It includes diffuse connective tissue diseases and diseases of joints and peri-articular soft tissues, including muscles, tendons, bursae, ligaments, etc., caused by various etiologies. The term “rheumatism” refers to chronic pain in joints, peri-articular soft tissues, muscles and bones.
In Chinese medicine, rheumatism is a disease in which the body feels wind, cold, or dampness and causes body pain or body weight, joint pain, and unfavorable flexion and extension.
The two are similar in terms of symptomatic manifestations, while Western medicine is mainly defined histologically, Chinese medicine focuses on the etiology and pathogenesis.
Diffuse connective tissue disease is referred to as connective tissue disease? It is a major category of rheumatic diseases, which in addition to having a long course and myoarticular lesions common to rheumatic diseases, also has the following characteristics: 1. It is an autoimmune disease, once called collagen disease. 2. It is based on pathological changes of chronic inflammation of blood vessels and connective tissues. 3. The lesions involve multiple systems, and there are large clinical differences among individuals. 4. It is effective in the treatment of glucocorticoids.
The current classification of rheumatic diseases mainly includes: autoimmune rheumatic diseases (such as rheumatoid arthritis), endocrine metabolic rheumatic diseases (such as gout), infectious rheumatic diseases (such as reactive arthritis), degenerative rheumatic diseases (such as osteophytic joint moxibustion) and other systemic diseases with arthritis as the main manifestation. Rheumatic diseases cover a wide range of areas and are related to almost all clinical disciplines, such as internal medicine, orthopedics, dermatology, dentistry, ophthalmology, and radiology, and are also an important part of clinical immunology.
Rheumatic diseases are most closely related to immunology in basic medicine. Nowadays, in addition to the classical methods, modern molecular biology has been widely used in the study of rheumatic diseases and their pathogenesis, and research work at the genetic level has been carried out. At present, it is believed that the etiology of many rheumatic diseases is closely related to genetics, environment and infection, which are closely related as a whole, in line with the theory of Chinese medicine’s “Heavenly Man corresponds to Heavenly Man”.
According to the different causes of this type of disease, the classification is as follows.
I. Diffuse connective tissue
(a) rheumatoid arthritis
(2) Juvenile rheumatoid arthritis (1) multi-joint onset; (2) less joint onset.
(C) lupus erythematosus (1) discoid; (2) systemic.
(D) Scleroderma
1.Localized type (1) linear; (2) patchy.
(2) systemic sclerosis (1) diffuse scleroderma; (2) CREST syndrome; (3) due to chemicals (or drugs).
(E) diffuse fasciitis with or without eosinophilia
(F) polymyositis
1, polymyositis
2, dermatomyositis
3, polymyositis or dermatomyositis associated with malignancy
4, childhood polymyositis or dermatomyositis associated with vascular disease
(G) Necrotizing vasculitis and other types of vascular lesions
1.Nodular polyarteritis
2.Allergic granuloma
3, hypersensitivity vasculitis (1) serum sickness; (2) allergic purpura; (3) mixed cryoglobulinemia; (4) associated with malignancy; (5) hypocomplementemic vasculitis
4, granulomatous arteritis (1) Wegener’s granulomatosis; (2) giant cell (temporal) arteritis with or without rheumatic polymyalgia; (3) Takayasu arteritis.
5, Kawasaki disease (also known as Kawasaki disease)
(6) Leukoaraiosis
(H) dry syndrome
1.Primary
2.Secondary Associated with another connective tissue disease.
(ix) overlap syndrome
1.Mixed connective tissue disease
(J) Other
1.Rheumatic polymyalgia
2.Recurrent lipofuscinosis
3, recurrent polychondritis
4.Erythema nodosum
Second, the arthritis complicating spondylitis (seronegative spondyloarthropathy)
(A) Ankylosing spondylitis
(B) Reiter’s syndrome
(C) psoriatic arthritis
(D) inflammatory bowel disease arthritis
III. Osteoarthritis
(a) Primary (1) peripheral (2) spinal.
(B) secondary (1) congenital (2) metabolic (3) traumatic (4) other arthropathies.
IV. Infection
(i) Directly caused by bacteria, viruses, fungi, parasites, spirochetes.
(ii) Reactive (1) Bacterial Rheumatic fever, subacute infectious neoendocarditis, after dysentery; (2) Viral; (3) After vaccine; (4) Other.
V. Metabolic and endocrine diseases
(I) Crystal-related
1.Sodium urate (gout)
2.Calcium pyrophosphate (pseudogout, chondrogenic calcinosis)
3.Alkaline calcium phosphate (apatite)
(II) Other biochemical abnormalities
1.Amyloidosis Primary and secondary.
