Rheumatoid arthritis is an autoimmune disease that leads to progressive joint and peripheral destruction, synovitis, oozing, cell proliferation, granulomas, cartilage and bone destruction, joint ankylosis and dysfunction.
It is symmetrical and chronic, with systemic manifestations and positive serum autoantibodies.
Etiology: 1 infection, 2 genetic, 3 immune disorders.
Clinical manifestations: fatigue, weight loss, poor appetite, low fever and finger joint pain.
1, joint symptoms: morning stiffness, swelling and pain.
2. Extra-articular manifestations: rheumatoid nodules, vasculitis, heart disease, lung disease, kidney damage, ocular uveitis or keratitis, Felty’s syndrome (anti-nuclear antibody positive, etc.), dry syndrome, gastrointestinal damage.
Physical and chemical examinations
1.X-ray examination: joint osteoporosis, erosion, swelling. Advanced joint space narrowing and fibrosis.
2.Anemia, increased lymphocytes, eosinophils, platelets, and fast sedimentation.
3.Hyperviscosity syndrome.
4, Positive rheumatoid factor: lymphocytes and plasma cells of synovial membrane produce rheumatoid factor.
5, turbidity of synovial fluid, decreased viscosity, intracytoplasmic inclusions.
IV. Diagnostic criteria (1987) Diagnosis can be made with 4 of the following.
1.Morning stiffness lasting at least 1 hour.
2. 3 or more arthritis.
3.Hand arthritis (wrist, metacarpophalangeal, proximal interphalangeal joints).
4.Rheumatoid nodules.
5, Positive rheumatoid factor.
6.X-ray bone erosion or decalcification.
V. Differential diagnosis
1, systemic lupus erythematosus (SLE).
2, ankylosing spondylitis.
3, gout.
4, osteoarthritis.
5, nodular disease, amyloidosis, Whipple’s disease, psoriatic arthritis.
Sixth, the principle of treatment to relieve joint pain, prevent joint destruction, preserve and improve joint function.
1.Rest and nutrition.
2.Physiotherapy: local heat therapy, hot water bath, hot spring bath, steam therapy and paraffin therapy, cold compress, infrared, ultra-short wave or short wave heat transmission therapy.
3.Medication.
(1) Non-steroidal anti-inflammatory drugs: isobutylene propionic acid, salicylates like aspirin are still preferred.
(2) Adrenocorticotropic hormone: has significant effect on acute inflammation.
(3) Penicillamine.
(4) Sparing meproline.
(5) Reglanzapine.
(6) Gold preparations.
(7) Immunosuppressants: cyclophosphamide, azathioprine, leflunomide.
(8) Immune-enhancing agents: thymidine.
4) Surgical treatment: synovial debridement, joint fusion and artificial joint replacement.