Diagnosis and Treatment of Arthritis
[Overview] Rheumatoid arthritis (RA) is an autoimmune disease with unknown cause, which is more common in middle-aged people. The prevalence rate in China is about 0.32-0.36%. The main symptoms are symmetric, chronic, progressive polyarthritis. Chronic inflammation and hyperplasia of the joint synovium form pannus, invading joint cartilage, subchondral bone, ligaments, and tendons, causing destruction of joint cartilage, bone, and joint capsule, ultimately leading to joint deformity and loss of function. Written by Senhua Dai from the Department of Endocrinology/Rheumatology and Immunology at Pingxiang People's Hospital.
[Clinical Manifestations] The condition and course of the disease vary individually, ranging from brief, mild oligoarthritis to rapidly progressive polyarthritis. The most commonly affected joints include proximal interphalangeal joints, metacarpophalangeal joints, wrists, elbows, shoulders, knees, and toes; cervical vertebrae, temporomandibular joints, sternoclavicular and acromioclavicular joints can also be involved, accompanied by restricted movement; hip joint involvement is rare. Arthritis often presents as symmetrical, persistent swelling and tenderness, often accompanied by morning stiffness. The most common joint deformities are wrist and elbow ankylosis, subluxation of the metacarpophalangeal joints, ulnar deviation of the fingers, and "swan-neck" or buttonhole deformities. In severe cases, joints become fibrous or bony ankylosed, and due to muscle atrophy and spasm around the joints, joint function is lost, making self-care impossible. Besides joint symptoms, rheumatoid nodules and visceral lesions such as heart, lung, kidney, peripheral nerves, and eyes may occur.
[Experiments] Most patients in the active phase have mild to moderate normocytic anemia, with mostly normal white blood cell counts. Sometimes eosinophilia and thrombocytosis may be observed. Serum immunoglobulins IgG, IgM, IgA may increase, serum complement levels are mostly normal or slightly elevated, and 60%-80% of patients have high levels of rheumatoid factor (RF). However, RF positivity can also be seen in chronic infections (hepatitis, tuberculosis, etc.), other connective tissue diseases, and normal individuals. Other autoantibodies such as anti-keratin antibody (AKA), anti-perinuclear factor (APF), and anti-cyclic citrullinated peptide (CCP) have higher diagnostic specificity for rheumatoid arthritis.
[X-ray Examination] To confirm the diagnosis, stage, and progression of this disease, radiographs including both wrist joints and hands should be taken at the onset of the disease.