I am Wang Jun from the Department of Rheumatology, Ningbo Hospital of Traditional Chinese Medicine. Today, I will give you an overview of rheumatoid arthritis treatment and precautions in Chinese and Western medicine, welcome to listen and interact. The rheumatoid arthritis patient precautions. 1, what is rheumatoid arthritis rheumatoid arthritis definition rheumatoid arthritis is a multi-systemic inflammatory autoimmune disease involving mainly peripheral joints. 1858 by the British doctor Garrod first proposed the name rheumatoid arthritis, it is characterized by symmetric peripheral polyarthritis. It is characterized by symmetric peripheral polyarthritis, mainly in the small joints of the extremities, and has a characteristic distribution, namely the proximal interphalangeal joints, metacarpophalangeal joints and wrist joints are the most susceptible, mostly symmetrical, so that it can be distinguished from other arthropathies, and can also involve, for example, the cervical spine, temporomandibular joints, cricoarytenoid joints, and even the auditory tuberosities. The inflammation of the heart, lungs, kidneys, blood vessels, etc., can appear as heart valve inflammation, interstitial pneumonia, pleural effusion, pleurisy, nephritis, vasculitis, amyloidosis, and other extra-articular disorders. It is a systemic disease of unknown origin and is quite complex in general, but may have only partial manifestations in a specific patient. In order to diagnose or exclude rheumatoid factor, we will give patients a rheumatoid factor, the interpretation of the meaning of rheumatoid factor, many people think that a positive rheumatoid factor plus joint pain = rheumatoid factor, including many doctors, but also some patients review rheumatoid factor, found to be high, they are worried, thinking that the disease has worsened, in fact, this is not correct. The significance of rheumatoid factor lies in the diagnosis and prognosis. The sensitivity and specificity of rheumatoid factor is not particularly strong in the diagnosis of rheumatoid gland, and a small amount of rheumatoid factor can be found in 5% of normal people, so you can neither diagnose rheumatoid gland on the basis of positive rheumatoid factor alone, nor exclude rheumatoid gland because of negative rheumatoid factor. Now there is also an anti-cyclic citrullinated peptide antibody, which is better than rheumatoid factor. Some patients are found to have positive anti-cyclic citrullinated peptide antibodies, but they are asymptomatic, and then it takes several years before they develop rheumatoid arthritis, which means that they can be predicted. The prognosis for patients with positive antibodies is poor, with possible early joint destruction and involvement of internal organs, but changes in the concentrations of these two antibodies are not related to changes in the disease, but to blood sedimentation, C-reactive protein, platelets, etc. Therefore, it is recommended that patients do not need to be overly anxious about changes in rheumatoid factor and anti-CCP antibodies, nor do they need to be reviewed frequently. 2, rheumatoid arthritis treatment of a century of history and the current situation For more than a hundred years, people’s understanding of rheumatoid arthritis treatment has gradually deepened, the invention of aspirin in 1899, was used for rheumatoid pain and anti-inflammatory, which is the beginning of modern medical treatment in the true sense; the emergence of slow-acting drugs, or anti-rheumatic drugs to change the condition of the last century 3, 40s, mainly gold preparations, 50s hormones In the 1950s, hormones were used for the treatment of rheumatoid arthritis, which was a big event in the treatment of rheumatoid arthritis, and it was found that the symptoms of rheumatoid arthritis could be relieved. At that time, high doses were used, but it was later found that they could not solve the fundamental problem, and the patient’s joints would still be deformed after long-term observation, and the side effects of high doses of hormones were so great that they were left out of use for a long time. It was only in the 1980s that its effects were reevaluated and small doses were used as a “bridge treatment” before the onset of slow-acting drugs. A comprehensive understanding of hormones will be discussed at the end; in the 60s, based on the results of a large-scale population epidemiological survey, it was considered a benign disease, and a “pyramid” treatment plan was given accordingly, that is, the drugs for the treatment of wind-like Guan were divided into three choices according to efficacy, side effects, price and other factors, and one drug This treatment plan is a disaster for the patients with wind-like disease! Inadequate treatment has led to a large number of patients with uncontrollable disease, disability and other serious complications, the 80s methotrexate for the treatment of wind-like off, the efficacy is better than other slow-acting drugs such as gold preparations, so the application has increased year by year, the status has steadily increased, even in the last decade of the popularity of biological agents, the status has not declined, but as the application of biological agents must be used with the use of It has been valued as an “anchoring” drug that must be used in conjunction with biologics. But there is a problem, that is, domestic methotrexate for the treatment of rheumatoid off has not been written into the manual, the manual is still written for the treatment of tumor indications, some patients read the manual and dare not eat, in fact, there is no need, there are several reasons: ① efficacy is exact, ② in the treatment of rheumatoid off the dose, side effects are small, ③ extremely cheap, ④ abroad is this indication, a statistic of the United States, rheumatology In the 1990s, as people’s understanding of rheumatoid arthritis deepened, based on clinical epidemiological surveys, it was concluded that rheumatoid arthritis is a disease in which patients suffer from pain, progressive joint destruction, loss of function, loss of money and shortened life expectancy, and is not a benign disease! In 1999, a landmark event was the launch of tumor necrosis factor alpha antagonist, which brought the treatment effect of P. aeruginosa to a new level. The proportion of inflammation in remission increased from less than 30% to more than 40% with traditional drugs, and it has additional benefits in stopping joint destruction, which has promoted the rapid progress from basic to clinical, and from theory to practice, and made the clinical remission of wind-like disease a reality. The treatment is up to standard. 3, the rheumatoid arthritis of Chinese medicine treatment overview ancient Chinese doctors do not know rheumatoid arthritis, think it is “paralysis”, paralysis is not pass, not pass is pain, “not pass” the cause of the recognition of wind, cold, damp, heat, stagnant blood, phlegm paralysis, qi, blood, yin and Yang deficiency, etc., on this basis created a lot of prescriptions On this basis, many formulas have been created, and certain curative effects have been achieved, but in general, the curative effects are not good, especially in preventing the destruction of joints, and many patients have deformities at a later stage. Modern Chinese medicine treatment of rheumatoid arthritis combines the advantages of Chinese medicine and Western medicine, and combines the identification of disease and symptomatic treatment, the identification of medicine and modern pharmacological research of Chinese medicine: in general, it conforms to the requirements of Chinese medicine’s diagnosis and treatment: “if it is deficient, it should be tonified; if it is real, it should be diarrhea; if it is cold, it should be warmed; if it is hot, it should be cleared”; specific medicine, in line with modern pharmacological research For example, raw earth, tortoise shell, deer horn tablet and Xianling spleen are all used in experimental studies to promote adrenal cortical function and increase hormone levels, so we use raw earth and tortoise shell for kidney yin deficiency and deer horn tablet and Xianling spleen for kidney yang deficiency on the basis of dialectical evidence. Another example is that raw Dihuang has immune suppressing effect, which should be applied in large doses clinically; Ginseng and Lingzhi have immune enhancing effect, which cannot be used in most cases. Chinese herbal medicine treatment follows the above principles based on 6 aspects, 1, inhibit excessive cellular and humoral immunity, specific drugs such as raw earth, lonicera, tiger root, golden bird root, scutellaria, etc., 2, dispel rheumatism, anti-inflammatory and pain relief, with qiangwu, xiaoxin, gutu grass, myrtle root, yanhuosuo, Xu Changqing, etc., 3, change synovial vascular permeability, promote water and reduce swelling, with scape seed, cinnamon branch, etc., 4, protect bone The use of Boneset, Boneset, Radix Angelicae Sinensis, Chuanjian, Rhizoma Chuanxiong, etc., 5. Promote adrenal gland function and increase the level of hormones in the body, raw and ripe ground, tortoise shell, Xianling spleen, Bacopa monnieri, Baijian, Boneset, etc., 6. Try to apply herbal medicines with less toxic side effects, which do not hurt the spleen and stomach and are suitable for long-term use. Chinese herbal medicine alone has good efficacy for some patients with mild rheumatoid arthritis, with few side effects. But on the whole, it can not completely replace Western medicine, and is still in an auxiliary treatment status. 4, rheumatoid arthritis patients of note (1) have a clear understanding of the disease they suffer from Like hypertension and diabetes, rheumatoid off is a lifelong disease, and not so benign, as mentioned earlier, is a non-benign disease, currently incurable, but some patients can be long-term relief, that is, swelling and pain does not attack, joint function is basically not damaged, it is impossible to relieve, most patients are also To achieve this, we need to cooperate with the patient and the doctor to develop a practical treatment plan and strictly follow this plan, which should include at least two points: first, long-term maintenance treatment with medication, and second, regular follow-up visits, one cannot be missing. In clinical practice, we often come across patients who, after getting better, would like to say goodbye to their wind-like disease early and throw away their medical records, which is very undesirable and very detrimental to the doctor’s judgment of your disease in the future. There is a concept that for chronic diseases, the patient should be the attitude is to live with the disease, do not want to drive away the disease, travel all over the world, visit famous doctors, drugs tried all over, found that also did not cure, the results and discouraged, that is not cure ah, can be cured can win the Nobel Prize well! And can not be ignored, when it does not, then it will be an inch of progress. (2) Find a specialist, it is not recommended to change hospitals frequently. An article published in the journal Arthritis and Rheumatoid in 2000 mentions that patients who consult a rheumatologist as early as possible are more likely to improve their condition at an early stage; there is a saying that a line is like a mountain, for medical science, a professional is like a mountain, the specialist has a more comprehensive grasp of the characteristics of the disease and can better make the right