Overview】 Rheumatoid arthritis (RA) is an autoimmune disease of unknown etiology, mostly seen in middle-aged women, with a prevalence of 0.32-0.36% in China. 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, eventually leading to joint deformity and loss of function. Clinical manifestations] 1. Symptoms and signs There are individual differences in the condition and course of the disease, ranging from transient, mild oligoarthritis to acute progressive polyarthritis. The most commonly affected joints are the proximal interphalangeal joints, metacarpophalangeal joints, wrists, elbows, shoulders, knees and toe joints; the cervical spine, temporomandibular joints, sternoclavicular and acromioclavicular joints can also be involved, with restricted movement; hip joint involvement is rare. Arthritis often presents with symmetrical, persistent swelling and pressure pain, and morning stiffness often lasts more than an hour. The most common joint deformities are ankylosis of the wrist and elbow, 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. 2.Laboratory examination Most active patients have mild to moderate orthocytic hypochromic anemia, white blood cell count is mostly normal, sometimes eosinophil and platelet increase, serum immunoglobulin IgG, IgM, IgA can be elevated, serum complement level is mostly normal or mildly elevated, 60%-80% of patients have high level of rheumatoid factor (RF), but RF Positive RF is also seen in chronic infections (hepatitis, tuberculosis, etc.), other connective tissue diseases and in normal elderly people. Other autoantibodies such as anti-keratin antibodies (AKA), anti-perinuclear factor (APF) and anti-cyclic citrullinated polypeptide (CCP) have high diagnostic specificity for the diagnosis of rheumatoid arthritis, but the sensitivity is only about 30%. In order to clarify the diagnosis, stage and development of the disease, X-rays of both wrists and hands and/or feet should be taken at the beginning of the disease, as well as X-rays of other affected joints. early X-rays of RA show swelling of the soft tissues around the joints, mild osteoporosis near the joints, followed by joint space narrowing, joint destruction, joint dislocation or fusion. The diagnosis of rheumatoid arthritis is mainly based on clinical manifestations, autoantibodies and X-ray changes. Typical cases are not difficult to diagnose according to the 1987 American College of Rheumatology classification criteria, but some atypical, early rheumatoid arthritis with monoarthritis as the first symptom is often misdiagnosed or missed. For these patients, in addition to blood and urine tests, blood sedimentation, C-reactive protein and rheumatoid factor, magnetic resonance imaging (MRI) can also be performed for early diagnosis. Patients with suspected rheumatoid arthritis should be reviewed regularly and followed up closely. The 1987 American College of Rheumatology classification criteria: 1. morning stiffness stiffness in and around the joint for at least 1 hour (duration of disease ≥ 6 weeks); 2. arthritis in 3 or more regional joint sites physicians observed involvement of 3 of the following 14 regions (left or right proximal interphalangeal joint, metacarpophalangeal joint, wrist, elbow, knee, ankle, and metatarsophalangeal joint) with concurrent soft tissue swelling or effusion (not 3, hand arthritis wrist, metacarpophalangeal or proximal interphalangeal arthritis, at least one joint swelling (duration of disease ≥ 6 weeks); 4, symmetric arthritis both joints involved (bilateral proximal interphalangeal, metacarpophalangeal and metatarsophalangeal joints involved, not necessarily absolutely symmetrical) (duration of disease ≥ 6 weeks); 5, rheumatoid nodules physician observed in the site of the bony prominence, the surface of the extensor muscle or Positive rheumatoid factor Any test proving abnormal serum rheumatoid factor level, and the positive rate of this method in the normal population is less than 5%; 7. Radiological changes Radiological changes typical of rheumatoid arthritis in the posterior-anterior phase of the hand and wrist: must include bone erosion or definite bone decalcification in the affected joint and its adjacent parts The above 7 items meet 4 or 4 The diagnosis of rheumatoid arthritis can be made by satisfying all of the above and excluding other arthritis.