03.2019 Life Guide
Sore and pain everywhere!Do you have rheumatoid arthritis?
Far Eastern Memorial Hospital Allergy and Immunorheumatology Department / Dr. Zhang Tinghui
Doctor, I often feel sour here and painful there. Have I got rheumatism? In fact, joint soreness is a common symptom, some of which are just joint degeneration, and some of which are more serious "rheumatoid arthritis". How can we identify it? This issue of "Health Column" has a professional doctor to answer.
What is "rheumatoid arthritis"?
Rheumatoid arthritis (RA) is a chronic, inflammatory polyarthritis. The so-called "chronic" is a disease requiring long-term drug control. However, in the early stage of onset, most patients are often hard to believe and accept. Arthritis is also a disease requiring long-term drug use.
The most important basis for the diagnosis of rheumatoid arthritis is the swelling of the synovial soft tissue near the joint caused by inflammation, rather than simple pain. Patients usually have recurrent swelling and pain in their joints for a month or two before they come to the rheumatology department for medical treatment. Rheumatoid arthritis may invade less joints at first, and often more than five joints at last. When diagnosed, the assessment of hand joints is the main method. More than 70% of fingers, palms and wrists also invade shoulders, knees, ankles and other joints. Although it may occur in men, women, young and old, but most of them are middle-aged women. If they do not actively seek medical treatment or medication, in addition to affecting their work and life, they are more likely to progress to destruction of bones, joint deformations, and even disabilities.
How to diagnose rheumatoid arthritis?
In order to curb the disease as early as possible and treat it effectively, the American Rheumatism Medical Association and the European Rheumatism Federation proposed a new classification criterion in 2010 (see Table 1 for details) to assess the comprehensive scores of four projects, namely, "Infringed Joints", "Serology", "Acute Inflammation Indicators" and "How Long Will Symptoms Appear", in order to diagnose which patients will develop into rheumatoid joints. Rheumatoid arthritis can be diagnosed if points/credits are above 6. In principle, the more inflammation of facet joints, the more positive rheumatoid factor (RF) or anti-cyclic citrulline antibody (anti-CCP), the higher the inflammation index or symptoms lasting for more than six weeks, the more consistent with the diagnosis of rheumatoid arthritis. As for other autoimmune diseases, such as xerosis, lupus erythematosus, or degenerative arthritis of the hand, it may also be chronic and predisposing to arthritis of the hand, especially degenerative arthritis of the hand, which usually invades the distal interphalangeal joint of the hand. Although often deformed, there is little swelling of the soft tissue. Generally speaking, palpation is only a sensation of skin and bones. Special attention should be paid to the distinction between rheumatoid arthritis and rheumatoid arthritis. In addition to the palpation of joints, blood tests will also be taken if there are doubts in clinic. It should be noted that rheumatoid factors sometimes appear false positive, which should be interpreted by doctors in conjunction with joint symptoms.
Treatment of rheumatoid arthritis
Establishing the diagnosis of rheumatoid arthritis and receiving drug treatment as soon as possible is the only way to prevent joint damage and deformation. Doctors usually give different treatments depending on the severity of arthritis and whether the patient has other chronic diseases. They may include anti-inflammatory and analgesic drugs, steroids, traditional immunomodulatory drugs (or anti-rheumatic drugs), and newly developed biological agents (target therapy) in recent years. Although traditional anti-rheumatic drugs have certain effects, their effects are slow, and it often takes more than one or two months to see the results. In some cases, even if the combination of two or three traditional drugs can not be effectively controlled, biological agents can be considered at this time.
The so-called biological agents are aimed at the abnormal immune mechanism in inflammatory reaction. Although the "target therapy" produced by biotechnology has a rapid effect and relatively few metabolic side effects, we should pay attention to the risk of infection. In addition, because biologicals are expensive, health insurance will only be paid if traditional anti-rheumatic drugs or steroids are used for a certain period of time and more than a certain dose.
Seeking a doctor
No matter what medication is used, the most important thing is to cooperate with doctors, discuss and master their own conditions; because rheumatoid arthritis can not be cured at present, it can only be controlled, so the best condition control can be achieved by cooperating with tracing and medication between doctors and patients. In addition, Far Eastern Memorial Hospital's Friends of Enrichment, a support group for immune rheumatism, not only promotes correct medical concepts, but also provides opportunities for patient-to-patient exchanges. Sometimes, the personal statement and mood sharing of the patients are better than the thousands of words of the doctors. I hope that the patients can advance hand in hand with the doctors and other patients on the long way to control the disease and enjoy life.
