skin ulcers, reticular bruising, and ocular symptoms.
(5) Raynaud’s sign
Fingertips may turn white when exposed to cold or emotional changes, then turn purple, and finally turn red with numbness, pain and severe skin ulcers.
(6) Abnormal autoantibody blood indicators
Anti-ENA antibody, anti-ds-DNA antibody, anti-platelet antibody, anti-nuclear antibody, anti-cardiolipin antibody, rheumatoid factor, etc.
3.Check
(1) Elevated peripheral blood leukocyte count
The leukocyte count is elevated, and the proportion of neutrophils is also significantly increased, and some of them show leftward nuclear shift.
(2) Elevated blood sedimentation and C-reactive protein
Sedimentation and C-reactive protein are usually indicators of various inflammatory conditions. In the acute phase of rheumatoid arthritis patients, sedimentation can reach 90 mm/hour or more; C-reactive protein is also above 30 mg/L (30 μg/mL). After the acute phase (about 1 to 2 months), it gradually returns to normal.
(3) Joint fluid examination
It is often exudate, and the white blood cell count can be close to normal in mild cases, and up to 80×l09 or more in severe cases, mostly neutrophils. Bacterial culture is negative.
(4) Rheumatoid factor and anti-nuclear antibody are negative.
4.Diagnosis
It is mainly based on the history of hemolytic streptococcal infection 1 to 4 weeks before the onset, acute wandering large arthritis, often accompanied by other manifestations of rheumatic fever such as myocarditis, annular erythema, subcutaneous nodules, etc., significantly higher agglutination potency of anti-streptococcal hemolysin “0” in serum, positive pharyngeal swab culture and blood leukocytosis.
5.Differential diagnosis
(1) Rheumatoid arthritis as multiple symmetrical small arthritis of the fingers and palms and spondylitis.
(2) Migratory arthritis caused by sepsis often has signs of primary infection, positive blood and bone marrow cultures and a tendency to septic intra-articular exudate and can find the pathogenic bacteria.
(3) Tuberculous arthritis mostly involves a single joint, preferably in joints with frequent hand friction or weight bearing.
(4) Allergic arthritis of tuberculosis infection.
(5) Lymphoma and sarcoidosis.
(6) Lyme arthritis, which is an epidemic disease transmitted by ticks.
(7) Identification of gout, the incidence of gout has increased significantly, and gout is easily confused with rheumatoid arthritis in the early stages of arthritis-like arthritis.
6, complications
Rheumatoid arthritis patients during acute pain, due to prolonged bed rest, or taking hormones for too long, etc., can cause the patient’s body immune function is low, a number of complications. The common ones are as follows.
(1) Pneumonia
Pneumonia is often combined with bacterial infection due to decreased immunity.
(2) Urinary tract infection
Patients with rheumatoid arthritis are often prone to urinary tract infections if they do not pay attention to daily life or if they suffer from colds.
(3) Cushing’s syndrome
If patients use hormones for a long time, they often have Cushing’s syndrome due to the suppression of adrenal cortical function in the body. The common symptoms include full-moon face, buffalo back, weight gain, etc.
(4) Mouth ulcers
Patients with rheumatoid arthritis often develop oral ulcers after taking immunosuppressive drugs. In addition, adverse reactions such as nausea and vomiting, anorexia, skin rash and loss of taste sensation may occur.
(5) Infectious diseases
Patients are more susceptible to infection than normal people when certain infectious diseases are prevalent in the society because they have had the disease for too long and their own immune function is reduced.