Rheumatoid arthritis

Rheumatoid arthritis

Summary

Rheumatoid arthritis is a kind of chronic whole body one's own immune disease. Mainly infringe every joint of whole body, present occuring frequently and symmetry chronically and increase the slippery membrane inflammation of natural disposition, therefore cause the destruction of articular cartilage and joint capsule, cause the strong straight deformity of joint finally. Besides joint, health other organs or tissues can also be given much trouble, including places such as hypodermis, heart, blood vessel, lung, spleen, lymph node, eyes and serous coat,etc.. Age is many among 25- 55 years old that this disease has illness coming on, see to children too. Women's morbidity is 2- 3 times higher than that of men. This disease is presented chronically and passed, pathological change increases the drama and relieves and hocket repeatedly. There are rheumatoid factor and immune complex that exist in the most patients blood plasma. Rheumatoid arthritis is a personal disease relying mainly on joint and joint surrounding tissue non- suppurative inflammation, often accompany abarticular disease, symptom, so called rheumatoid disease. Synovial cavity slippery the intersection of membrane and inflammation, ooze liquid, cell hyperplasia, granulation swollen to form, cartilage and bon tissue are destroyed, and function obstacle that the joint is strong and straight finally. Infringe more small joints, for instance hand, foot and wrist jonint,etc., it is often symmetry, it is chronic to be presented and pass, can relieve temporarily nature, because much damaged systematically, can find one's own antibody in serum.


Cause of disease

The cause of disease of this disease is not clear. The factor related to having illness coming on is as follows,

Infect: The focus relates to the fact that a disease has illness coming on.

Heredity: The patient HLA-DRwu antigenic detection rate of this disease obviously rises, it relates to heredity to point out and have illness coming on.

The immunity is in disorder: A large number of experiment materials support rheumatoid arthritis to be inflammation and reactive disease due to the regulating function disorder of immune system at present.


Pathology

(1) Basic pathological change

Rheumatoid arthritis as one the intersection of whole body and the intersection of and immune disease, give much trouble in the organ and organization while being other in joint, lymphocyte, plasma cell and macrophage closely related to immunoreaction are soaked, and can accompany the lymphocytic follicle to take shape. In addition, this disease, pathological change mainly involves the connective tissue, collagenic disease, the intersection of quality and collagenous thread and blood vessel can appear the intersection of cellulose and kinds of sex change or necrosis (will probably deposit by some immune complex due to) among the whole body ,Shown as: Rheumatoid swollen granulation or rheumatoid brief summary form, have sure characteristic nature. Under the mirror, brief summary central authorities, for large stretch of the intersection of cellulose and kinds of necrosis, have nuclear to take the form of bar or kinds of upper leather cell that arrange radially around, the periphery is outgrowth capillary and fibrous master cell again, companion's above-mentioned inflammatory cell is soaked. Then fiber finally. The brief summary of rheumatoid mainly takes place on the skin, secondly places such as heart, lung, spleen and serous coat,etc.. Vascular inflammation: Mainly happen in the venule and arteriolar, the weight differs, a few serious ones present cellulose a kind of necrosis arteritis, often with thrombosis.

(2) Pathological change of every organ

1. The joint has the most common pathological change, and symmetry that are mostly the occuring frequently, often involve brothers' small joint, especially mean digital articulation, palm refer to joint and Shu's toe joint, secondly it is joints such as knee, ankle, wrist, elbow, hip and vertebra,etc. in the near side.

( 1) Slippery membrane pathological change: In early days, main pathological change, in the slippery membrane, can be divided into acute and chronic two stages, there is no obvious demarcation line between the two.

Acute slippery the intersection of membrane and the intersection of joint and swelling at the inflammation, slippery membrane congest edema, surface slippery membrane organize, can see cooking stove necrosis and cellulose, cover. This can see neutral cells to soak, take lymphocytes and macrophages as the core. Muddy and lacteal in the synovial cavity to store up the liquid, or visible fibrin clot.

