1. Rheumatoid arthritis:
Clinical manifestations include multiple organ involvement, Rheumatoid nodules have specific manifestations, with hard nodules of varying sizes appearing on the extensor surface of the forearm, below the olecranon of the ulna, and and the Achilles tendon . (Imaging staging and diagnostic standards are the test points)
The active stage and imaging stage of rheumatism
ESR and CRP can reflect the activity of the disease, but rheumatoid factor RF does not reflect the activity of the disease. RF positivity only helps Diagnosis of RA.
RA’s x-ray staging :
html Stage 51: Soft tissue swelling around the joint, no destructive changes in the articular surface, visible osteoporosis at the joint end; Stage 52, narrowing of the joint space; Stage 53, osteoporosis The song is obvious, Articular cartilage and subchondral bone are destroyed, and moth-eaten changes appear;
html stage 54, in addition to the manifestations of stages 1 and 3, also has fibrous or bony ankylosis.
Diagnostic criteria for rheumatoid arthritis:
① Morning stiffness in or around the joints lasting at least 1 hour per day
② Swelling or fluid accumulation in at least 3 joints
③ Swelling of at least one joint of the proximal carpometacarpophalangeal joint
④Symmetric arthritis
⑤Rheumatoid knot Section
⑥ Rheumatoid factor positive
⑦ Imaging must include joint erosion or decalcification
It must meet 4 items to be diagnosed, and items ①~④ must last for 6 weeks.
Treatment: In addition to physical therapy, non-steroidal drugs and hormones, they can only improve symptoms but cannot control the condition. The anti-rheumatic drugs methotrexate that improve the condition are the first choice. Although they can improve the condition, they do not control the symptoms.
2. Systemic lupus erythematosus
Lupus has a different mechanism from rheumatoid. It is an immune disease in which pathogenic autoimmune complexes and antibodies form to damage the self. Rheumatoid is a synovitis of the joints. The disease has a genetic predisposition.
Clinical manifestations: shows symmetrical proximal joint inflammation like rheumatoid arthritis, but without joint destruction; there are various manifestations such as discoid erythema, discoid erythema, photosensitivity, Raynaud's phenomenon, inflammation of various systems, and low fever.
Laboratory tests:
① antinuclear antibody ANA: the best screening;
② anti-dsDNA antibody : one of the marker antibodies, related to activity;
③ anti-Sm antibody: for early atypical diagnosis, not related to activity;
④ Anti-SSA antibody : related to photosensitivity and skin lesions
⑤ anti-SSB antibody : Sjögren's syndrome related
⑥ represents activity: in addition to ②, there are also lupus band tests, complement C3 decrease, anti-rRNP antibody .
Diagnosis: There are 11 criteria, but unlike rheumatoid arthritis, diagnosis can be made with specific antibodies and manifestations of multi-system damage.
Treatment of : Glucocorticoid is the first choice for this disease, cyclophosphamide is the first choice for inducing remission period. It is currently believed that hydroxychloroquine should be used as background treatment for SLE, and it can be used for a long time during the induction and maintenance period.
Sjögren's syndrome
Dry oral and eye mucosa, SSA, SSB specific antibodies; vasculitis , Behcet's disease, etc. Practicing doctors only appear as differential diagnosis, immunotherapy , and symptomatic treatment is enough. Rheumatoid and lupus are the focus, and others can be briefly understood.
