Treatment of rheumatoid arthritis includes general treatment and medication.
The aim of treatment is to reduce pain and slow down the progression of the disease. Commonly used therapeutic drugs include NSAIDs, slow-acting drugs, biologics, and glucocorticoids.
NSAIDs: the more widely used ones include celecoxib, nimesulide dispersible tablets, diclofenac, meloxicam, etc. Xue Luan, Department of Rheumatology and Immunology, Shanghai Yueyang Hospital
Slow-acting drugs: including methotrexate, leflunomide, salazosulfapyridine, chloroquine/hydroxychloroquine, azathioprine, etc. They can suppress inflammation and reduce the amount of adrenocorticosteroids. The main side effects of these drugs are liver damage, pneumonia and bone marrow suppression and most likely an increased risk of malignancy with prolonged drug use. Patients should be made fully aware of these potential side effects and advised to use the medication under expert supervision.
Glucocorticosteroids: Significantly effective for acute inflammation, with more side effects for long-term application and highly prone to relapse after discontinuation
Biological agents: compared to conventional drug therapy, both doctors and patients can observe the efficacy of biological agents, which can be almost immediate. The common side effects of these drugs are infections, including bacteria, tuberculosis, viruses, etc. There is a lack of long-term follow-up information on whether long-term application can cause an increased chance of developing tumors. This class of drugs is expensive.
General treatment.
1, glucocorticoids and immunosuppressants: In general, glucocorticoids do not have significant effect on the disease, but usually have certain effect on inflammatory myopathy, inflammatory phase of interstitial lung disease; in the early edema phase, they also have effect on arthralgia and myalgia. The dose of prednisone is 30-40mg/day for several weeks and then tapered to a maintenance dose of 10-15mg/day. In patients with advanced azotemia, glucocorticoids are contraindicated because they promote occlusive changes in the renal vasculature. The efficacy of immunosuppressants is uncertain. Commonly used are cyclosporine A, cyclophosphamide, azathioprine, methotrexate, etc. There are reports on the skin, joints and renal lesions have certain efficacy, combined with glucocorticoids, can often improve the efficacy and reduce the amount of glucocorticoids.
2, penicillamine: in the process of conversion of collagen into collagen, monoamine oxidase is required to participate in polymerization and cross-linking. Penicillamine can complex the copper ions in MAO, thus inhibiting the maturation of new collagen and activating collagenase to degrade the formed collagen fibers. Common adverse reactions include fever, anorexia, nausea, vomiting, mouth ulcers, abnormal taste, rash, leukopenia and thrombocytopenia, proteinuria and hematuria.
Gout
Commonly used drugs include.
1.Non-steroidal anti-inflammatory drugs: used during acute attacks to reduce pain, commonly used include colchicine, indomethacin, diclofenac, etc. However, colchicine has greater side effects and is now less commonly used.
2, glucocorticoids: acute attack, joint pain is difficult to control, can be used, can quickly improve the pain symptoms, does not advocate long-term use.
3.Inhibit uric acid production drugs: mainly allopurinol. Acute attacks are prohibited. The side effects of the drug are large, and the more serious adverse reactions are exfoliative dermatitis.
4.Gout Lixin/Ligrisen: Inhibit the reabsorption of uric acid by the renal tubules, thus reducing the concentration of uric acid in the blood. It is prohibited in the acute stage.
5.Sodium bicarbonate tablets: It can alkalize urine and promote the excretion of uric acid.
Gout patients when strict control of diet, less purine intake, diet, see the content of the rehabilitation health care section of the website.
Osteoporosis
1.Alendronate: inhibit the role of osteoclasts, and at the same time has the effect of prevention and treatment of osteoporosis.
2. Calcitonin: absorbed by subcutaneous, intramuscular or nasal injection, effective for women with osteoporosis who have stopped menstruating for more than five years. Side effects include loss of appetite, flushing, rash, nausea and dizziness. However, as soon as the medication is stopped, the rate of bone loss will begin to accelerate, so long-term treatment is necessary.
3.Calcium and vitamin D: The combination is more effective.
4.Hormone supplementation therapy: Estrogen plus luteinizing hormone can prevent and treat osteoporosis. If there is no uterus, progesterone is not needed.
Postmenopausal osteoporosis is a highly prevalent condition in postmenopausal women, with foreign statistics showing a risk rate of 58% in women over the age of 60. It is associated with reduced levels of hormones synthesized by the ovaries, resulting in bone pain and fractures, which seriously affects the quality of life of women and increases their disability and mortality rates. Because its pathogenesis has not been fully elucidated, drug treatment has limitations, and long-term use of Western drugs can easily bring many side effects to patients.
Osteoarthritis
1, chondroprotective agents, clinically used are glucose sulfate, aminoglucose, sodium hyaluronate, the first two are oral drugs, sodium hyaluronate is mainly for joint cavity injection, such drugs can promote cartilage repair, generally longer medication time.
2, the application of non-steroidal anti-inflammatory drugs: non-steroidal anti-inflammatory drugs have the effect of local anti-inflammatory and pain relief, can improve joint pain symptoms.
3, Chinese medicine using methods such as liver and kidney treatment, can reduce the symptoms and delay the progress of the disease.