Chronic slippery membrane inflammation relatively has change of characteristic nature, are shown as: There are a large number of lymphocytes, macrophages and plasma cells that are soaked in the slippery membrane, and can form the lymphocytic brief summary, the longer one of course of disease can see and grow the centre. Slippery the intersection of membrane and cell enliven hyperplasia, can form multi-layer form, and what big and small afterbirth of the core does it it is obvious. The latter afterbirth thick liquid slightly basophilia, core have 2- 12, lie in the thick liquid periphery of afterbirth arrange in the shape of garland more. Slippery membrane fluffy hyperplasia and blood vessel Yi take shape. The chronic inflammation of the slippery membrane, cause new born blood vessel and fiber to organize hyperplasia, the slippery membrane is increased thick by the abnormality, and it is fluffy to form a lot of and break out to stretch to the synovial cavity. The inflammation granulation tissue is expanded, form the blood vessel Yi to the edge portion of articular cartilage in the slippery membrane, and cover and destroy the articular cartilage gradually.

( 2) The articular cartilage is changed: Acute slippery membrane inflammation can disappear instead of involving the articular cartilage, but when inflammation break out and change into chronically repeatedly, the articular cartilage must nearly be damaged. Show as different person who dye of ground substance subside or disappear, can be verified while being blue to dye with first aniline first. Blood vessel Yi that the edge of articular cartilage forms corrodes and destroys the articular cartilage directly, can be seen the cartilage rotten and special mess necrosis juncture of the two. And covers to the extension of disposition on the surface of whole articular cartilage with the blood vessel Yi gradually, the articular cartilage is destroyed seriously, is replaced by the blood vessel Yi finally. Long-term chronic inflammation and breaking out repeatedly, the constant hyperplasia of slippery film, organization piles up the fiber day by day, the fibrous disposition oozes out thing constant machine and cicatrix, make the synovial cavity narrow in the synovial cavity, the articular cartilage is destroyed and replaced by the blood vessel Yi at the same time, the fiber adhesion take place in two joint surfaces, it is strong and straight to form the fiber joint, can develop into the bone joint strong and straight finally. Because muscle convulsion and tendon lax around the joint, can cause joint dislocation or half dislocation, have aggravated the joint deformity.

( 3) The change of the adjacent tissue of joint: Chronic rheumatoid arthritis will cause the neighbouring bon tissue of joint to absorb and make ossicle to destroy with osteoporosis and articular cartilage, can be seen the small bag sometimes and take shape, the cortex of nearby bone is corroded and destroyed once in a while, can cause pathology fracture. These changes and broken bone cells and macrophages carry on ossicle to absorb, employ cortical hormone drug therapy and are involved etc. and have something to do by joint inflammation for a long time. The tendon, ligament and muscle are often given much trouble near the joint, office cooking stove nature lymphocyte, plasma cell and macrophage are soaked, accidental rheumatoid brief summary. Muscles are waste to wither with the sex. The enlargement of lymph nodes of drainage of joint pathological change, the hyperplasia of lymphoid tissue, it is obvious to grow in the centre, the granulation of accidental rheumatoid is swollen to take shape.

2. Rheumatoid disease beyond the joint changes uncommonly, many companions send to the person who has obvious active joint pathological change.

( 1) Lower tubercle of the skin: A joint see inviting with the most common one in other rheumatoid disease 20% - 25% Case,juxta-articular when lying in moring, most often osseous to stress and press into position suddenly at hawk mouth. Or a plurality of singly, size is from several millimetres to 2cm, the quality is hard, has no tenderness. The intersection of naked eye and view is ashen, central authorities is * yellow color necrosis districts, present typical rheumatoid granulation swollenly to change under the mirror. The time of lower tubercle of the skin present is relatively long, do not retreat for sustainable several months or several years.

( 2) Pathological changes such as heart and lung,etc.: Rheumatoid granulation swollen, vascular inflammation and lymphocyte, plasma cell and macrophage can appear to soak etc., change in a lot of organs and tissues, but more common on the heart ' Membrane) outside the membrane, cardiac muscle and heart in the heart With the lung, cause the quality among the heart, lung cooking stove or filling the air fiber finally. Cause the heart valve to be out of shape and not closing completely once in a while. It causes fibrous disposition pericarditis and pleurisy that the serous coat is given much trouble, cause pericardium and pleura to increase the thick, adhesion extensively finally.

( 3) Vascular pathological change: Acute cellulose a kind of necrosis arteritis appears once in a while, accompany thrombosis and cause infarction of corresponding organization frequently. The aorta can also be given much trouble.


