In the clinical treatment of various peripheral arthritis, joint pain and ankylosing spondylitis, we find that many patients have this confusion: when they have pain in the spine or other joints, the first choice is often to go to the orthopedic department of the hospital, and some of them have run to several orthopedic departments of hospitals, but their condition is still not under control, and they often have to endure the pain caused by the disease. Some people’s condition is delayed for decades, which is really regrettable and painful. This is all the result of not knowing enough about their disease and not seeking proper medical attention.
However, with these diseases, if you go to the rheumatology department early, you may take more correct medical treatment, and there will not be so many patients with deformities of bones and joints, and there will not be so many patients in long-term pain.
Why does this happen? How should patients with joint pain, swollen joints, and spinal ankylosis be seen? Is surgery necessary to treat the symptoms of the joint, and is there a way to treat it without surgery? Why do many patients not choose the right department at the beginning?
One important reason is that there is still no “orthopedic medicine” in the medical field. When you go to the hospital, you will often find that generally speaking, for a certain type of disease, the hospital will have a corresponding medical and surgical department for non-surgical and surgical treatment, such as respiratory medicine and thoracic surgery for lung diseases, cardiovascular medicine and cardiovascular surgery for cardiovascular diseases, gastroenterology and general surgery, hepatobiliary surgery and anorectal surgery for abdominal and gastrointestinal diseases, and nephrology and urology for urinary system diseases. For diseases of the urinary system, there are nephrology and urology, and so on.
Therefore, once a patient has a disease of the above system, he or she will first go to internal medicine to see if there is any medicine to treat it. However, when patients have bone and joint diseases, they go to the hospital and see: “There is no “orthopedics”, but only “orthopedics”! Therefore, they have to go to the orthopedic department to register for treatment.
Orthopedics is a discipline mainly engaged in bone and joint surgical treatment. Due to the history of medical development, orthopedics is mainly a discipline developed from the treatment of trauma and fracture, and gradually transitioned to the surgical treatment of bone tumors, bone orthopedics and joint diseases, and now even developed to minimally invasive techniques for surgery. Therefore, the most important task of orthopedics is to perform surgical procedures, and orthopedic surgeons are most experienced in how to perform surgical treatment for bone and joint diseases.
However, many bone and joint diseases, in fact, do not require surgical treatment; some diseases can be controlled medically first, and surgical treatment is only considered when medical control is ineffective; some diseases, although requiring surgical treatment, require regular medical treatment before and after surgery to escort them. In this case, patients need to go to “orthopedic medicine” for consultation first, and difficult patients need to be consulted by “orthopedic medicine” and orthopedic department together to establish the best treatment plan, so that patients can get the best treatment effect, maximum pain relief and the most The patient can get the best treatment effect, the greatest pain relief and the most convenient and quick treatment.
A patient with osteoarthritis had been treated in rheumatology and immunology to control the disease, but when he went to surgery for another disease, he stopped all the drugs given by the rheumatology and immunology department, and three weeks later, the patient’s joints were painful again, so he had to start the medical treatment from the beginning again.
However, there is no “orthopedic department” in the hospital, so what should the patient do? The answer is that they should go to the “Rheumatology and Immunology Department” for treatment.
Some patients have some experience with this answer. “Oh, yes. There are many doctors or friends who have said that your disease may be rheumatism”; “Your case is too much wind, too much moisture, you should drive away the wind to dispel dampness treatment”. However, some patients do not understand, “No, bone and joint pain, you should go to orthopedics, there should be no relationship with rheumatology! . Although these friends’ perceptions are incorrect and incomplete, they reflect the reality of the current treatment of bone and joint diseases, and this is where our rheumatologists need to work hard.
In fact, rheumatology and immunology is in a way “osteoarticular medicine”, but of course rheumatology and immunology may have other manifestations besides bone and joint manifestations. When a patient has joint pain, swelling, stiffness and other symptoms, it is the right choice to go to the rheumatology department first, because.