2.Vascular disease
3, other congenital diseases Marfan syndrome, Ehlers-Danlos syndrome, osteogenesis imperfecta.
4.Endocrine diseases Diabetes mellitus, acromegaly, hyperparathyroidism, hypothyroidism.
5, immunodeficiency diseases hypogammaglobulinemia, lgA deficiency, complement deficiency.
(C) Genetic diseases
1, congenital polyarticular curvature
2.Overactivity syndrome
3.Progressive ossifying myositis
VI. Tumorigenic
(a) Primary synovial tumor, synovial sarcoma.
(B) Secondary leukemia, multiple myeloma, metastases.
VII. Neurovascular disease
(a) Neuroarthropathy
(B) neurological arthropathy
(C) Compressive neuropathy
1.Peripheral nerve compression (carpal tunnel syndrome)
2, nerve root compression
3, spinal stenosis
(D) sympathetic reflex atrophy
(E) other Raynaud’s phenomenon (disease)
VIII. Bone and cartilage lesions
(A) osteoporosis systemic, limited
(B) osteochondrosis
(C) hypertrophic osteoarthropathy
(D) diffuse primary bone hypertrophy
(E) osteoarthritis
(F) ischemic osteonecrosis
(vii) costochondritis
(H) other
Nine, non-articular rheumatic diseases
(A) periarticular lesions bursitis, tendinopathy, adhesion telangiectasia, cysts.
(B) intervertebral disc lesions
(C) primary lower back pain
(D) Other
1.Fibromyalgia, fibromyalgia
2.Psychogenic rheumatism
3. Localized pain
X. Other diseases with joint symptoms
(A) Periodic rheumatism
(B) intermittent joint effusion
(C) drug-induced rheumatic syndrome
(d) Other chronic active hepatitis, multicentric monocyte-macrophage hyperplasia, trauma, etc.
The above classification shows that some of them are secondary to diseases of more definite etiology, such as tumors, endocrine-metabolic diseases, infections, etc. The most common rheumatic diseases in internal medicine work are diffuse connective tissue disease and seronegative spondyloarthropathies.
So how are the common rheumatic diseases diagnosed? It depends on the clinical manifestations of symptoms and examination of laboratory indicators.
Commonly used test indicators and methods include the following.
(a) Autoantibodies Within the scope of rheumatic diseases, autoantibodies that should be used clinically are divided into the following four categories: antinuclear antibody spectrum, rheumatoid factor, anti-neutrophil plasma antibody, and antiphospholipid antibody. They are useful for the diagnosis of connective tissue diseases in many ways.
1. Antinuclear antibody profile. The different index parameters in this antibody spectrum are highly correlated with many different diseases.
2, rheumatoid factor Besides appearing in rheumatoid arthritis, it is also seen in other connective tissue diseases, such as systemic lupus erythematosus, dry syndrome, mixed connective tissue disease, systemic sclerosis, etc. It should be noted that the clinical diagnosis of rheumatoid arthritis does not depend only on the rheumatoid factor, but also on the diagnostic criteria, so it does not mean that a positive rheumatoid factor is diagnostic of rheumatoid. However, the rheumatoid factor titer of rheumatoid patients is related to the disease.
3. Anti-neutrophil cytoplasmic antibody (ANCA) is classified into C-ANCA (cytoplasmic type) and P-ANCA (perinuclear type) according to the pattern of fluorescence seen in normal human neutrophils as a substrate, and other respective antigens are intracytoplasmic serine protease and bone oxidase. This antibody is extremely helpful in the diagnosis of vasculitis and different ANCA antigens suggest different vasculitis, e.g. C-ANCA is mainly seen in Wegener’s granulomatosis, Churg-Strauss syndrome, P-ANCA is seen in microscopic polyarteritis nodosa , crescentic nephritis, rheumatoid arthritis, systemic lupus erythematosus, etc.
4. Antiphospholipid antibodies Clinical applications include the determination of two types of antiphospholipid antibodies and lupus anticoagulant. This antibody appears in a variety of autoimmune diseases such as systemic lupus erythematosus. Antiphospholipid syndrome refers to those with clinical manifestations of arterial or venous embolism, thrombocytopenia, habitual abortion with anti-cardiolipin antibodies and/or lupus anticoagulant, which can also be primary in addition to secondary to SLE.
(ii) Synovial fluid examination To some extent, it reflects synovial inflammation of the joint. In particular, finding urate crystals in synovial fluid or positive synovial bacterial culture can help confirm the diagnosis of gout or septic arthritis, respectively. However, they are less commonly used in clinical practice.
(iii) Joint imaging X-ray examination is useful for the diagnosis and differential diagnosis of joint lesions, as well as for the follow-up of the evolution of joint lesions. It is the most commonly used diagnostic imaging method, and there are also CT, MRI and nuclear examinations.