Clinical manifestation

Get up disease to be many to have the intersection of fatigue and unable, the intersection of weight and lighten, the intersection of stomach and the intersection of receive well, low-heat and shouting pain numb in every limb,etc. and forerunner's symptom in several month for less than several week early slow.

( 1) Joint symptom:

1,Stiff in the morning: The first symptom of the joint, often appear before the joint pains. Pain is uncomfortable at the time of the stiff beginning activity of joint, it is stiff in the morning that joint activity increases to lighten or disappear. It is obvious in the morning that the joint is stiff in the morning, lighten in the afternoon.

2,The joint swells and aches: Present symmetry more, often invade and the palm refers to joint, wrist jonint, shoulder joint, toe digital articulation, ankle joint and knee joint. The joint is red, swollen, hot, aches, activity obstacle.

( 2) Abarticular to behave: Whether it is a part or its complication that rheumatoid arthritis displays all over. Joint pathological change of this disease can be disabled, but will not cause death. And abarticular often displays the lethal reason that is a disease.

1,Rheumatoid and tubercle: Saw to 15- 20% of the patients, the one that saw more the forearm and is often pressed stretched the side, such as one chi of sides and hawk's mouth. Touch to soft amorphous activity brief summary or one kind of brief summaries of rubber which is affixed to the periosteum under the cover. Serum rheumatoid factor is strong the cover lower rheumatoid and tubercle of the positive one are more common.

2,Rheumatoid vascular inflammation: Rheumatoid vascular inflammation is a basic pathological change of a disease, besides joint and joint surrounding tissue, vascular inflammation can happen in other places of whole body. Shown as and carried vascular inflammation far, ulcer of skin, neuropathy around changes, pericarditis, viscera arteritis such as heart, lung, intestine, spleen, pancreas, kidney, lymph node and testis,etc..

3,Kind of rheumatic heart disease: The heart is given much trouble, the cardiac muscle, valve ring or aorta root rheumatoid granulation are swollen takes shape, cardiac muscle, membrane and petals of ring lymphocyte soak and fiber take in the heart.

4,Rheumatoid pulmonary tuberculosis: Chronic fiber pneumonia is relatively common, the small blood vessel of lung soaks fibrin a kind of necrosis and monocyte, generate heat, dyspnea, coughs and chest pain.

5,The kidney is damaged.

6,The eye behaves: The grape and membrane inflammation are a common pathological change of childhood sex rheumatoid arthritis, often cause keratitis as human rheumatic arthritis.

7,Felty syndrome: It is a kind of serious rheumatoid arthritis, often cause the spleen to be swelling, neutral cells are reduced, the positive rate of rheumatoid factor of serum is high, it is positive to resist the nuclear antibody.

8,Dry syndrome: It is a kind of chronic inflammation one's own immune disease. Mainly infringe lachrymal gland and all kinds of salivary gland,etc., lead to the fact the body of gland is destroyed and secreted and reduced or scarce, dry disease group relying mainly on eyes and oral cavity mucous membrane of clinical manifestation.

9,Damage the digestive tract.


Check the project

The blood is alike: There is straight cell straight pigment anaemia, lymphocytes and the blood platelet increase and behave for activity one. Erythrocyte sedimentation rate is accelerated. It is the symbol that rheumatoid arthritis accompanies the serious whole body complication that acidophil increases.

Glue stagnat syndrome high: The rheumatoid factor IgM and IgG complex can form the viscous aggregate, causes and glues stagnat syndrome high.

Rheumatoid factor: Lymphocyte and the plasma cell in the slippery membrane of patient's joint of rheumatoid arthritis can produce a large number of rheumatoid factors, there are IgM, IgG and IgA rheumatoid factors

X-ray examination: Slice can see joint surface fuzzily in the joint X-ray, there are aggressive damages. Osteoporosis that the close joint of early period gets along with at disease, soft tissue swelling, ossicle corrodes phenomena. Articular cartilage necrosis can make the interval of joint change the narrow and fiber in later period.


