People mainly understand “rheumatism” as a type of disease related to wind, cold, humid weather and geographical environmental factors. For doctors, rheumatism is a general term for diseases that mainly affect joints, muscles, bones and soft tissues around joints, such as tendons, ligaments, bursae, fascia and other parts. Rheumatology is one of the main subspecialties of clinical medicine. Currently, rheumatology contains more than 200 diseases, and common diseases include rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, dry syndrome, leukoarthrosis, systemic sclerosis, dermatomyositis, osteoarthritis, gout and systemic vasculitis. With the advancement of technology and increased awareness, rheumatic diseases have become more common. However, because most rheumatic diseases can affect the whole body, including the brain, heart, lungs, kidneys, blood system and other important organ lesions, serious life-threatening, some patients do not have timely and regular diagnosis and treatment, often the condition is more serious before going to the rheumatology department, when the condition is irreversible, resulting in serious consequences. So, when what happens should you go to the rheumatology department? Xuanwu Hospital of Capital Medical University Rheumatology and Immunology Department Li Xuemei (1) joint swelling and pain and deformation: most rheumatic immune diseases have joint symptoms, mainly swelling or pain, which can be accompanied by red and hot skin around the joints for a long or short period of time. For example, rheumatoid arthritis should be considered for symmetrical small joint swelling and pain in both hands; osteoarthritis should be considered for bony enlargement, deformation and knee swelling and pain in both hands; sudden redness, swelling and hot pain in the metatarsophalangeal joint of the first thumb of the foot often suggest gout; rheumatoid arthritis should be considered for wandering pain in large joints throughout the body. (2) Morning stiffness refers to a feeling of adhesion in the joints, back and soft tissues after waking up in the morning, which can be reduced after activity. In rheumatoid arthritis, morning stiffness can last for more than one hour, while in other diseases, the duration of morning stiffness is relatively short. (3) Skin and mucous membrane symptoms: unexplained rash, skin irritation after sun exposure, oral ulcers, vulvar ulcers, skin ulcers, eye congestion, reticular cyanosis, skin nodules, erythema, etc. For example, systemic lupus erythematosus may present with a butterfly rash on the face, dermatomyositis may present with a V-shaped rash on the forehead and a shawl rash, and recurrent mouth ulcers are commonly associated with systemic lupus erythematosus. Sun allergic dermatitis can be a manifestation of lupus erythematosus, but also seen in undifferentiated connective tissue disease, mixed connective tissue disease, etc. (4). Unexplained fever: Unexplained prolonged fever is a major problem in internal medicine, and the longest clinical causes are infections, tumors, and rheumatic diseases. If conventional anti-infection treatment is ineffective, especially if antibiotic treatment is ineffective and there are no obvious signs of tumor, we must pay attention to the possibility of rheumatic immune disease. The active phase of rheumatic diseases can all appear fever, low fever is common, such as rheumatic fever, reactive arthritis, while adult Steele’s disease shows high fever is common, can also alternate between high fever and low fever or no fever. (5) Raynaud’s phenomenon: Raynaud’s phenomenon is the appearance of hands or feet turn white and then purple when cold or mood change, and turn red after warmth or mood stability, and finally turn to normal color. It is most common in scleroderma, mixed connective tissue disease, systemic lupus erythematosus, various vasculitis, etc. (6) Dry mouth and dry eyes manifestation: Dry mouth mainly manifests as little saliva, the need to drink water several times a day, red tongue with little moss, and in severe cases, tooth loss. Dry eyes are mainly manifested as dry eyes, with the feeling of entering sand, and need to order eye drops several times a day to relieve the symptoms of dry eyes. Dry skin is manifested as less sweating, skin flaking, itching, etc. A common rheumatic disease is dryness syndrome. (7) Myalgia and muscle weakness: If there is pain and weakness in the muscles of the limbs, difficulty in standing up after squatting, difficulty in raising the arms, etc., or accompanied by purple around the eyes, rash on the front chest and back. Blood sampling for liver function aminotransferases, elevated muscle enzymes, etc., suggest dermatomyositis, polymyositis, metabolic myopathy and tumor-related myopathy, etc. (8) Low back pain and alternating hip pain: The main feature is that rest is aggravated, especially low back pain is common in the latter half of the night, which can affect sleep, alleviated after activity, stiffness when getting up, sometimes accompanied by knee, ankle, heel swelling and pain, spinal arthritis, especially ankylosing spondylitis, should be excluded. (9) Multi-system or multi-organ problems: mainly manifested as, heart, liver, kidney, lung, brain, hematological system, skin and joints and other multi-system damage, the longest seen in systemic lupus erythematosus, systemic vasculitis, systemic sclerosis, etc. (10) Others: such as myocardial infarction, cerebral infarction, epileptic seizures in young people; recurrent unexplained spontaneous abortion for more than 2 times; recurrent auricular and nose redness and pain; recurrent purulent or bloody nasal discharge with asthma; recurrent finger and toe salami-like changes; hard, swollen and tight skin with reduced texture; generalized pain with insomnia and cold and fearful limbs. In addition, these test abnormalities also require consultation with the rheumatology department: unexplained decrease in white blood cells or red blood cells or platelets, urine protein or urine occult blood, increased uric acid, inconsistent blood pressure in both arms, decreased or absent pulse, interstitial lung lesions, enlarged liver, spleen and lymph nodes, and unexplained abnormal liver function. In short, the manifestations of rheumatic immune diseases are diverse, and the above clinical symptoms are only some common manifestations.