What Is a Rheumatologist?

Rheumatic diseases are a group of extremely common clinical symptoms with joint pain and chills as the main symptoms. Rheumatism is an abbreviation for rheumatic diseases, which refers to a large group of diseases that affect bones, joints, muscles and the surrounding soft tissues, such as bursa, tendons, fascia, blood vessels, and nerves.

Basic Information

English name: rheumatic disease
Visiting department: Department of Internal Medicine, Rheumatology and Immunology

Common symptoms: Headache, fever, slight sweat, bad wind, weight, uncomfortable urination, joint pain, inability to flex, etc.
Contagious: no

Classification of rheumatic diseases

Diffuse connective tissue disease

(1) Rheumatoid arthritis.

(2) Juvenile arthritis.

(3) Lupus erythematosus

1) disc-shaped;

2) Systematic.

(4) Scleroderma

1) Local type linear; spotted.

2) Systemic sclerosis diffuse scleroderma; CREST syndrome; caused by chemicals (or drugs).

(5) diffuse fasciitis

Diffuse fasciitis with or without eosinophilia.

(6) Polymyositis and Dermatomyositis

Polymyositis; Dermatomyositis; Polymyositis or dermatomyositis associated with malignant tumors; Polymyositis or dermatomyositis in children is associated with vascular disease.

(7) Necrotizing vasculitis and other types of vascular disease

1) Nodular polyarteritis.

2) Allergic eosinophilic granulomatous vasculitis (Churg-Strauss syndrome).

3) Hypersensitivity vasculitis serum disease; allergic purpura; mixed cryoglobulinemia; caused by malignant tumors; hypocomplement vasculitis.

4) Granulomatous arteritis Wegener's granulomatosis; giant cell (temporal) arteritis with or without rheumatic polymyalgia; arteritis.

5) Kawasaki's disease.

6) Behcet syndrome.

(8) Sjogren's syndrome.

(9) Overlap syndrome.

(10) Others Rheumatic polymyalgia; Recurrent panniculitis; Recurrent polychondritis; Nodular erythema.

2. Serum negative spinal arthropathy

(1) Ankylosing spondylitis.

(2) Reiter syndrome.

(3) Psoriatic arthritis.

(4) inflammatory bowel disease arthritis.

3. Osteoarthritis.

4. Infectious arthritis.

5. Arthropathy due to metabolic and endocrine diseases

(1) Crystal-induced arthritis

Caused by crystals of sodium urate (gout); Caused by crystals of calcium pyrophosphate (pseudogout, cartilage calcification); Caused by crystals of alkaline calcium phosphate (hydroxyapatite).

(2) Other biochemical abnormalities

1) Amyloidosis Primary; Secondary.

2) Vascular disease.

3) Other congenital diseases Marfan syndrome; Ehlers-Danlos syndrome; osteogenesis imperfecta.

4) Endocrine disease diabetes, acromegaly, hyperparathyroidism, hypothyroidism.

5) Immune deficiency disease Hypoglycemia; lgA deficiency; complement deficiency.

(3) Hereditary diseases congenital polyarticular flexion; hyperactivity syndrome; progressive ossifying myositis.

6. Tumorous rheumatism

(1) Primary synovial tumor; synovial sarcoma.

(2) Secondary leukemia; multiple myeloma; metastatic tumor.

7. Bone and cartilage lesions

(1) Systemic and localized osteoporosis.

(2) Osteomalacia.

(3) Hypertrophic osteoarthritis.

(4) Diffuse primary bone hypertrophy.

(5) Osteitis.

(6) Ischemic osteonecrosis.

(7) Costal chondritis.

(8) Others.

8. Non-articular rheumatism

(1) Periarticular lesions include bursitis, tendinopathy, attachment point inflammation, and cysts.

(2) Intervertebral disc disease.

(3) Primary lower back pain.

(4) Others Fibromyalgia, Fibritis; Mental rheumatism.

9. Other diseases with joint symptoms

(1) Periodic rheumatism.

(2) Intermittent joint effusion.

(3) Drug-induced rheumatism syndrome.

(4) Other chronic active hepatitis, polycentric mononuclear-macrophages, trauma, etc.

It can be seen from the above classification that some of them are secondary to diseases with a clear etiology, such as tumors, endocrine-metabolic diseases, and infections. The most common rheumatic diseases in medical work are diffuse connective tissue disease and serum-negative spondyloarthropathy.

