1.What is rheumatic disease?
Rheumatic diseases refer to a group of diseases affecting bones, joints and their surrounding soft tissues, such as muscles, bursae, fascia, ligaments and nerves. Their causes are diverse, and can be infectious, immune, metabolic, endocrine, degenerative, geographic environmental, genetic or tumorigenic. Rheumatic diseases and the people say “wind, dampness, stroke” is not a concept, more is closely related to immune factors of a large class of diseases.
2.What are the hazards of rheumatic diseases?
Rheumatic disease is a very common chronic disease, lifelong disease, bringing patients with great physical and psychological harm. The American College of Rheumatology summarized the harm of rheumatic diseases as 5D, namely, disability – Disability, pain – Discomfort, death – Death, economic loss – Dollar lost, drug toxicity – Drug toxicity. There are about 4 to 5 million patients with rheumatoid arthritis in China, and up to 80% of them become disabled after 20 years of illness, and about 1/3 of the patients with working ability lose their working ability within 2 years after the onset of the disease, while the average retirement age of patients with ankylosing spondylitis is 39.4 years. Therefore, it is the heavy responsibility of every rheumatology medical staff to popularize the knowledge of rheumatic diseases to the whole society, help the majority of patients to establish a positive and standardized treatment attitude, and reduce the pain of rheumatic patients.
3.What are the common symptoms of rheumatic diseases?
According to the survey, there are still many people who do not understand rheumatic diseases, so let’s learn the common symptoms of rheumatic diseases together!
(1) Fever is a common symptom of rheumatic diseases, which can be low fever, moderate fever, or high fever, often manifested as irregular fever, generally without chills, antibiotics are ineffective, while the blood sedimentation is fast, such as systemic lupus erythematosus, dry syndrome, adult Steele’s disease, lipofuscinosis, etc. can be fever as the first symptom.
(2) Pain is the main symptom of rheumatic diseases and an important cause of functional impairment. Joint pain, neck and shoulder pain, low back pain, and heel pain are often the main manifestations of rheumatic diseases, sometimes accompanied by swelling of the joints. For example, rheumatoid arthritis often has symmetrical joint swelling and pain, especially in the hand and wrist joints; ankylosing spondylitis has low back pain, heel pain, and pain at the root of the thigh; dermatomyositis/polymyositis often has pain and weakness in the muscles of the limbs.
(3) Skin and mucous membrane symptoms: many rheumatic diseases often have skin and mucous membrane damage, such as systemic lupus erythematosus, dermatomyositis/polymyositis, leukodystrophy, lipofuscinosis, dry syndrome may have rash, photosensitivity, oral ulcers, vulvar ulcers, reticular bruising, skin ulcers, etc.
(4) Raynaud’s syndrome: whitening of the finger (toe) ends when exposed to cold or emotional agitation, followed by purple, red or accompanied by numbness and pain of the finger (toe) ends, severe skin ulcers may be seen in scleroderma, rheumatoid arthritis, mixed connective tissue disease, systemic lupus erythematosus.
(5) Others: such as repeated redness of both eyes, loss of vision, pus and blood nasal discharge, ear swelling and pain, hearing loss, weakness, headache, dizziness, repeated syncope, cold limbs, unexplained weight loss, abnormal liver function for which no cause can be found, etc.
4.What are the drugs commonly used in the treatment of rheumatic diseases?
Drugs commonly used in the treatment of rheumatic diseases are non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids, anti-rheumatic drugs to improve the condition, botanical drugs, biological agents, etc.
(1) non-steroidal anti-inflammatory drugs (NSAIDs): the role of such drugs have antipyretic, anti-inflammatory and analgesic, and to reduce the inflammatory response and purpose. Commonly used are ibuprofen, meloxicam, piroxicam, naproxen, loxoprofen sodium, celecoxib, etoricoxib, etc. The main gastrointestinal adverse reactions, liver and kidney damage, avoid the simultaneous use of 2 and more drugs of this class.
(2) Glucocorticoids:These drugs have strong anti-inflammatory, anti-allergic and immunosuppressive effects, with strong and rapid elimination of inflammation and various symptoms brought about by inflammatory reactions, such as fever, joint swelling and pain. Clinical applications include short-acting, intermediate-acting and long-acting preparations. They can be administered orally, intramuscularly or intra-articularly, or intravenously, depending on the type of disease and condition. The side effects of long-term glucocorticosteroids should be noted, including masking infection, osteoporosis, femoral head necrosis, diabetes, peptic ulcer, hypertension and mental abnormality, etc. Also, if the drug is stopped too quickly, the disease may rebound. Except for patients with severe diseases, in principle, small doses and short courses of treatment are appropriate.
(3) anti-rheumatic drugs to improve the disease (DMARDs): also known as slow-acting anti-rheumatic drugs. DMARDs include chloroquine, hydroxychloroquine, salbutamol, methotrexate, azathioprine, cyclophosphamide, penicillamine, gold, cyclosporine A and leflunomide. A and leflunomide, etc.
(4) Biological agents: The main biological agents available for the treatment of rheumatic diseases are tumor necrosis factor (TNF)-α antagonists, anti-CD20 monoclonal antibodies, interleukin (IL-l, IL-6) antagonists and T-cell co-stimulation signal inhibitors. The tumor necrosis factor (TNF)-α antagonists commonly used in clinical practice include etanercept, infliximab, adalimumab, IL-l antagonists such as anabolic acid, and anti-CD20 monoclonal antibodies such as rituximab.
(5) Botanicals: botanicals commonly used in the treatment of rheumatoid arthritis include rheumatism, albuglossine, and cyanophylline. The main adverse effects of these drugs are rash, hair loss, gastrointestinal reactions, bone marrow suppression, elevated liver enzymes and elevated blood creatinine.
(6) Surgical treatment: For example, patients with rheumatoid arthritis can undergo synovectomy in the early stage and arthroplasty, or tendon repair or transfer in the late stage. Improve the quality of life of patients.
(7) Others: including technetium-methylene diphosphonate (Yunque), which can inhibit prostaglandin synthesis, inhibit collagenase activity, prevent cartilage decomposition and destruction, and inhibit osteoclasts, and is used to treat rheumatoid arthritis, ankylosing spondylitis, osteoarthritis and osteoporosis. There are also immunosorbent and plasma clearance therapies, which can remove circulating immune complexes from the serum and are used for ANCA-related vasculitis, lupus nephritis, etc.; intravenous gammaglobulin can be used for patients with severe systemic lupus erythematosus, dermatomyositis, and vasculitis.