First, the performance of the joints is particularly prominent when rheumatic immune disease is present. The onset of rheumatic immune disease is mainly the abnormal activation of the immune system in the body. The so-called immune system is the body’s system to prevent bacteria, viruses, molds and other damage to the body. Under normal circumstances, when these “little bad guys” enter the body, it will activate our immune system, and once the immune system is mobilized, these bacteria and viruses can be completely killed, and the body will be healthy.
However, when suffering from rheumatic immune disease, the immune system is faulty and treats its own cells and tissues as “enemies” such as bacteria and viruses, and the harder the immune system works, the more damage it does to the body. The main target of the immune system is our joints, so it is not surprising that people with rheumatic immune diseases have joint pain, swollen joints, arthritis or joint deformities.
Second, why do many people with rheumatic immune disease have arthritis, or even arthritis as the main symptom? This is a long story, simply put, the immune system is like our army, the task of the army is of course to destroy the enemy, to protect their own people. But one of the first tasks of the army is to distinguish “who is our enemy and who is our friend”. If the enemy is not distinguished from us, we can not properly fight the enemy, and can not protect our friends, so it is bound to fail. And how to distinguish between the enemy and us? As a military, probably the most important distinction is “who is hurting our interests and who is protecting our interests”.
In fact, the immune system is similar. When bacteria and viruses enter our body, our immune system will not harm them if they do not cause damage to our tissues, for example, there are a large number of bacteria in our gastrointestinal tract, but we are “at peace” with them. The bacteria and viruses that destroy our cells and tissues and cause us to have a fever and feel sick are, of course, the enemy. However, there are times when our body is not invaded by bacteria and viruses, the body will also suffer, this damage is the “wind and moisture” to the body damage. People in the north, may have had or seen the cold weather on our body caused by “frostbite”. In fact, this kind of injury will also exist in normal times, but this time the earliest and most important injury is mainly the joints.
This is because the joints, which exist mainly to facilitate the movement of various parts of the body, can be said to be “skin and bones”: there are no muscles, no blood vessels, and even no fluid in the joints. Since there is no blood circulation at a body temperature of 37°C, the joints are the most difficult to keep warm. When the air is humid, when the wind blows, or when you touch cold water, the cells in the joints freeze and scream.
When the cells in the joints are hurt by humidity and cold air, the immune system is not smart enough to think that bacteria or viruses are coming in and attacking us, so it can’t wait to jump up, but the “angry immune system” can’t find the bacteria or viruses and shoots randomly, so it will But the “angry immune system” can’t find the bacteria and viruses, so it fires indiscriminately, so it hurts our joints and other organs more.
How to deal with the “indiscriminate and indiscriminate shooting of the immune system”? It is certainly not right to deal with it too hard, such as using drugs to knock out the whole immune system, because then it will not be able to deal with the bacteria and viruses that destroy our body. But we can’t just ignore it, because then the “indiscriminate firing of the immune system” will also harm our body and cause death in serious cases. What can we do?
We clinicians cannot condone the “errant immune system” without hitting it too hard. Therefore, this leads to our current treatment principles: control, educate and guide the immune system. Clinicians mostly apply immune agents to suppress immune system function, but not too heavily, while using different immunosuppressive agents according to the patient’s specific situation, sometimes with multiple immunosuppressive agents used simultaneously to enhance the effect and reduce toxic side effects.
However, throughout the treatment process, it is necessary to hold it well, not too heavy and not too light, which is the experience of rheumatology clinicians. Although rheumatology is a young discipline, with only about ten years of history in our country, but recently due to increased awareness, the discipline of rheumatology and immunology can be said to have advanced by leaps and bounds, and the number of doctors practicing in the last decade has increased more than tenfold, and many new therapeutic drugs and treatments have been invented, which should be said to be a blessing for the majority of patients.
Thirdly, it can be seen that many patients with arthritis, joint pain and swollen joints actually do not need surgery for rheumatic immune diseases and should be seen and treated in the rheumatology department, which will be more professional and have better results. Of course, for those patients who still need surgery, the rheumatologist will communicate with the orthopedic surgeon in time and ask the orthopedic surgeon for a consultation, so that you can get the best treatment.