What Is Hemarthrosis?

Arthritis generally refers to inflammatory diseases that occur in human joints and surrounding tissues, and are caused by inflammation, infection, degradation, trauma or other factors, and can be divided into dozens of types. There are more than 100 million arthritis patients in China, and the number is increasing. The clinical manifestations are redness, swelling, heat, pain, dysfunction and joint deformity of the joints. In severe cases, joint disability is caused and the quality of life of patients is affected. According to statistics, half of the people over 50 years of age in China suffer from osteoarthritis, and 90% of women and 80% of men over 65 years of age suffer from osteoarthritis. The prevalence rate in China is 0.34% to 0.36%, and the life span of severe cases is shortened by about 10-15 years.

Basic Information

English name

arthritis

Visiting department

orthopedics

Common causes

Caused by inflammation, infection, degradation, trauma, or other factors

Common symptoms

Joint redness, swelling, heat, pain, dysfunction and joint deformities

Causes of arthritis

The etiology of arthritis is complex and is mainly related to factors such as autoimmune response, infection, metabolic disorders, trauma, and degenerative diseases. According to the etiology, arthritis can be divided into bone, rheumatoid, tonicity, reactivity, gout, rheumatism, purulent and so on.

Classification of arthritis

Many diseases can cause arthritic lesions, and the more common clinical arthritis are as follows:

Osteoarthritis

Also known as degenerative joint disease, osteoarthropathy. Bone hyperplasia is closely related to human aging. Most elderly people may be accompanied by bone hyperplasia, which is naturally easy to get osteoarthritis. Clinical data show that the prevalence of osteoarthritis is only 2% in people under 45, and 68% in people over 65. From the doctor's point of view, people have different degrees of osteoarthritis into old age.

2. Rheumatoid arthritis

The disease often manifests as pain in the facet joints (finger joints, wrist joints, etc.), and the symptom of the disease is symmetrical. 80% of rheumatoid arthritis patients are between 35 and 50 years old, but the elderly and young children can also develop the disease. Because of its complex relationship with heredity, infection, environment, and immunity, it cannot be completely cured clinically. It can only be controlled by medication and maintain joint function.

3. Ankylosing spondylitis

Most manifested as spinal, sacroiliac joints and other axial joint diseases. The etiology is unclear. It is generally believed that genetic factors and environmental factors interact. The disease is more common in men, and the age of onset is more than 40 years old. In severe cases, it can cause spine and joint deformities and affect daily life.

4. Reactive arthritis

Inflammatory joint disease triggered by extra-articular infection factors such as intestinal system and urinary system. Decreasing infection rate and improving immunity have certain prevention and cure effects.

5. Gouty arthritis

Arthritis due to urate crystals and deposits. The onset is mostly acute unilateral arthritis. The main symptoms are sudden swelling and pain in the big toe of the foot. The pain is "painless". The course of the disease can be relieved for about a week. The prevention method is effective anti-oxidation, preventing the nucleic acid from being oxidatively decomposed, thereby reducing the production of endogenous purines (80%), and then reducing the production of uric acid. At the same time, change the dietary habits of life and eat less exogenous purines such as animal offal, seafood, beer and liquor, so as to reduce the production of uric acid.

Clinical manifestations of arthritis

Most arthritis have a long course and are difficult to heal, making treatment difficult. Therefore, early detection, early diagnosis, and early treatment can help prevent the progression of arthritis and improve the prognosis of patients.

Joint pain

Is the main manifestation of arthritis. Different types of arthritis can exhibit different pain characteristics.

2. Joint swelling

Swelling is a common manifestation of arthritis and the result of the progress of inflammation and is not necessarily related to the degree of joint pain. Generally proportional to disease.

3. Joint dysfunction

Joint pain and inflammation cause edema around the joint tissue, protective spasms of surrounding muscles, and destruction of joint structure, resulting in limited joint movement. Patients with chronic arthritis may suffer permanent joint loss due to long-term limited joint mobility.

4. Signs

The signs of different types of arthritis are also different, and erythema, malformations, swelling of the soft tissues, joint swelling, exudate, swollen bones, bone abrasion, tenderness, muscle atrophy or weakness, limited range of joint motion, and compression of the nerve root And other signs.

Arthritis check

Laboratory inspection

(1 ) General examination Blood routine, urine routine, erythrocyte sedimentation, C-reactive protein, biochemical (liver, kidney function, A / G), immunoglobulin, protein electrophoresis, complement, etc. Blood routine, protein electrophoresis, immune complexes and serum complement are generally in the normal range. Patients with synovitis may have a slight increase in C-reactive protein (CRP) and a slight increase in blood cell sedimentation rate (ESR). Patients with secondary arthritis may develop abnormal laboratory-related examinations.

