Rheumatoid arthritis is an autoimmune disease of unknown etiology, mostly seen in middle-aged women, with a prevalence of about
The prevalence in China is about 0.32-0.36%. The main manifestation is symmetrical, chronic, progressive polyarthritis. Chronic inflammation and hyperplasia of the synovial membrane, formation of vascular opacities, invasion of articular cartilage, subchondral bone, ligaments and tendons, resulting in destruction of articular cartilage, bone and joint capsule, leading to joint deformity and loss of function. The condition and course of the disease vary individually, from transient, mild oligoarthritis to acutely progressive polyarthritis. The most commonly affected joints are the proximal interphalangeal, metacarpophalangeal, wrist, elbow, shoulder, knee, and toe joints; the cervical spine, temporomandibular, sternoclavicular, and acromioclavicular joints may also be involved with limited motion; the hip joint is rarely involved. Arthritis often presents with symmetrical, persistent swelling and pressure pain, and morning stiffness often lasts more than an hour.
Morning stiffness often lasts for more than one hour. The most common joint deformities are ankylosis of the wrist and elbow joints, subluxation of the metacarpophalangeal joints, ulnar deviation of the fingers, and “swan-neck” and buttonhole-like manifestations. In severe cases, the joints are fibrous or bony ankylosis, and the joint function is lost due to muscle atrophy and spasm around the joints, making life unmanageable. In addition to joint symptoms, extra-articular or visceral damage, such as rheumatoid nodules, heart, lung, kidney, peripheral nerve and eye lesions, may also occur. At present, the treatment of rheumatoid arthritis includes drug therapy, surgical treatment and psychological rehabilitation treatment. 1, drug treatment The current domestic and foreign applications of drugs, as well as plant drugs can not completely control joint destruction, but only to relieve pain, reduce or delay the development of inflammation. Commonly used drugs for the treatment of rheumatoid arthritis are divided into four categories, namely non-steroidal anti-inflammatory drugs (NSAIDs), anti-rheumatic drugs to improve the condition (DMARDs), glucocorticoids and phytomedicines. 2.Surgical treatment Rheumatoid arthritis patients after active formal or drug treatment, the disease still can not be controlled, in order to prevent the destruction of the joint, correct the deformity, improve the quality of life can be considered for surgery. However, surgery does not cure rheumatoid arthritis, so the post-operative drug treatment is still required. Commonly used surgeries include synovectomy, arthroplasty, soft tissue release or repair surgery, and joint fusion. 3, psychological and rehabilitation treatment joint pain, fear of disability or already facing disability, unable to take care of themselves, economic loss, family, friends and other relationships change, the cessation of social recreational activities and many other factors inevitably bring mental pressure to patients with rheumatoid arthritis, they are eager to treatment, but worried about drug adverse reactions or the actual effect of drugs less confidence, which in turn increases the psychological burden of patients. Depression is the most common psychiatric symptom among patients with rheumatoid arthritis, and severe depression hinders the recovery of the disease. Therefore, along with active and rational drug therapy, attention should be paid to the psychological treatment of rheumatoid arthritis. In addition, the selection of the treatment plan and the evaluation of the efficacy should also take into account the changes in the patient’s psychiatric symptoms. In the acute stage, patients with severe joint pain and systemic symptoms should rest in bed, and pay attention to the resting position to avoid pressure on the joints as much as possible. Passive and active joint mobility training is carried out to prevent muscle atrophy as far as the condition allows. For patients in remission, more exercise is performed without fatiguing the patient
In the remission stage, the patient should be given more exercise without making him/her feel fatigue, to recover physical strength, and under the guidance of physical rehabilitation physician. 4, other treatments Biological agents such as anti-TNF-α, stem cell transplantation and other new therapies have begun to be used in the treatment of rheumatoid arthritis, its exact efficacy and adverse effects are pending more cases of long-term observation and follow-up. Most patients with rheumatoid arthritis have a prolonged disease course, and the disability rate is high in the first 2-3 years of rheumatoid arthritis, and if not treated early and reasonably, joint destruction reaches 70% within 3 years. Active and correct treatment can lead to remission in more than 80% of rheumatoid arthritis patients, and only a few eventually become disabled. Treatment strategy In today’s world, where rheumatoid arthritis cannot be cured, preventing joint destruction, preserving joint function and maximizing the patient’s quality of life are our highest goals; therefore, the timing of treatment is very important. Early aggressive and rational treatment with DMARDs is the key to reduce disability
. There are no accurate indicators to predict the prognosis, it is usually believed that: men have a better prognosis than women; those with late onset have a better prognosis than those with early onset; the number of joints involved at the beginning of the disease or with metatarsophalangeal joints involved, or the number of joints involved in the course of the disease is greater than 20 has a poor prognosis; persistent high titer rheumatoid factor positive, persistent increased sedimentation, increased C-reactive protein, increased eosinophils in the blood all suggest a poor prognosis; there are severe The prognosis is poor if there are severe peripheral symptoms (fever, anemia, weakness) and extra-articular manifestations (rheumatoid nodules, sclerositis, interstitial lung disease, pericardial disease, systemic vasculitis and other visceral injuries); the prognosis is poor if the symptoms are difficult to control with short-term hormone therapy or the maintenance dose of hormone cannot be reduced to less than 10 mg/day.