I. What is rheumatism In the daily outpatient work of doctors, we often hear the majority of patients mention “stomach disease”, “heart disease”, “lung disease”, “brain disease” and other words. “They often think rheumatism is a single disease. So is the “rheumatism” mentioned by the patients a single disease or not, and if so, what kind of disease is it? We say that the “rheumatism” mentioned by the patient is actually the same as “stomach disease”, “heart disease”, “lung disease” and “brain disease”. The concept of “brain disease” is similar to that of “stomach disease”, “heart disease”, “lung disease” and “brain disease”, and is a general term used by patients for a large group of diseases. The term “brain disease” refers to diseases of the nervous system. However, “rheumatism” does not refer to a specific system disease, but is a general term for a group of diseases in which patients have joint and muscle pain, fear of cold and wind as the main symptoms. What is the definition of rheumatism in modern medicine? Modern medicine considers rheumatism to be a large group of diseases with different causes, complex clinical symptoms and a wide range of diseases. In general, rheumatism is the general term for a large group of diseases with bone, joint, muscle, ligament, bursa and fascia pain as the main clinical manifestations, including more than 100 kinds of diseases, among which the most common rheumatism are rheumatoid arthritis, osteoarthritis (with osteophytes as the main lesion, such as cervical spondylosis, lumbar spondylosis, etc.), gouty arthritis, ankylosing spondylitis, systemic lupus erythematosus, dry syndrome Scleroderma, dermatomyositis, fibromyalgia syndrome, rheumatic polymyalgia, etc. It can be seen that rheumatism is the collective name of a large group of diseases, which all have different degrees of joint muscle pain and other clinical manifestations. So is it that as long as the joint muscle pain is suffering from rheumatism, to go to the rheumatology department for consultation? Second, the common symptoms of rheumatic diseases 1, joint pain Joint pain is one of the most common symptoms of rheumatic diseases, almost all rheumatic diseases are accompanied by joint pain to varying degrees, and almost all joints in the body can be involved. However, various rheumatic diseases appear joint pain has its different degree of characteristics and preferred location, need to further differentiate. For example, pain in the wrist and hand joints and knee joints is the main manifestation of rheumatoid arthritis, osteoarthritis and other diseases. Rheumatoid arthritis mainly affects the proximal interphalangeal joints, metacarpophalangeal joints, wrist joints and knee joints of both hands, and is mostly symmetrical and persistent pain, which may be accompanied by joint redness and swelling, morning stiffness of more than 1 hour, and other accompanying symptoms. The pain may be symmetrical and can be relieved after rest. If the main manifestation is pain in the back and neck joints, it can be seen in osteoarthritis, ankylosing spondylitis and other diseases. If cervical spine pain is the main manifestation, accompanied by cervical flexion and extension restrictions, unilateral upper limb radiating pain or numbness, or even dizziness when rotating the head and neck, you should be alert to the possibility of cervical spondylosis, which belongs to the category of osteoarthritis. If the onset of lumbar back pain is mainly in middle-aged and elderly people over 50 years old, with a long course of disease, lumbar pain, restricted flexion and extension, unilateral lower limb radiating pain or numbness, aggravated by prolonged standing and sitting, consider lumbar degeneration, lumbar disc herniation, lumbar spinal stenosis and other diseases, which belong to the category of osteoarthritis. If a young man has long-lasting low back or even coccyx pain with limited flexion and extension, morning stiffness, etc., and has a family history of genetic predisposition, he needs to be alert to the possibility of ankylosing spondylitis. If a young man has sudden onset of severe pain in the back of the foot and toe joints at night, with redness and swelling, limited flexion and extension, affecting walking, and a history of eating a diet high in purines such as lamb, seafood, animal offal and beer before the attack, consider the possibility of a gouty arthritis attack. In addition, shoulder joint pain can be seen in frozen shoulder (osteoarthritis), rheumatoid arthritis; heel pain can be seen in osteoarthritis, osteoporosis, etc. 2, muscle pain Muscle pain is also