(2 ) Autoantibodies Rheumatoid factor, anti-cyclic citrulline antibody, rheumatoid factor IgG and IgA, anti-perinuclear factor, anti-keratin antibody, anti-nuclear antibody, anti-ENA antibody, etc.

(3 ) Genetic markers HLA-DR4 and HLA-DR1 subtypes.

2. Imaging examination

(1 ) X- ray examination of the joint X-ray shows swelling of the soft tissue, osteoporosis, and subchondral bone sclerosis and / or articular surface cystic changes, invasive bone destruction, articular surface blur, asymmetric joint space Stenosis, joint fusion and dislocation. Hyperplasia of the joint edges and osteophyte formation may be accompanied by joint fluid of varying degrees, and free bodies or joint deformation can be seen in some joints.

(2 ) CT examinations include joint CT and chest CT.

(3 ) MRI examination The MRI examination of the joint is very helpful for finding early joint lesions in patients with rheumatoid arthritis.

(4 ) Ultrasound Joint ultrasound is a simple, non-invasive examination, which has differentiating significance for synovitis, joint effusion, and joint destruction.

3. Special inspection

(1 ) Arthrocentesis For joints with joint effusion, joint fluid examination includes joint fluid culture, rheumatoid factor detection, etc., and polarized light detection to identify gout urate crystals.

(2 ) Arthroscopy and synovial biopsy are valuable for the diagnosis and differential diagnosis of arthritis.

Arthritis diagnosis

Rheumatoid arthritis

Is a common acute or chronic connective tissue inflammation. It can recur and affect the heart. Clinically, it is characterized by joint and muscle walking pain. Is an allergic disease. It is one of the main manifestations of rheumatic fever, and it usually starts with acute fever and joint pain. Typical manifestations are mild or moderate fever, migratory polyarthritis, and the affected joints are usually large joints such as knees, ankles, shoulders, elbows, and wrists. They are usually transferred from one joint to another, and the lesions are locally red and swollen. , Burning, severe pain, some patients also have several joints at the same time. Atypical patients only have joint pain and no other inflammation manifestations. Acute inflammation usually subsides within 2 to 4 weeks, leaving no sequelae, but often recurrent. If rheumatism affects the heart, myocarditis can occur and even heart valve disease can remain.

2. Rheumatoid arthritis

The disease is one of the most common types of chronic arthritis. Associated with genetic, bacterial and viral infections, environmental factors including smoking. It can occur at any age, but it is more common in women aged 40-60. The American Rheumatology Association's diagnostic criteria for rheumatoid arthritis classification standards revised in 1987 ( 4 can be confirmed):

(1) Morning stiffness lasts for at least 1 hour (6 weeks).

(2) 3 or more joints are involved (6 weeks).

(3) Hand joints (wrist, metacarpophalangeal joint, or proximal interphalangeal joint) are involved (6 weeks).

(4) Symmetric arthritis (6 weeks).

(5) Rheumatoid subcutaneous nodules.

(6) X-ray changes of hand joints (expressed as osteoporosis or obvious decalcification of joints and their adjacent areas, and narrowing of joint space).

(7) Serum rheumatoid factor is positive (titer> 1:32).

3. Osteoarthritis

More common in middle-aged and elderly people, the onset process is mostly slow. Hands, knees, hips, and spine joints are susceptible, while the metacarpophalangeal, wrist, and other joints are less affected. The condition usually worsens with activity or decreases with rest. Morning stiffness is less than half an hour. Heberden and Bouchard nodules can be seen on the hands when the hands are involved, and the knee joint can touch the friction. There are no extra-articular manifestations such as subcutaneous nodules and vasculitis. Rheumatoid factor is mostly negative, and a few elderly patients may have a low titer.

4. Gouty arthritis

Gout is a metabolic disease caused by abnormal purine metabolism and increased uric acid synthesis. Renal dysfunction can also result in increased uric acid levels due to decreased uric acid clearance in the kidneys. The saturation of uric acid in the plasma leads to the deposition of monosodium urate crystals in the relatively devoid of blood vessels around the distal joints. The appearance of such crystals can lead to acute inflammatory synovitis in single or multiple joints. Gout is more common in men and the toe is the most common affected area. Most patients with gout have first metatarsophalangeal joint involvement at some point in their lives. Other areas of the foot that may be affected are the back of the foot, heel, and ankle.

