I. What is rheumatoid arthritis?
1, rheumatoid arthritis (RA) is a chronic, systemic disease of unknown etiology, mainly inflammatory synovitis, is one of the most common rheumatic immune diseases. It is characterized by symmetric, aggressive arthritis of the wrist, metacarpophalangeal joints, proximal interphalangeal joints and small joints of the foot, and can be accompanied by extra-articular organ damage such as interstitial lung lesions, peripheral nerve damage, etc. Most patients with RA have positive serum rheumatoid factor and anti-CCP antibodies, and RA can lead to joint deformity and loss of function.
2, the onset of RA may be related to genetics, infection, sex hormones, etc. RA can occur at any age, the onset of middle-aged women is more, the high incidence of age 40 to 60 years, the incidence of women for men 2 to 3 times.
The clinical features of rheumatoid arthritis
1, rheumatoid arthritis patients can be accompanied by weight loss, low fever and fatigue and other systemic symptoms.
2, morning stiffness: morning joint sticky feeling, the subjective feeling of inflexible joint movement when waking up in the morning, is a non-specific manifestation of arthritis, the time of morning stiffness reflects the severity of arthritis.
3. Typical manifestations of arthritis
(1) Symmetrical, multi-joint swelling and pain: the wrist, metacarpophalangeal joints, proximal interphalangeal joints and other small joints are mainly involved.
②Joint deformity: pike swelling, ulnar deviation, swan neck-like deformity, button flower-like deformity, etc.
③If the joint swelling or deformity compresses the median nerve, it may cause carpal tunnel syndrome, cervical spine involvement may have neck pain and weakness, atlantoaxial joint subluxation, there may be spinal cord compression.
4.Extra-articular manifestations
Rheumatoid nodules may appear in patients with high titers of rheumatoid factor and long-term RA activity, mostly in the elbow, joint eminence and other joint prominences and frequently pressurized areas; rheumatoid vasculitis (necrotizing small arteritis mainly involving small arteries, which may manifest as finger and toe end necrosis, skin ulcers, etc.).
②Cardiac involvement, respiratory system involvement: there may be coronary arteritis, interstitial lung lesions, etc.
③Renal damage: mainly primary glomerulonephritis and tubulointerstitial nephritis, renal amyloidosis and renal damage secondary to drug therapy (penicillamine and NSAIDs).
④Nervous system: In addition to symptoms of peripheral nerve compression, there may be ischemic neuropathy secondary to vasculitis.
⑤Anemia: It is the most common extra-articular manifestation of RA and is chronic disease anemia, often mild to moderate.
(6) Digestive system: Most of them are caused by the side effects of glucocorticoids and painkillers.
(7) Eye: some patients may have uveitis and sclerositis, which may be caused by vasculitis; there may also be secondary dry conjunctival keratitis, etc.
Three, rheumatoid arthritis treatment principles
Rheumatoid arthritis treatment principles include patient education, early treatment, combined medication, and individualized treatment. Drug treatment program should be individualized, mainly including non-steroidal anti-inflammatory analgesics, slow-acting drugs to improve the condition, glucocorticoids, biological agents and botanicals, etc.
1, non-steroidal anti-inflammatory analgesics (NSAIDs) have anti-inflammatory and analgesic effects: is the most commonly used drugs in the treatment of rheumatoid arthritis, this drug can not inhibit the progression of bone destruction in RA, but can only improve the symptoms of joint swelling and pain, commonly used drugs include loxoprofen, celecoxib, etc.
2, slow-acting drugs to improve the condition (DMARDs): the first-line drugs for RA treatment are methotrexate, leflunomide, lutetrabenazine, hydroxychloroquine, etc. These drugs have a slow onset of action, but can inhibit the destruction of bone in RA.
3, glucocorticoids: is not the first choice and must be used in the treatment of rheumatoid arthritis drugs. The following cases can be considered: ① rheumatoid vasculitis including peripheral neuropathy, interstitial lung lesions, iritis, etc. ②Transitional treatment: Patients with severe rheumatoid arthritis can use small doses of hormones for rapid relief. Once the disease is under control, hormones should be reduced or slowly discontinued first. ③Patients whose regular improvement of the condition by slow drug treatment is ineffective can add small doses of hormones. ④Local application: such as intra-articular injection can effectively relieve the inflammation of local joints. The principle of hormone use is short-term small dose (prednisone ≤10mg/d) application, while paying attention to stomach protection and prevention of osteoporosis and other complications.
4, biological agents: currently used more TNF-α inhibitors and IL-6 antagonists, these drugs play an important role in refractory severe rheumatoid arthritis.
5, botanical drugs: such as Leigongtang polyglucoside tablets, white peony total glucoside, etc.
Four, RA patients need to strengthen functional exercise
Functional exercise is an important way to restore and maintain joint function in patients with rheumatoid arthritis. Generally speaking, in the acute phase of rheumatoid arthritis, joint swelling and pain should be appropriate to limit joint activities. When the disease is stable, that is, after the pain and swelling of the joint is relieved, appropriate functional exercises should be gradually performed without increasing the pain of the patient. For those who do not have obvious joint swelling and pain but have reversible joint movement limitation, they should be encouraged to perform formal functional exercises. In hospitals with conditions, this should be done under the guidance of rheumatologists and rehabilitation specialists.