Rheumatoid arthritis (RA) is a chronic, systemic disease with inflammatory synovitis of unknown etiology. It is characterized by multiple joints, symmetry, and aggressive joint inflammation of the hand and foot facet joints, often accompanied by involvement of extra-articular organs and positive serum rheumatoid factor, which can lead to joint deformities and loss of function.
The onset of RA may be related to heredity, infection, sex hormones and so on. The pathology of RA arthritis mainly includes a proliferation of synovial lining cells, infiltration of a large number of inflammatory cells in the interstitium, and the formation of microvessels, the formation of pannus, and the destruction of cartilage and bone tissue.
1. prone People
Women are more common, and the incidence rate is 2 to 3 times that of men. It can occur at any age, with a high incidence of 40 to 60 years old.
2. Symptoms and signs
It may be accompanied by systemic symptoms such as weight loss, low fever, and fatigue.
(1) Morning stiffness The subjective feeling of inflexible joint movement when getting up in the morning is a non-specific manifestation of joint inflammation, and its duration is directly proportional to the severity of inflammation.
(2) The manifestations of joint involvement ① Polyarticular involvement presents symmetric polyarthritis (often ≥5 joints). The susceptible joints include the hands, feet, wrists, ankles, and temporomandibular joints. Others may include elbows, shoulders, cervical spine, hips, and knees. ②Joint deformity The deformities of the hand include fusiform swelling, ulnar deviation, swan neck deformity, button pattern deformity and so on. Foot deformities include supine toe deformity, valgus deformity, metatarsophalangeal joint subluxation, curved hammer toe, and foot valgus deformity caused by the downward subluxation of the metatarsal head. ③Other carpal tunnel/tarsal tunnel syndrome caused by the compression of the median nerve/posterior tibial nerve, the knee joint cavity squeezes into the back of the joint to form a popliteal cyst (Baker’s cyst), cervical spine involvement (the second and third cervical vertebrae are more See) There may be neck pain, neck weakness and difficulty in maintaining its normal position, atlantoaxial subluxation, and corresponding manifestations of spinal cord compression and insufficient blood supply to the vertebrobasilar artery.
(3) Extra-articular manifestations ①General manifestations may include fever and rheumatoid nodules (organized granulomas, which are related to high titer RF, severe joint destruction and RA activities, and are more common in elbows and joint olecranon processes, Sacrum and other joint carina and frequent compression), rheumatoid vasculitis (necrotizing arteritis that mainly involves small arteries, which can be manifested as finger and toe necrosis, skin ulcers, peripheral neuropathy, etc.) and lymph nodes Swelling. ②Heart involvement can have pericarditis, pericardial effusion, epicardium, myocardial and valve nodules, myocarditis, coronary arteritis, aortitis, conduction disorders, chronic endocarditis, and heart valve fibrosis. ③Respiratory system involvement may include pleurisy, pleural effusion, pulmonary arteritis, interstitial lung disease, and nodular lung disease. ④The renal manifestations mainly include primary glomerular and tubulointerstitial nephritis, renal amyloidosis, and renal damage secondary to drug therapy (gold preparations, penicillamine and NSAIDs). ⑤ In addition to the symptoms of peripheral nerve compression, the nervous system can also induce neurological diseases, myelopathy, peripheral neuropathy, ischemic neuropathy secondary to vasculitis, muscle hypertrophy, and neurological diseases caused by drugs. ⑥Anemia is the most common extra-articular manifestation of RA. It is anemia of chronic disease, often mild to moderate. ⑦The digestive system can be caused by RA vasculitis, complications or drug treatment. ⑧Uveitis may occur in young patients and scleritis in adults, which may be caused by vasculitis. There may also be sicca conjunctival keratitis, scleral softening, scleral softening and perforation, and corneal dissolution.
(4) 1% of RA patients with Felty syndrome may have splenomegaly, neutropenia (and thrombocytopenia, decreased red blood cell count), and often have severe joint disease, high titer of RF and ANA positive, belonging to one type Severe RA.
(5) Relieving seronegative, symmetrical synovitis with pitting edema syndrome (RS3PE) is more common in men, often onset after 55 years of age, with acute onset, with symmetrical wrist joints, flexor tendon sheaths and small hand joints Inflammation, there may be pitting edema on the back of the hand. Morning stiffness lasts for a long time (0.5 to 1 day), but RF is negative, and X-rays usually have no bone destruction. 56% of patients are HLA-B7 positive. Therapeutic response to NSAIDs alone is poor, while low-dose glucocorticoids have a significant effect. It usually resolves spontaneously after 1 year, and the prognosis is good.
(6) Adult Still disease (AOSD) is a rare type of RA in which acute onset and relief of high fever, arthritis, rash, etc. alternate. It is named for its clinical manifestations similar to systemic-onset juvenile rheumatoid arthritis (Still disease). Some patients turn into typical RA after several episodes.
(7) Senile-onset RA often begins at the age of 65, with small gender differences, mostly acute onset, and rapid development (part of the initial manifestation is OA, and typical RA manifestations appear after a few years). The prominent manifestations are hand and foot edema, carpal tunnel and tarsal tunnel syndrome, and polymyalgia. Morning stiffness is obvious, 60% to 70% RF is positive, but the titer is mostly low. X-rays are mainly osteoporosis, with few invasive changes. Patients often die due to complications such as cardiovascular, infection and impaired renal function. NSAIDs should be selected carefully. Small doses of hormones can be used, which respond better to slow-acting antirheumatic drugs (SAARD).
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