5. Ankylosing spondylitis

Frequent in young men, there is a clear tendency of familial disease. Main axis joints such as sacroiliac and spinal joints are mainly involved. Peripheral joints may also be involved, but they are mostly large joints of the lower limbs. They are asymmetrical swelling and pain, and are often accompanied by spinous processes, greater trochanter, and Achilles , Spinal costal joints and other tendons and ligaments attachment points pain. Severe lesions can occur with spinal stiffness, cervical, lumbar, and thoracic spine movement restrictions, "humpback", which seriously affects patients' daily lives. Extra-articular manifestations are mostly iridocyclitis, cardiac blockade, and aortic valve insufficiency. X-ray film shows sacroiliac joint invasion, destruction or fusion. More than 90% of patients were positive for HLA-B ₂₇ and negative for rheumatoid factor.

6. Reactive arthritis

The onset of this disease is acute, and there is often a history of intestinal or urinary tract infections before onset. The major joints (especially the lower extremity joints) are mainly affected by asymmetry, and generally there is no symmetry involving the proximal interphalangeal joints of the fingers, small joints such as the wrist joint. May be associated with ophthalmitis, urethritis, balanitis, and fever, etc. HLA-B ₂₇ may be positive and rheumatoid factor negative, and patients may have X-ray changes in asymmetric sacroiliitis.

7. Infectious arthritis

Related to bacterial infections. Common pathogenic bacteria include Staphylococcus aureus, Diplococcus pneumoniae, Meningococcus, Neisseria gonorrhoeae, Streptococcus, Mycobacterium tuberculosis. Pathogenesis includes direct bacterial infection and pathogenic bacterial release of toxins or metabolites during infection, including subacute bacterial endocarditis and post-scarlet arthritis. Arthritis caused by direct bacterial infection is manifested as joint redness, swelling and pain, and joint dysfunction. Asymmetry in weight-bearing joints of the lower limbs. Large joint involvement is more common, such as the hip and knee joints. Arthrocentesis often shows purulent changes. Smears or cultures can find bacteria. Mycobacterium tuberculosis-associated arthritis is prevalent in young people, and evidence of tuberculosis elsewhere includes lung or lymph node tuberculosis. May have nodular erythema, and serum rheumatoid factor is negative. The tuberculin test was positive. Arthritis caused by bacterial metabolites or toxins can heal in 1 to 2 weeks, and joint symptoms are migratory.

8. Other

Such as traumatic arthritis, psoriatic arthritis, and enteric arthritis. Autoimmune diseases such as systemic lupus erythematosus, Sjogren's syndrome, scleroderma, and tumors often show arthritis in the occurrence and development of the disease.

Arthritis Treatment

Drug treatment

According to the type of arthritis, the characteristics of the symptoms, the associated diseases and other conditions, choose the appropriate treatment. The principle of treatment is early diagnosis and reasonable and combined use as early as possible. The commonly used anti-rheumatic drugs are as follows:

(1 ) Non-steroidal anti-inflammatory drugs can inhibit the synthesis of prostaglandins and rapidly produce anti-inflammatory and analgesic effects, have a good effect on relieving pain, and can relieve headaches, muscle pain, including joint pain associated with osteoarthritis. The drug has a fast onset of action and a rapid metabolism in the body. Once the metabolism is completed, the pain begins immediately and the maintenance time is short. The course of the disease cannot be changed. Clinically used are ibuprofen, penicillamine, diclofenac, aspirin, indomethacin, and the like.

(2 ) Cartilage protective agents such as glucosamine sulfate can promote cartilage synthesis, inhibit joint cartilage decomposition, and also have anti-inflammatory effects. Sulfate, which is rich in glucosamine sulfate, is also one of the essential components for the synthesis of cartilage matrix. Such drugs can relieve pain symptoms and improve joint function. Long-term use (more than 2 years) can also delay the destruction of joint structure. Glucosamine sulfate has a slower onset of action, but the drug is safe and suitable for long-term use as a basic treatment.

(3 ) Slow-acting antirheumatic drugs are mostly used for rheumatoid arthritis and seronegative spinal arthropathy. It has a certain controlling effect on the condition but its effect is slow. Commonly used are gold mixture (intramuscular or oral), penicillamine, sulfasalazine, chloroquine and so on.

(4 ) Cytotoxic drugs produce immunosuppressive effects through different pathways. Commonly used are cyclophosphamide, methotrexate, Jin Duchun and so on. They are often second-line drugs for systemic lupus erythematosus, rheumatoid arthritis, and vasculitis. Although there are many and serious side effects, they have a great effect on improving the healing of these diseases.