diagnosis and treatment for the patient. For a specific patient, sometimes the characteristics of his disease can only be found after several visits, frequent changes of hospitals and doctors are not conducive to the observation of the disease, which may delay your diagnosis and treatment, and may also appear to be in a hurry to seek treatment, or even be deceived. (3) Diet and living taboos Patients who come to our Chinese medicine hospital always ask, “What is good to eat? Are there any taboos? Based on modern nutritional research, the diet of patients with wind-like disease is generally not too taboo, in principle, there is no taboo, many patients listen to rumors, this and that do not eat, resulting in malnutrition, anemia, hypoproteinemia, making the disease more complex, difficult to control, but more than worth the loss. What is clear is that foods rich in ? 3 fatty acids may reduce joint symptoms, such as fresh or frozen fish, tofu and olive oil, etc. Other foods that may have a role in relieving joint symptoms are deep-sea salmon oil, shiitake mushrooms and black fungus, bitter melon and loofah, celery, yams and lentils, and various fruits. Cereals and wheat, which aggravate symptoms in 57% and 54% of patients, respectively, should be minimized. In addition, individualization is also a principle, you should not eat if you are uncomfortable, especially if your joint symptoms will worsen. Pay attention to these will be fine. (4) Psychological adjustment To be open-minded, smile often, tolerance, optimism, cheerfulness, maintain psychological balance; do not be too strong, not to “bull’s-eye”, avoid emotional ups and downs and sentimental, to ensure good sleep; anger control is very important: anger is equal to suicide, seriously affect the immune function, there are two very reasonable words: anger, is to torture yourself with other people’s mistakes. Is to take the mistakes of others to torture themselves, anger, is to take the mistakes of others to punish themselves. Of course, moderate catharsis is also necessary, pay attention to a degree: four points of catharsis, six points of patience. Studies have shown that 2/3 of patients have a close temporal relationship between life stimulation and disease exacerbation. Another study found that depressed rheumatoid arthritis patients have more severe joint pain and significantly more painful episodes per day. Conversely, an outgoing and cheerful personality can reduce pain in patients with arthritis. (5) How to understand the significance of hormones in the treatment of rheumatoid arthritis? Hormones have strong anti-inflammatory effects, and they have strong swelling and pain-relieving effects on various inflammatory swellings and pains; they have rapid fever-reducing effects on various fevers; they can reduce many clinical conditions, and often have “fast-acting” effects. It is one of the most widely used drugs in clinical practice. However, hormones are also a controversial drug, and their significant efficacy and serious side effects, as well as hormone dependence, make clinicians and patients “love and hate” hormones, and some people call them the “opium” of rheumatism. In fact, hormones are different from opiates and other drugs, and there are essential differences! If they are used in a standardized way, and if they are used in a good and artistic way, the effects of hormones can be maximized and side effects can be avoided. It is an autoimmune disease with T-cell hyperactivity, which can be controlled without large doses of hormones, about two grains, and most of the side effects of hormones are directly related to the dose; the course of hormones is not very long, within a few months, when the slow-acting drug takes effect, it can be gradually withdrawn. It is like a bridge that can be torn down after crossing the river. The first problem to pay attention to is osteoporosis, a side effect that occurs when very small doses of hormones are applied, so most of our patients are given calcium and vitamin D supplements at the same time, and those with osteoporosis have to apply bisphosphonate preparations such as Fosamax; the second is peptic ulcer, which can be prevented with proton pump inhibitors, and after paying attention to this, no patients with serious side effects have been found for years. Of course, sometimes it is necessary to use high doses. As an example, one time I had a patient with a wind-like off, with severe joint swelling and a fever of 39°C. I had already used 40 mg of prednisone, and the doctor on duty used 10 mg of dexamethasone that night, and the patient was very happy the next day, because the fever went down and the joint swelling disappeared, and the effect was really amazing. Then I quickly reduced the patient’s hormone to a very small dose, so that the total dosage is actually not greater than a small dose for a long time, and the side effects are not too big, and the effect is also very good, but of course not every patient can use this way, the doctor needs to have enough grasp of the disease, otherwise it is called “abuse”. Now there are many advertisements of the so-called “ancestral secret recipes”, “native medicine”, claiming that the efficacy is better than Western medicine, and pure Chinese medicine, non-toxic side effects, in fact, it is added hormones, and the amount is relatively large, the effect is really good at first, this confusion leads to Many patients are deceived and spend a lot of money for long-term use, thinking it is very good, but the result is not only unable to stop the destruction of joints, but also have serious side effects. Therefore, the correct attitude towards hormones is to apply them under the guidance of a specialist, not to reject them and not to abuse them.