Rheumatic Arthriris Pain Relief Patch:Rheumatism is a set of infringement of joints, bones, muscles, blood vessels and related soft tissue or connective tissue disease, most of them autoimmune diseases.Much more discreet and slow, long course of disease, and most have a genetic predisposition.Diagnosis and treatment of all has the certain difficulty;How can detect different autoantibodies in the blood, may be associated with different HLA subtype;For non steroid anti-inflammatory drugs (NSAID), glucocorticoid and immunosuppressants have better short-term or long-term sexual response.
Rheumatism is a set of infringement of joints, bones, muscles, blood vessels and related soft tissue or connective tissue disease, most of them autoimmune diseases.Much more discreet and slow, long course of disease, and most have a genetic predisposition.Diagnosis and treatment of all has the certain difficulty;How can detect different autoantibodies in the blood, may be associated with different HLA subtype;For non steroid anti-inflammatory drugs (NSAID), glucocorticoid and immunosuppressants have better short-term or long-term sexual response.
Disease is introduced
Generally think that cause joint and muscle pain diseases are attributable to rheumatism.Continue down, still on the classification of rheumatism, generalized the existing more than 100 kinds of diseases, including infectious, autoimmune and metabolic, internal secretory, hereditary, degenerative, tumor, local, toxic and other causes of disease.In a narrow sense should be confined to the internal medicine category of dozens of diseases related to immune.Some of the disease or the interdisciplinary, such as gout, osseous arthritis, infectious arthritis, etc.
Classification of diseases
1. Give priority to with arthritis, such AS rheumatoid arthritis (RA), who began, the disease is divided into childhood and adult, ankylosing spondylitis (AS) and psoriatic arthritis.
2. Related to infection, such as rheumatic fever, lyme disease, syndrome, Wright reactive arthritis.
3. Diffuse connective tissue diseases: systemic lupus erythematosus (SLE), primary sjogren's syndrome (pSS), systemic sclerosis (SSc), multiple myositis (PM) and dermatomyositis (DM), mixed connective tissue disease (MCTD), vasculitis
1.Immune response: the body of exogenous or endogenous antigenic substances directly or through the stimulation of macrophages present, make the corresponding T cell activation, part of the T - caused cells to produce large amounts of a variety of inflammatory cytokines all kinds of tissues and organs different degrees of injury or damage;Part of the T - cells activated B - again, produced a large number of antibodies, direct or complex formation with antigen immune complex, make the tissue or organ damage or destruction.In addition by mononuclear cells of monocyte chemotactic protein (such as MCP - 1), can also be involved in the inflammatory response.Most of rheumatoid disease, or due to infection of exogenous antigen material, or due to generate endogenous antigenic substance in the body, can start or exacerbate this autoimmune reaction, can appear in a variety of serum antibodies.
2. Genetic background: recent studies have shown that some rheumatic diseases, connective tissue diseases, in particular, the expression of genetic susceptibility and disease, and patients is closely related to early or atypical cases and prognosis of disease has a certain meaning;The HLA (human leukocyte antigen) is most important.
3. The infection factors, according to a study to clarify the years a variety of infection factor, microbial antigens or super antigen, can be directly or indirectly stimulate or launch an immune response.
4. Endocrine factors: studies have demonstrated that estrogen and progesterone disorders, related to the occurrence of a variety of rheumatism.
5. Environment and physical factors, such as ultraviolet radiation can induce SLE.
6. Others: some drugs such as procaine amide, some oral contraceptives may induce SLE and ANCA positive small vasculitis.
Clinical manifestations of
1. Rheumatism is mostly about the disease and symptoms, and can be as high as 70-80%, about 50% is only pain, or red, swollen, heat, pain, and impaired the overall inflammation;Multiple joints involved.Abuse and joint size inspects have different diseases.
2. The heterogeneity, that is, the same disease, there are different subtypes, due to the genetic background, causes, mechanism is also different, therefore the types of clinical manifestation, symptoms, severity and response to treatment.
3. Rheumatism is violation of multi-system disease, pathological overlap, many similar symptoms, such as MCTD for the type of performance.
4. In a variety of serum antibodies and immune complex (CIC), and can be deposited on tissue (skin, synovial) or organ disease (kidney, liver).