(5 ) Adrenocortical hormone is an anti-inflammatory and anti-allergic drug, which significantly improves the healing of connective tissue diseases such as systemic lupus erythematosus, but cannot cure these diseases. Its many side effects increase with the increase of dosage and treatment course. If used for a long time, it can aggravate the damage of articular cartilage and the symptoms of osteoarthritis. Therefore, it should be carefully selected when measuring its efficacy and side effects.

(6 ) Streptococcal infections such as antibiotics can cause rheumatic fever arthritis. The use of penicillin in the acute phase is the most effective drug for controlling streptococcal infections. Patients with acute rheumatic fever have long-term antibiotics to prevent long-term rheumatic carditis. Occur, adult prevention must not be shorter than 5 years, and children remain at least 18 years old. Tuberculous arthritis and fungal arthritis require active and effective antituberculosis or antifungal medication.

(7 ) Treatment of gouty arthritis Including the acute phase of drug treatment, including high-dose non-steroidal anti-inflammatory drugs or colchicine and uric acid lowering during the remission phase. Uric acid-lowering drugs mainly include allopurinol that inhibits uric acid production and benzbromarone that promotes uric acid excretion.

2. Surgical Therapy

Surgical treatment mainly includes arthrocentesis, synovectomy, joint replacement, joint orthopedics, joint fusion, etc.

3. Bone marrow transplant

The treatment of rheumatoid arthritis does have significant effects. The autologous bone marrow transplantation method that restores the function of the immune system to promote the recovery of patients has achieved good results in treating rheumatoid arthritis in children.

4. Immunity and biological therapy

This type of treatment is the main link for the onset of arthritis and the pathogenesis of pathological changes, such as target molecule therapy for cytokines, plasma exchange, immune purification, immune reconstruction, mesenchymal stem cell transplantation, etc., and it is mainly used for other treatments that are ineffective and progress rapidly And patients with refractory severe arthritis are mainly rheumatoid arthritis.

5. Other treatments

Including physical, rehabilitation, vocational training, and psychological treatment. Physical therapy mainly includes the following: DC electrotherapy and drug iontophoresis, low frequency pulse electrotherapy, intermediate frequency current therapy, high frequency electrotherapy, magnetic field therapy, ultrasound therapy, acupuncture, and light therapy, that is, infrared, ultraviolet, and cold therapy. Rehabilitation and vocational training focus on functional exercises and lifestyle adjustments. Functional hospitals should perform functional exercises under the guidance of rehabilitation specialists.

Prognosis of arthritis

The etiology, course, individual differences, and treatment of arthritis are different, and their prognosis is also different. Most patients with reactive arthritis have a self-limiting course of disease that resolves within 3 to 5 months. In the past ten years, with the early combined application of slow-acting antirheumatic drugs, the treatment of extra-articular lesions and the continuous emergence of new therapies have significantly improved the prognosis of rheumatoid arthritis. The condition of most patients with rheumatoid arthritis can be well controlled or even completely relieved.

Arthritis prevention

1. Avoid the environmental factors that induce the onset of arthritis

Humid environment is helpful for the growth of some pathogenic bacteria, and has a certain relationship with the onset of arthritis. Therefore, you should always pay attention to hygiene, keep the room well ventilated and good air, prevent moisture and warmth, and avoid the spread of pathogenic bacteria, especially streptococci. In addition, exposure to other environmental factors such as ultraviolet rays and certain chemicals may cause abnormal immune responses in some susceptible people, leading to the occurrence of different arthritis. The susceptible people should avoid strong ultraviolet rays and certain chemical substances. contact.

2. Eat a reasonable diet and maintain a good lifestyle

Lack of nutrition may lead to aggravation of arthritis, while excess nutrition and obesity may induce or aggravate gouty arthritis and osteoarthritis. Therefore, a scientific and reasonable diet is a measure to prevent the occurrence of certain arthritis, such as reducing the intake of animal internal organs, Purine-rich foods such as seafood, poultry, and beans can effectively prevent gouty arthritis. The risk of rheumatoid arthritis in smokers is significantly increased, and smoking cessation has become one of the preventive measures for rheumatoid arthritis.

3. Moderate exercise to maintain a pleasant mood and improve the body's immunity

The stability of the immune system is related to mood. Many patients clinically experience autoimmune disease after experiencing adverse life events. Therefore, maintaining an optimistic and stable mentality is conducive to the prevention of arthritis caused by autoimmune diseases.