one of the most common symptoms of rheumatic diseases, almost all muscle groups in the body can be involved, but various rheumatic diseases also have their different degree of muscle pain characteristics and the preferred location, need to further differentiate. If symmetrical soreness and stiffness of the proximal muscles of the neck, back, scapula and pelvic girdle predominate, leading to difficulty in walking, getting up, dressing and combing hair, generally without muscle weakness and muscle atrophy, and the onset is above 50 years old, the diagnosis of rheumatic polymyalgia should be considered. If the painful stiffness of widely distributed skeletal muscles throughout the body is accompanied by multiple symmetrical widely distributed pressure points, and the onset is in women aged 20-45, they may suffer from fibromyalgia syndrome, and emotional abnormalities, cold, fatigue and other triggers can often trigger or aggravate the symptoms, while the patient is accompanied by more severe sleep disorders. Patients who have proximal myalgia with tenderness, with proximal muscle weakness, symmetrical weakness of limb girdle muscles and anterior cervical flexors, and also dysphagia or ventilator weakness need to be alerted to the possibility of dermatomyositis. In addition, systemic lupus erythematosus and polyarteritis nodosa can also appear myalgia, and the latter is mainly diffuse myalgia, accompanied by lesions such as reticulocutaneous cyanosis. Raynaud’s phenomenon Raynaud’s phenomenon is a paroxysmal ischemia of the finger or toe end, manifested by cold stimulation, such as contact with cold water, cold air, etc., the finger or toe end first pale, followed by cyanosis, red, may be accompanied by pain, lasting for several minutes or hours, can return to normal on its own. Some rheumatic diseases can be secondary to Raynaud’s phenomenon, more common are systemic sclerosis. Raynaud’s phenomenon is mostly the first symptom of the disease, and can be accompanied by numbness of both hands, symmetrical finger swelling or stiffness. In addition, patients with systemic lupus erythematosus also have Raynaud’s phenomenon. 4, skin and mucous membrane manifestations rheumatic diseases often involve multiple systems, skin and mucous membrane tissue can often also appear rheumatic diseases more specific lesions. For example, patients with leukoaraiosis with recurrent oral mucosal ulcers, genital mucosal ulcers as a typical manifestation, but also with the lower extremities of light red nodular erythema. Patients with dermatomyositis have characteristic rashes, i.e., the sunward rash, which refers to edematous dark purple spots on the upper eyelids that can spread to the cheeks, neck, forehead and exposed areas, and the Gordon’s sign, which is mainly a purplish-red rash located on the extensor surface of the interphalangeal joints, slightly above the skin surface. In patients with SLE, limited discoid erythema, dark red, round or irregular in shape, can be seen on the cheeks, auricles, scalp, etc. Patients with systemic sclerosis can see hard and swollen skin on both upper extremities with roughness and decreased elasticity, which can spread to the face, neck and lower extremities, with manifestations such as mask face and hooked nose. Patients with rheumatoid arthritis may have rheumatoid nodules, which can be several centimeters in diameter, palpable under the skin or out of the tendon sheaths in the elbows, heels, scapular area, and hands. Patients with psoriatic arthritis can be clearly visible psoriatic rash performance. 5, fever rheumatic disease is an autoimmune disease, the body’s intense immune response can lead to fever, so fever is a lot of rheumatic disease can appear symptoms, in some diseases fever is even the first symptom. Fever in rheumatic diseases is mainly low to medium fever, but high fever can also be seen, usually excluding fever caused by infectious factors. In young women, fever of unknown origin is the first symptom, and if it is accompanied by joint and muscle pain, rash, erythema and multisystem damage, it is necessary to be alert to the possibility of SLE. If there is a transient rash, joint pain, lymph node enlargement, and hepatosplenomegaly, the patient should be alerted to the possibility of adult Still’s disease. In addition, low to moderate fever can be seen in the acute phase of rheumatoid arthritis and fever can be seen in the acute phase of gouty arthritis. Once the above common symptoms of rheumatic diseases are present, and other systemic diseases are excluded, further consultation with the rheumatology department is required.