(iv) Pathology The pathological changes seen in biopsy, such as lupus bands for systemic lupus erythematosus, rheumatoid nodules for rheumatoid arthritis, labyrinthitis for dry syndrome, and synovial lesions for arthritis of different etiologies, all have important significance. In addition, for some unexplained rashes pathological examination can also provide the most direct and confident basis.
The diagnosis of rheumatic diseases is more complicated, so we will not discuss them all here.
Rheumatic diseases are mostly chronic diseases, and the purpose of treatment is to improve the healing of the disease, maintain the function of its joints and organs, and relieve the relevant symptoms. Commonly used treatment methods are as follows.
I. Drug therapy The principle of treatment is early diagnosis and early and reasonable, joint drug use. The commonly used anti-rheumatic drugs are as follows.
(a) non-Zithromax anti-inflammatory drugs These drugs can inhibit the synthesis of prostaglandins and rapidly produce anti-inflammatory and analgesic effects, which have a better effect on relieving pain, but cannot change the course of the disease. Clinically commonly used are ibuprofen, naproxen, diclofenac, indomethacin, etc.
(B) slow-acting anti-rheumatic drugs These drugs have a certain control effect on the disease but the onset of action is slow. These drugs produce immunosuppressive effects through different channels. Commonly used ones are cyclophosphamide, methotrexate, hydroxychloroquine, and tretinoin. They are often the second-line drugs for SLE, rheumatoid arthritis and vasculitis. Although the side effects are more frequent and serious, they have a great effect on improving the healing of these diseases.
(iii) Adrenocorticotropic hormones These drugs are strong anti-inflammatory and anti-allergic drugs that significantly improve the healing of various connective tissue diseases such as SLE, but do not cure these diseases. Their numerous side effects increase with the increase of dose and the prolongation of treatment course, so they should be used carefully when assessing their efficacy and side effects.
(iv) Biological agents In recent years, biological agents such as Yicep have been gradually developed to inhibit the development of rheumatic diseases by inhibiting an important inflammatory mediator in the process of lesion response: tumor necrosis factor. Currently, there are data showing that biologic agents are fast-acting and have good effects. However, they are expensive and have various side effects and contraindications.
Second, surgical treatment includes different orthopedic surgery, artificial joint replacement, synovectomy and so on. Surgery cannot cure the disease function and improve the ability of joint function and life.
Third, other treatments including physical, rehabilitation, vocational training, psychological and other treatments, is an indispensable part of the comprehensive treatment of this type of disease. Modern Methodist medicine believes that: the treatment of rheumatic diseases and their prognosis are closely related to the patient’s literacy, psychology, etc.
On the prevention of rheumatic diseases.
1, strengthen exercise, enhance physical fitness
Regular participation in physical exercise, such as health care gymnastics, practice qigong, taijiquan, do radio gymnastics, walking, etc., is of great benefit. Anyone who adheres to physical exercise, the body is strong, strong resistance to disease, rarely fall ill, and its ability to resist the wind, cold and dampness than the average person who has not gone through physical exercise is much stronger. At the same time should also pay attention to the body can bear as a limit, not excessive exercise, to avoid increasing the weight-bearing burden on the joints.
2, to avoid the wind, cold and damp invasion
Spring is the time for everything to sprout, but also rheumatoid arthritis season, so to prevent cold, rain and moisture, the joints should pay attention to keep warm, do not wear wet clothes, wet shoes, wet socks, etc.. In the summer heat, don’t take cold and cold drinks. In autumn, when the climate is dry and the weather becomes cooler, it is important to prevent the wind and cold from attacking. In winter, when the wind is cold and bony, it is most important to keep warm.
3, pay attention to the combination of work and rest
Diet, regular living, work and rest are the main measures to strengthen health care. Clinically, some rheumatoid arthritis patients, although the basic control of the disease in the recovery period, often due to fatigue and re-aggravation or relapse, so to combine work and rest, activities and rest to moderate.
4, maintain a normal psychological state
Some patients are triggered by mental stimulation, excessive sadness, depression, etc.; and after suffering from the disease, emotional fluctuations often aggravate the disease. All these suggest that mental (or psychological) factors have some influence on the disease. Therefore, maintaining a normal psychological state is important to maintain the normal immune function of the body.
5, prevention and control of infection
Some rheumatoid arthritis develops after suffering from infectious diseases such as tonsillitis, pharyngitis, sinusitis, chronic cholecystitis, dental caries and so on. It is believed that this is due to the body’s immune response to the pathogens of these infections that cause the disease. Therefore, it is also important to prevent infections and to control the infected lesions in the body.