1.What kind of disease is rheumatoid arthritis (RA)?
Rheumatoid arthritis (RA) is a systemic autoimmune disease with erosive arthritis as its main manifestation. Rheumatoid arthritis can occur at any age, with a peak incidence between the ages of 30 and 50. The prevalence of rheumatoid arthritis in mainland China is about 0.2% to 0.4%. Rheumatoid arthritis is most commonly seen in small joints such as the finger joints of both hands, wrist joints, and toe joints, and is characterized by symmetrical and persistent multi-joint swelling, pain, morning stiffness, and restricted movement. The pathology is characterized by chronic inflammation of the synovial membrane, formation of vascular opacities, and destruction of cartilage and bone of the joint, which may eventually lead to joint deformity and loss of function. In addition, patients may also have systemic manifestations such as fever and fatigue. Rheumatoid factor (RF) and anti-cyclic citrullinated polypeptide (CCP) antibodies and other autoantibodies can be found in the serum.
2.What are the common clinical manifestations of early rheumatoid arthritis (RA)?
The common clinical manifestations of early rheumatoid arthritis (RA) are symmetrical, persistent joint swelling, pain, pressure and tautness, most often seen in the two finger joints, wrist joints, elbow joints, toe joints and temporomandibular joints (difficulty opening the mouth), joint swelling and pain and tautness, which are obvious when waking up in the morning after sleeping, but reduced or relieved after activity, a phenomenon called “morning stiffness This phenomenon is called “morning stiffness” and is also a characteristic manifestation of rheumatoid arthritis.
3, rheumatoid arthritis (RA) early diagnosis of the new criteria?
Rheumatoid arthritis early diagnosis criteria: the duration of rheumatoid arthritis <6 months; currently according to the new rheumatoid arthritis criteria proposed in the 2010. rheumatology guidelines, namely: at least 1 joint swelling and pain, and evidence of synovitis (clinical or ultrasound or magnetic resonance examination); while excluding other diseases caused by arthritis, and there are typical changes in the routine radiological rheumatoid arthritis bone destruction, can be diagnosed as rheumatoid arthritis.
4.What are the current tests for early detection of rheumatoid arthritis?
For patients with suspected rheumatoid arthritis, in addition to tests such as: rheumatoid factor (RF), anti-cyclic citrullinated peptide (CCP) antibodies, blood sedimentation (ESR), C-reactive protein (CRP) and routine blood tests, imaging of the joints should also be considered: especially magnetic resonance imaging (MRI) and ultrasonography for early diagnosis.
MRI: MRI is superior to x-ray in showing joint lesions and has been increasingly used in the diagnosis of rheumatoid arthritis in recent years. MRI can show signs such as bone marrow edema, synovitis (synovial thickening), joint effusion, bone erosion, and tendonitis at the beginning of the inflammatory response of the joint. It is useful for the early diagnosis of rheumatoid arthritis.
Ultrasonography: High-frequency ultrasound can clearly show the joint cavity, synovial membrane, bursa, joint cavity effusion, thickness and morphology of articular cartilage, etc. Color Doppler flow imaging (CDFI) and color Doppler energy map (CDE) can visually detect the distribution of blood flow within the joint tissue and reflect synovial hyperplasia with high sensitivity. Ultrasonography can also dynamically determine the amount of joint effusion and the distance from the body surface, which can be used to guide joint puncture and treatment.
Diagnosis of arthritis by ultrasound – Diagnosis of rheumatoid arthritis: whenever there is bone erosion, synovitis (synovial hyperplasia), effusion, and a significant increase in blood flow. Even if anti-cyclic citrullinated peptide (CCP) antibodies, rheumatoid factor, inflammatory index C-reactive protein (CRP) and sedimentation (ESR) are negative, rheumatoid arthritis is still considered.
5.What are the poor prognostic factors of rheumatoid arthritis?
After the diagnosis of rheumatoid arthritis, special attention should also be paid to its poor prognostic factors, which are closely related to determining the treatment plan.
6.Why should patients with rheumatoid arthritis undergo standardized treatment?
The aim of rheumatoid arthritis treatment is to control the disease in a timely manner and improve joint function and prognosis. That is to say, try to prevent the patient’s joints from deformation, deformation, loss of labor, so that life can not be self-care. Therefore, it is necessary to emphasize the principles of early diagnosis, early treatment, combined medication and individualized treatment.
7, rheumatoid arthritis patients how to standardize treatment?
