I. Overview
Rheumatoid arthritis is an autoimmune disease characterized by chronic progressive arthropathy and is characterized by symmetric polyarthritis. Patients may have extra-articular manifestations such as fever, anemia, subcutaneous nodules, vasculitis, pericarditis, and lymph node enlargement. Untreated rheumatoid arthritis can recur for years, eventually leading to joint deformity and loss of function.
The incidence of rheumatoid arthritis is still relatively high, about 22-60/100,000 people. Domestic survey results show that the incidence of rheumatoid arthritis in China is 0.3-1.5%. Nanjing has about 50,000 such patients. Rheumatoid arthritis can occur at any age, and the incidence increases gradually with age, with the peak incidence at the age of 40-50. The disease is more prevalent in women. The ratio of men to women is about 1:3.
1. Etiology
The true cause of rheumatoid arthritis is not clear. It is believed that the following factors are more likely to occur rheumatoid arthritis. 1, bacterial and viral infections, such as Mycobacterium avium and Mycobacterium tuberculosis, EBV and microvirus infections; 2, genetic background, the disease has the characteristics of a compound genetic disease, the chance of twins suffering from rheumatoid arthritis with 13%-27%, much higher than the incidence of rheumatoid arthritis in the general population: 3, endocrine The incidence of rheumatoid arthritis in menopausal women is significantly higher than that of men of the same age and older women. The majority of patients are significantly better after pregnancy, while the condition often worsens 1-3 months after delivery. There are also many cases of rheumatoid arthritis that occur within 3 months after delivery; 4. Other factors Cold, humidity, fatigue, trauma, smoking and mental stimulation may be related to the occurrence of rheumatoid arthritis.
2.Harm
The most direct harm of rheumatoid arthritis is the decrease of quality of life. The pain, swelling and stiffness of the joints lead to the inability to take care of themselves, and even affect sleep, the long duration of the disease, the high cost of treatment, bringing a heavy burden on the family and society, at the same time, the patient’s mental stress is also great, many patients have low self-esteem and guilt, which leads to family conflicts. Rheumatoid arthritis can also lead to osteoporosis, and the incidence of fractures should be increased accordingly. Long-term use of hormones, immunosuppressants, and anti-inflammatory drugs can bring about the side effects of some drugs. Rheumatoid arthritis does not directly cause death, but in advanced, severe or long-term bedridden patients, death can be caused by combined infections, gastrointestinal bleeding, heart and lung disorders or renal amyloidosis.
3. Prevention of rheumatoid arthritis
Since the cause of rheumatoid arthritis is unknown, there is no clear and effective prevention method. The following methods may be effective in the prevention of rheumatoid arthritis: 1, avoid long-term living and living in a cold, humid environment; 2, pay attention to the combination of work and rest, avoid overwork: 3, prevent trauma; 4, quit smoking and alcohol; 5, maintain a good psychological state, reduce mental stimulation; 6, strengthen physical exercise, improve the ability to resist disease.
Second, the performance of rheumatoid arthritis
The typical early manifestation of rheumatoid arthritis is morning stiffness, i.e., the stiffness and tightness of the joints after the patient wakes up in the morning, which can be significantly improved after the activity. Morning stiffness is one of the manifestations of many arthritis and even rheumatoid polymyalgia, but it is most prominent in rheumatoid arthritis where morning stiffness can last for more than 1h or even the whole morning and is more severe. Generally, morning stiffness is reduced after slowly moving the joints. A number of patients tend to use hot water to wash their hands to relieve morning stiffness. Morning stiffness that lasts for more than 1h is considered diagnostic for rheumatoid arthritis and also indicates the activity of the lesion.
Those with the following manifestations should be examined at a hospital to rule out rheumatoid arthritis.1. Unexplained generalized fatigue, discomfort or generalized muscle pain followed by morning stiffness, pain and swelling of the joints within a few weeks to a few months. Initially, it is mostly asymmetric, but later it manifests as symmetric arthritis. Joint swelling and pain may appear in multiple locations, one after the other. However, the symptoms of the previous joint do not completely resolve before the involvement of another joint. In prolonged cases, there may be atrophy of the muscles around the joint and muscle weakness. Some patients may have systemic manifestations such as hypothermia, fatigue and weight loss. 2. Elderly people may have symptoms such as joint swelling and pain and morning stiffness within a few days, which may be triggered by infection, trauma and cold stimulation. 3. Pain and swelling of a single joint without obvious triggers or with only minor trauma. It may last for several weeks to months, after which other joints gradually appear to be involved.