5. Renault phenomena often appear in this kind of disease, such as SLE, MCTD.
Because of rheumatism is varied, should collect medical history in detail, in addition to the personal history, including family history;The comprehensive physical examination, paying special attention to joint symptoms, skin and mucosal lesions, whether Renault phenomenon, vasculitis lesions.According to the preliminary examination different disease history.
(1) routine inspection: rheumatism is assault and systemic system of multiple organ disease, so to make a comprehensive examination, blood, urine, blood sedimentation, CRP, comprehensive biochemical examination (liver function, renal function, muscle enzymes, etc.).
(2) serologic test: (1) general: RF, C3, C4 and CH50, CIC, IgG, IgA, IgM, IgE.(2) the particularity: a. antinuclear antibody spectrum of rheumatoid disease, diagnosis and differential diagnosis has the very vital significance.ANA usually do first, such as the drop degree > 1:40, should further check for other projects.B. HLA: although HLA has close correlation with rheumatism, but at present, there are few know about its and commonly used, more specific such AS HLA b - 27 on AS positive rate can be AS high AS 81.8%, also to Wright syndrome can reach 40%, in psoriasis is only 10%;DR4 / DR1 on positive RA 49-79%, JRA was 7%, but the JRA Dw4 26%, Dw14 was 47%, the DR3 in SLE is only 2.7%, in pSS is 5.6%.Only 3.3% of Behcet's disease HLA B5 is positive.C. other: such as Anti keratin antibody (AKA), resistance to histones antibody (Anti - histone antibody), for antiphospholipid antibodies, antinuclear weeks factor (ANCA) of diagnostic reference value to some disease.
(3) joint fluid check: fresh joint fluid is very important, should make a rule, the raise, serology and immunology examination.
(1) X-ray plain film: generally are commonly used, side, the size of the joints are available, limbs, shoulder, spine, sacroiliac joints;According to different diseases and parts, but also have different requirements, the damaged bone or growths typically show clearly, but as a result of image overlap, early small lesions is not easy to see;The synovial joint capsule, cartilage, meniscus, ligament is not displayed.
(2) computer imaging (CT) : can accurately display on a cross-sectional, subtle differences in the different tissue density is to observe small joint and soft tissue lesions of ideal inspection method.For AS much sacroiliac joint, spine;The knee joint cartilage and meniscus lesions, SLE of changes in the brain;Early pulmonary interstitial changes, etc.
(3) magnetic resonance imaging (MRI) : the joint and soft tissue lesions, than X-ray and CT of higher resolution, the soft tissue imaging is superior to CT.More used in bone, cartilage, meniscus and the diagnosis of fascia;It also helps to the brain, spinal cord disease.
(4) imaging: (1) joint imaging: air filter or organic iodine solution is commonly used in, also can use at the same time two kinds, called double contrast imaging.Can display the articular cartilage, meniscus, synovial membrane and ligaments and other structures.Helpful to the diagnosis of intra-articular lesions, usually for limb large joints, but has been less application.(2) angiography: divided into arteriography and vein angiography, the diagnosis of arteries inflammation or vasculitis is very helpful.
(5) : arthroscopy can be directly observed lesions of the various tissue, especially in the diagnosis and differential diagnosis of synovial inflammation, has great significance.When necessary, can take synovial biopsy and surgical treatment.
(6) biopsy: the diagnosis of difficult cases, such inspection, can assist in diagnosis.Such as skin and oral mucosa, kidney, liver, synovial joints, blood vessels, muscle, bone, cartilage, etc.Sometimes for immunohistochemical staining.
(7) isotope bone scan: to identify bone tumor (primary or secondary), myeloma are of great help.
Ultrasound examination (8) : the joint capsule, cartilage, synovial thickness, fluid can be judged.
Rheumatoid disease is a kind of infringement of a variety of organization system and internal organs of autoimmune diseases.Varying levels of immune inflammation, can cause into various tissue and organ damage, the serious influence its normal function.Even fatal damage.In addition, most of the symptoms of all the relevant section of the rheumatic diseases;Each patient, the same kind of disease, different course has its particularity.Should be carefully evaluation, in order to develop the individual treatment plan.Treatment goals should include relieve symptoms, improve disease, restore function, improve the quality of life, as far as possible, the continuation of the patient's life.Since most of the rheumatic diseases is still cannot effect a radical cure, so for the patient's cooperation, long-term adherence to treatment.Treatments include drugs, physical therapy, rest and exercise, orthopaedic and surgery.Education to know your patient, cooperate with treatment.