Treat

Treatment is to relieve joint pain and prevent the joint from destroying, keep and improve the joint function. Take different therapeutic method at different stages of disease, the concrete method is as follows,

1,Physiotherapy: It is stiff in the morning that some thermotherapy, hot bath, hot spring bath, vapour treatment and paraffin wax treatment,etc. can make pain lighten to disappear, the patient feels comfortable. Acute exudative pathological change can be by having a cold compress to lighten pain. Infrared ray, ultrashort wave or shortwave diathermy,etc. can also increase some blood circulation, impel inflammation and swelling to disappear, pain is lightened, and in order to strengthen medicines to some function.

2,Surgery treatment.

3,Drug therapy:

(1) Salicylate: Aspirin is still a first-selected medicine to treat rheumatoid arthritis.

(2) Indometacin: Non- steroids resists inflammation medicine, the result is better, it eases pain, brings down a fever and resists inflammation function stronger.

(3) Third of benzene of different cube is sour: Relatively resist inflammation, easing pain and function of bringing down a fever strong more than 10 times of aspirin, side effect is smaller than aspirin.

(4) Cortical hormone: There is prominent curative effect on acute inflammation, employ more side effects for a long time, it was extremely apt to recur after medicines stopped.

(5) Penicillamine: Employ the penicillamine treatment, besides making joint symptom relieve, can make erythrocyte sedimentation rate and C reflect albumens to reduce, the rheumatoid factor is transferred to negatively.

(6) Dredge A third chest acid.

(7) The intersection of Thunder God and rattan: Have function of diminishing inflammation, antibacterial, regulating immunity, blood circulation promoting silt, insecticidal etc..

(8) Gold preparation: Biochemistry that may interfere with cells reacts. Pain to joint and stiff to have obvious curative effect morning, too can make erythrocyte sedimentation rate and C react albumen take a favorable turn, it can be up to 70- 90% that efficient.

(9) Immune inhibitor: There is certain curative effect on this disease, the commonly used one has ring phosphorus amide, sulphur thiazole purine.

(10) The immunity strengthens pharmaceuticals: Thymosin.


The diet is recuperated


Cereal (wheat, grain, oat, rye) , food such as milk, milk product, tea, coffee, red meat, citrus fruit, the patient may produce the bad response after eating, make symptom of rheumatoid arthritis become more serious. Its reason including irritation, intestine penetrating increase and intestinal fungus group lacks proper care etc.. In addition, should not be edible either in the diet shrimp, crab,etc., because the sea product sends things, it is apt to cause aggravating and recurring of disease.

The diet treatment is a part of complex treatment of rheumatoid arthritis, including two following ways: Treat supplemented by first, two, in order to cancel treating. Supplement and treat, refer to supplementing patients and lack in the body or to relieving the food with beneficial symptom, mainly have fish oil and primrose oil in night. In addition it is extensive to still have Mytilus of green lip of New Zealand, selenium, vitamin, alga, royal jelly of bee, ginseng,etc. and is adopted by rheumatoid arthritis patient. Cancel treating, refer to removing food such as cereal and milk product,etc. which the patient can't tolerate in the diet. " fasting " Cancelled the commonly used method while treating in the past, should be jealous of relieving the most effective method diet of symptom too, but does not advocate using at present.

Unsaturated fatty acid can be competed for with the peanut and four alkene acid, reduced the inflammation nature medium synthetically and weakening lipoxidase is stimulated and lain between in vain plainly - a function formated, lie between plain in vain and 1 one causing inflammatory mediuming strong, unsaturated fatty acid relieve the intersection of joint and symptom through inhibiting inflammation and reacting promptly. So, the food rich in unsaturated long chain fatty acid, such as fish oil, night primrose oil,etc., and some microelements such as selenium, can make the rheumatoid arthritis patient's symptom relieve, reduce the joint numbers of pain and swelling, shorten the morning, strengthen the grip, delay fatigue,etc..

Think selenium resists inflammation and immune regulating action, can make the condition relieve to mend selenium for the rheumatoid arthritis patient at present. The diet treatment can only be cooked in order to relieve a kind of auxiliary measure of patient's symptom, adjust the diet correctly, prevent the means that symptom sends again too. Unsaturated long chain fatty acid, for instance the fish oil, night primrose,etc., and some microelements, if selenium can make symptom of the arthritis patient of rheumatoid relieve, can reduce the joint numbers of pain and swelling, reduce morning stiff time, the intersection of increase and grip, relieve tired, etc. But can't change the course of disease.


Rheumatoid arthritis
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