The diagnosis and treatment of rheumatoid arthritis
1. Diagnosis of rheumatoid arthritis
The common diagnostic criteria for rheumatoid arthritis are: (1) morning stiffness, lasting at least one hour: (2) arthritis, swelling or fluid accumulation in at least three groups of joints; (3) hand arthritis: (4) symmetric arthritis, i.e., symmetric arthritis on the left and right sides at the same time: (5) subcutaneous nodules: (6) positive rheumatoid factor: (7) hand and wrist x-ray showing bone erosion or osteoporosis. Items 1 to 4 above must last more than 6 weeks, and those who meet at least 4 of the 7 items above can be diagnosed with rheumatoid arthritis.
2.Treatment of rheumatoid arthritis
The treatment of rheumatoid arthritis mainly includes the following aspects: 1, drug therapy; 2, immune and biological therapy; 3, physical therapy; 4, functional exercise; 5, traditional Chinese medicine; 6, surgical treatment. For patients with rheumatoid arthritis whose medical treatment is ineffective and who have severe joint dysfunction, surgery is an effective treatment, which can reduce pain, swelling and other symptoms, delay the development of the disease, protect the function of the joints as much as possible, and correct deformities.
There are four types of surgical treatment for rheumatoid arthritis: 1. Synovectomy. The best time for synovectomy is early in the course of rheumatoid arthritis, when the lesion is confined to the synovial area and the hyaline cartilage and meniscal fibrocartilage of the joint surface have not yet been damaged. Synovectomy is feasible for those whose internal treatment is ineffective or not obvious. Early synovectomy is effective in stopping the development of local inflammation, effectively relieving pain, improving joint function, preventing spontaneous rupture of tendons and nerve compression, delaying the disease process and joint destruction, and reducing the degree of involvement of other organs in the body, but the long-term effects are still controversial. 2.Orthopaedic surgery. Most deformities of the hand can be corrected by orthopedic surgery, such as Newton’s hole deformity, which can be corrected by surgery to make the tendons balanced. Rheumatoid foot disease requires surgery for most forefoot deformities and lesions, such as bunion, metatarsophalangeal joint dislocation with claw toe deformity, etc., forefoot orthopedics is feasible. Osteotomy is feasible for the correction of internal and external knee deformities. For early rheumatoid arthritis of the hip joint, proximal femoral osteotomy and acetabular osteotomy orthopedics are feasible. 3. Artificial joint replacement. The development of artificial joint replacement technology has given hope to some rheumatoid arthritis patients with severe joint destruction in the late stage, and some long-term bedridden patients, through surgery, have regained standing and walking functions, partially or completely restored the ability to take care of themselves. It is now widely used at home and abroad as a mature treatment method. Hip replacement is very effective, and the long-term outcome of hip replacement for patients with rheumatoid arthritis seems to be similar to that of osteoarthritis, with a general 10-year excellent rate of about 90%. The effect of knee replacement is similar to that of hip replacement. Ankle arthroplasty is not widely performed, and prosthetic loosening develops rapidly. Although patients are generally satisfied with pain relief and functional improvement after surgery, this procedure should be used with caution. Metacarpophalangeal and metatarsophalangeal joint replacements are still more commonly used with silicone prostheses and have more definite results. The elbow, wrist, and shoulder joints are non-weight-bearing joints, and most patients do not necessarily require arthroplasty through synovectomy or other orthopedic surgery, as well as compensatory motion between other joints. In recent years, with the advent of joint surface replacement and new prostheses, the number of elbow joint replacement surgeries and postoperative outcomes have improved significantly.4. Joint fixation. Ankle and interphalangeal joints, wrist joints and other small joints can be fixed. In the last resort, joint fixation can not be used casually, but it can help us to deal with many difficult problems, so the choice of indications must be strictly controlled.
3.The treatment of young rheumatoid arthritis patients
This is a special problem in front of orthopaedic surgeons all over the world. Because of the late development of rheumatoid arthritis surgical treatment in China, there are still a considerable number of younger patients who have not received reasonable treatment. Many patients are accompanied by severe joint deformities and dysfunctions, the severity of which is hardly seen in developed countries. In juvenile rheumatoid arthritis patients, if the epiphysis is immature, it is better to wait until the epiphysis is closed and the bones become thicker, and the patient can better cooperate with postoperative rehabilitation before surgery, which is more effective. If soft tissue release, osteotomy and synovectomy can solve the problem, artificial joint replacement should be avoided as much as possible. If the patient has access to a custom-made prosthesis, the benefits of prosthetic arthroplasty for young arthritis patients will far outweigh the dangers of potential complications. In addition to improving function and correcting deformities, the greatest benefit is that it allows these patients to attend school, be employed, and marry at the same age as their peers during the prime of life, improving quality of life and making life more rewarding.