The following discussion on drugs in treating rheumatic diseases.
Treatment of rheumatoid disease of the drug can be divided into the following categories:
1. Non steroid anti-inflammatory drugs (NSAIDs) : the role of these drugs, mainly antipyretic, anti-inflammatory and analgesic, and to reduce inflammation reaction and purpose.The earliest for aspirin (acetylsalicylic acid) are still effective drugs for the treatment of acute rheumatic fever and rheumatic arthritis.Later produce all kinds of salicylic acid, a class of drugs commonly used with ibuprofen and diclofenac, indomethacin, piroxicam, naproxen, etc., but various drug pharmacokinetics and adverse reaction of each are not identical, mainly in gastrointestinal, renal, liver and blood system, it is important to note that when using dosage, usage, side effects, etc.
2. Adrenal cortical hormone, is mainly refers to glucocorticoids, because such drugs have the anti-inflammatory and immune inhibitory effect, has the strong and rapid eliminate inflammation and inflammation symptoms, such as fever, joint swelling and pain.So for a variety of rheumatic diseases, often used as the first line drugs.In the clinical application of short-acting, effect and long-term preparations.Oral use, muscle or joint cavity injection, intravenous injection, but according to disease, illness make different choices.But because it is not effect a radical cure drug, long-term use can cause infection, osteoporosis, femoral head necrosis, diabetes, peptic ulcers, high blood pressure, mental disorder, etc.;And such as withdrawal too easy generation condition bounce phenomenon, so we should pay attention to according to the disease and illness, adjust the kinds and dosage of the drug use.In addition to the severe patients, in small doses in principle, it is advisable to short course of treatment.
3. To improve the condition of anti-rheumatism drugs (DMARDs) is also called slow-acting drug rheumatism.These drugs include many kinds structure, effects of different drugs.Their commonness is working slowly, the accumulation of a certain role, so after discontinuation, disappear or slower, still can maintain for a period of time.They no anti-inflammatory analgesic effect directly, but through different mechanisms can have anti-inflammatory and immune or immunosuppression.Therefore, can also improve joint swelling, pain, rigidity and reducing systemic symptoms, reduce the acute phase response proteins, blood sedimentation.If use for a long time, also can improve other immune indexes, such as RF, ANA, etc.Some can be made radiation images is improved.DMARDs class of drugs including antimalarial chloroquine, hydroxychloroquine, willow nitrogen sulfanilamide pyridine, methotrexate, azathioprine, ring phosphoryl ammonia, penicillamine, gold agents, ring spore element A and fluorine mitt.
Above all kinds of drugs on the human body important organs (liver, kidney, bladder, lung, stomach, gonad) and organization (bone marrow) have different toxic effects, the choice of indications should be paid attention to.
4. Other: more than other treatment including tripterygium wilfordii glycoside, TGP, such as you can.
(1) you can: inhibition of prostaglandin synthesis, inhibit the activity of collagenase, decomposition and prevent cartilage destruction, inhibit osteoclast.Can diminish inflammation, analgesia.
(2) total glucoside tripterygium wilfordii: inhibition of T and B cell proliferation, inhibition of IL - 2 T - cells are generated and B - cell immune globulin.Inhibition of prostaglandin production.Have strong anti-inflammatory and immune inhibitory effect.
Rheumatism patients, in addition to drug therapy, there are a lot of circulating immune complex in blood, have high immunoglobulin, can choose immunosorbent and plasma clearance therapy;Remove the immune complex and higher immune globulin in the blood plasma, RF, etc.Such as too many lymphocytes immune activity, also can use a single nuclear cell removal of therapy.To improve T, B cells and macrophages and function of natural killer cells, reduce blood viscosity, dredge microcirculation, can achieve the goal of improving symptoms.
The surgical treatment
Can make synovium resection in patients with rheumatoid arthritis, early, late can make joint replacement, or tendon repair or transfer.Improve the patients quality of life.
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