Once the diagnosis of rheumatoid arthritis is established, the combined drug treatment plan is as follows.
(1) Non-steroidal anti-inflammatory drugs (NSAIDs)
These drugs have anti-inflammatory, analgesic, antipyretic and joint swelling effects, and are important in relieving joint swelling, pain, morning stiffness, limitation of movement and improving systemic symptoms. (Mainly by inhibiting cyclooxygenase (COX) activity and reducing prostaglandin synthesis)
Commonly used such drugs are: patients choose only one.
Diclofenac extended-release tablets: such as Intacrine 25mg 1 to 2 times a day, Fotarine 25 to 75mg 1 to 2 times a day, etc.
Meloxicam tablets: 7.5mg 1 to 2 times a day, Xilabao 0.2 1 to 2 times a day, anti-inflammatory pain suppository 50mg plug anal, once a night, many varieties of non-steroidal anti-inflammatory drugs, (patients only need to choose only one) but the use of non-steroidal anti-inflammatory drugs should pay attention to the following points.
① focus on the individualization of the type, dose and dosage form of NSAIDs.
(ii) The lowest possible effective dose and short course of treatment.
③ Generally choose one NSAID first. If there is no obvious effect for several days to 1 week, the dosage should be increased to the full amount. If it is still ineffective, then switch to another agent and avoid taking 2 or more NSAIDs at the same time.
④ For those with a history of peptic ulcer, it is advisable to use Cilazol optionally, or add proton pump inhibitor when using NSAIDs (while adding omeprazole 60mg once or twice a day).
(⑤ The elderly may choose NSAIDs with a short half-life or smaller doses.
(vi) Non-steroidal anti-inflammatory should be used with caution in people with high cardiovascular risk.
(⑦) Non-steroidal anti-inflammatory should be used with caution in people with renal insufficiency.
⑧ Pay attention to the regular monitoring of blood routine and liver and kidney function.
Topical preparations of NSAIDs (such as diclofenac diethylamine emulsion, capsaicin cream, ketoprofen gel, piroxicam patch, etc.) and phytomedicinal creams have certain effects on relieving joint swelling and pain with fewer adverse effects, and should be advocated for clinical use.
(2) disease-modifying antirheumatic drugs (DMARDs)
This class of drugs is slower than non-steroidal anti-inflammatory effect, about 1-6 months, so also known as slow-acting anti-rheumatic drugs (SAARDs), these drugs do not have obvious pain relief and anti-inflammatory effect, but can slow down or control the progress of the disease.
①Methotrexate (MTX) oral dose of 7.5-20 mg / week
②Sulfapyridine (SASP). Gradual increase from small doses helps to reduce adverse effects. It can be started at 250-500 mg orally 3 times a day and gradually increased to 750 mg 3 times a day. If the efficacy is not obvious, it can be increased to 3g per day.
③Leflunomide (LEF) is given orally at a dose of 10-20 mg/day.
④Anti-malarial drugs (HCQ) Hydroxychloroquine and chloroquine Hydroxychloroquine 200 mg twice a day or chloroquine 250 mg once a day.
Clinically, early application of DMARDs should be emphasized in patients with rheumatoid arthritis, and the combination of two or more DMARDs should be considered in patients with severe disease, multiple joint involvement, extra-articular manifestations or early joint destruction and other poor prognostic factors. The main combination of methotrexate, leflunomide, hydroxychloroquine and salazosulfapyridine, any two or three of the combination.
(3) Glucocorticoids (referred to as hormones)
Can rapidly improve joint swelling and pain and systemic symptoms. The principle of hormone treatment for rheumatoid arthritis is small doses (prednisone ≤ 7.5 mg/day), targeting joint lesions, as a “bridge” treatment, and a short course of treatment, which is only suitable for a small number of patients with rheumatoid arthritis. The use of hormones must be accompanied by DMARDs, and calcium and vitamin D should be supplemented during hormone therapy.
(4) Botanical preparations: Effective in relieving joint swelling and pain. Radix et Rhizoma (10-20 mg three times a day), Paeoniflorin (1 to 2 tablets three times a day)
(5) Biological agents
Biological agents that can treat rheumatoid arthritis mainly include tumor necrosis factor (TNF-α) antagonists: the main agents in this category include etanercept (etanercept), infliximab (infliximab) and adalimumab (adalimumab). Compared with conventional DMARDs, the main features of TNF-a antagonists are rapid onset of action, significant inhibition of bone destruction, and good overall patient tolerability.