Clinical manifestations of rheumatic diseases

Patients may have headaches, fever, micro sweats, bad wind, weight, uncomfortable urination, sore joints, and inflexibility. In addition to pain, joint lesions are accompanied by swelling and dyskinesia, showing a chronic course of alternation and remission. Due to the poor blood circulation of the patient, the nutrition required by the muscles or tissues cannot be transmitted through the blood circulation, which causes the patient's muscles to lack nutrition and accelerates aging and becomes stiff. Seriously, it can cause muscle and blood vessel atrophy in some patients. Some patients may have joint-induced Disability and visceral failure.

Rheumatic disease check

Autoantibodies

In the scope of rheumatic diseases, autoantibodies used in the clinic are divided into the following four categories: antinuclear antibody spectrum, rheumatoid factor, antineutrophil plasma antibody, and antiphospholipid antibody. It is very helpful for the diagnosis of diffuse connective tissue disease.

(1) Antinuclear antibody spectrum.

(2) Except for rheumatoid arthritis, rheumatoid factors are also found in other connective tissue diseases, such as systemic lupus erythematosus, Sjogren's syndrome, mixed connective tissue disease, and systemic sclerosis.

(3) Anti-neutrophil cytoplasmic antibody (ANCA) Using normal human neutrophils as a substrate, it is divided into C-ANCA (cytoplasmic) and P-ANCA (perinuclear) according to the fluorescence pattern seen. ), Other respective antigens are serine protease and bone oxidase in the cytoplasm. This antibody is very helpful for the diagnosis of vasculitis, and different ANCA antigens suggest different vasculitis. For example, C-ANCA mainly appears in Wegener's granulomatosis, Churg-Strauss syndrome, and P-ANCA is found under the microscope polyangiitis. Crescent body nephritis, rheumatoid arthritis, systemic lupus erythematosus, etc.

(4) Anti-phospholipid antibodies are used clinically by two methods: anti-phospholipid antibodies and lupus anticoagulants. This antibody appears in many autoimmune diseases such as systemic lupus erythematosus. Antiphospholipid syndrome refers to the clinical manifestations of arterial or venous thrombosis, thrombocytopenia, and habitual abortion. Patients with anticardiolipin antibodies and / or lupus anticoagulant positive may be primary in addition to diseases such as systemic lupus erythematosus.

2. Synovial fluid inspection

To some extent, it reflects joint synovial inflammation. In particular, finding urate crystals or synovial bacterial cultures in synovial fluid is helpful for the diagnosis of gout or septic arthritis, respectively.

3. Arthroscopy

X-ray examination is helpful for the diagnosis and differential diagnosis of joint disease, and can also follow up to understand the evolution of joint disease. It is currently the most commonly used imaging diagnostic method. Others include joint CT, MRI, and isotope tests.

Rheumatic disease diagnosis

Diagnosis can be made based on clinical manifestations and related examinations.

Rheumatic disease treatment

Rheumatic diseases are mostly chronic diseases. The purpose of treatment is to improve the prognosis of the disease, maintain the function of joints and organs, and alleviate related symptoms.

Anti-inflammatory and analgesic treatment

Rheumatism often invades joints, muscles, bones, and soft tissues. Pain, swelling, joint dysfunction, and fever are more prominent symptoms. Antipyretic, analgesic, and anti-inflammatory are the primary goals of treating this group of diseases.

2. Etiology treatment

If rheumatic diseases are not treated properly and reasonably, joints, muscles, bones and other diseases will cause dysfunction and deformity, leaving lifelong disability, affecting life and labor, and bringing economic losses to individuals and society. From the perspective of the tissues invaded by rheumatic diseases, systemic lupus erythematosus, rheumatoid arthritis, sjogren's syndrome, scleroderma, polymyositis, and necrotizing vasculitis, which have previously been referred to as connective tissue disease, have autoimmune functions. Disorders, a group of diseases that belong to autoimmune disorders. Gouty arthritis has been identified as a disorder of purine metabolism leading to the deposition of urate crystals in the joints, often involving joint cavities, bones, and ligaments. Therefore, in addition to symptomatic treatment to relieve symptoms, the treatment of rheumatism also requires etiology treatment. Autoimmune disorders require immunoregulation, such as the use of glucocorticoids and immunosuppressants.

3. Biological therapy and bone marrow transplantation

Biological treatment and bone marrow transplantation treatment have also been used in clinical trials.

4. Arthroscopic treatment

Arthroscopic treatment can be used for joint disease, which greatly improves the efficacy, improves the prognosis of the disease, significantly reduces the disability rate, and improves the quality of life of patients.