Patient education and the concept of holistic and standardized treatment are emphasized.
Appropriate rest, physical therapy, body therapy, topical medications, proper joint activities and muscle exercises play an important role in relieving symptoms and improving joint function.
Drug treatment
Non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs), biological agents, glucocorticoids, botanical preparations
Non-steroidal anti-inflammatory drugs: with anti-inflammatory, analgesic, antipyretic and reduce the role of joint swelling, is the most commonly used clinical rheumatoid arthritis treatment drugs. Non-steroidal anti-inflammatory drugs have an important role in relieving patients’ joint swelling and pain and improving systemic symptoms. Improve the condition of anti-rheumatic drugs: can slow down or control the progress of the disease. Biologics: are currently the main drugs to actively and effectively control inflammation, reduce bone destruction, reduce the amount of hormones and osteoporosis. Glucocorticoids: can rapidly improve joint swelling and pain and systemic symptoms. Botanical preparations: Radix et Rhizoma and Paeoniflora totalis: effective in relieving joint swelling and pain, but there is a lack of research on whether it slows down joint destruction.
Surgical treatment
Commonly used surgeries include synovectomy, artificial joint replacement, joint fusion, and soft tissue repair.
Patients with rheumatoid arthritis whose disease cannot be controlled after active medical treatment may consider surgery to correct deformities and improve quality of life. However, surgery does not cure rheumatoid arthritis, so postoperative medication is still required.
I. Ankylosing spondylitis
Ankylosing spondylitis (AS) is a chronic, progressive disease in which inflammation of the sacroiliac joints and spinal attachment points is the main lesion. In severe cases, it can lead to complete loss of work capacity. Clinical manifestations include lumbar pain, stiffness, and discomfort most commonly, intermittent joint pain with significant stiffness, and most patients with lumbar stiffness, with morning stiffness and stiffness after sitting for a long time, which can be reduced after light activity and hot baths.
1. Etiology
The etiology of AS has not been completely clarified, but is currently believed to be related to the following factors.
(1) Genetic factors: the incidence rate of AS families is 30 times that of normal people, while the incidence rate of RA families is only 2 to 2 times that of normal people.
(1) Genetic factors: The incidence rate of AS families is 30 times higher than that of normal individuals, while the family incidence rate of RA is only 2-10 times that of normal individuals.
(2) Infectious factors: urinary tract infection or pelvic infection spreads via the lymphatic route to the sacroiliac
It can also spread to other parts of the body and cause lesions in peripheral joints, tendons and uvea.
(3) Endocrine disorders or metabolic disorders.
2. Clinical manifestations
The disease occurs in young and middle-aged people aged 16-30 years old, 90% of them are male, and it has obvious family heredity.
A joint lesions
(1) Sacroiliac arthritis: About 90% of AS patients first show sacroiliac arthritis. It manifests as recurrent low back pain, stiffness in the sacroiliac region, intermittent or alternating low back pain and pain in the buttocks on both sides, which may radiate to the thighs. The brace leg elevation test is negative, and the 4-word test may be positive
(2) Lumbar spine lesion: restricted movement of the lower back and lumbar region. Forward flexion, lateral bending and rotation of the lumbar region may be limited.
(3) Thoracic spine lesion: early manifestation is back pain, anterior and lateral chest pain, and if the thoracic rib joint, sternoclavicular joint, sternoclavicular stalk joint and cribriform cartilage joint are involved, there is girdle-like chest pain; in severe cases, the patient develops hunchback deformity, and thoracic breathing is weakened or disappears.
(4) Cervical spine lesions: a few patients first manifest cervical spondylitis, preceded by neck pain and restricted movement.
(5) Peripheral arthropathy: About half of the patients with AS have transient acute peripheral arthritis, and about 25% have permanent peripheral joint damage.
B Extra-articular manifestations
In addition, AS can invade several systems throughout the body, triggering aortic valve lesions, eye lesions, pulmonary irregular fibrosis, osteoporosis, intervertebral discitis, etc.
3.Auxiliary examination
A Laboratory tests
990% of patients are positive for human leukocyte-associated antigen (HLA-B27), but about 7%-8% of the normal population also appear positive for HLA-B27, and generally do not rely on HLA-B27 for diagnosis. Elevated platelets, anemia, increased sedimentation and elevated C-reactive protein may be due to an active AS condition. Rheumatoid factor is negative.
B Imaging
X-rays of the pelvis are positive for 5 grades suggestive of sacroiliac arthritis.
Grade I: suspicious changes;
Grade II: minor limited erosion and sclerosis of the joint;
Grade III: moderate or progressive sacroiliitis with joint erosion, sclerosis, widening of the gap or partial ankylosis;
Grade IV: severe abnormality with complete joint ankylosis and X-ray suggesting bamboo-like changes in the spine.
CT or MRI examination is more sensitive for early detection of sacroiliac joint or spinal inflammatory damage.
4.Diagnostic criteria
Internationally, the New York criteria revised in 1984 are mostly used
(1) The duration of lower back pain lasts at least 3 months, and the pain improves with activity, but does not decrease with rest;
(2) Restricted movement of the lumbar spine in the anterior-posterior and lateral flexion directions;
(3) Thoracic extension is less than the normal value for the same age and sex;
(4) Bilateral sacroiliac arthritis grade II-IV, or unilateral sacroiliac arthritis grade III-IV.
The diagnosis of ankylosing spondylitis is confirmed if the patient has (4) and any 1 of (1)-(3), respectively.
Differential diagnosis of rheumatoid arthritis (RS) and ankylosing spondylitis (AS)