What Is Rheumatic Chorea?

Rheumatic arthritis is a common form of acute or chronic connective tissue inflammation. Rheumatoid arthritis is commonly referred to as one of the main manifestations of rheumatic fever. Clinically, it is characterized by sore joints and muscles, redness, swelling and pain. It is related to group B hemolytic streptococcal infection, and cold, humidity and other factors can induce the disease. Large joints of the lower limbs, such as the knee and ankle, are most commonly affected. Although the incidence of rheumatic fever has decreased significantly in recent decades, atypical rheumatic fever and chronic rheumatoid arthritis are not uncommon.

Basic Information

English name: rheumatic arthritis
Visiting department: Division of Rheumatology

Common causes: Related to group A hemolytic streptococcus infection
Common symptoms: Characterized by sore joints and muscles, redness and swelling

Etiology and pathology of rheumatoid arthritis

Based on the analysis of symptoms, epidemiology and immunology, rheumatoid arthritis is considered to be closely related to human hemolytic streptococcal infection, and the route of infection is crucial. However, the pathogenesis of rheumatic fever caused by group A streptococci is not fully understood. It has also been noted that the virus infection is also related to the disease.

The pathological changes in the active phase of rheumatoid arthritis are edema of the synovium and surrounding tissues, mucinous changes in the connective tissue below the synovium, fibroid changes, and inflammatory cell infiltration, and sometimes atypical rheumatoid bodies. After the active period, the exudate in the joint can be absorbed, and generally does not cause adhesions, so there are no sequelae such as joint deformation.

Clinical manifestations of rheumatoid arthritis

Pain

Joint pain is the first symptom of rheumatoid arthritis. Pain may occur in the whole body joints, but large joint involvement is more common, such as knee, ankle, shoulder, and wrist joints. Typical manifestations are symmetry, walking pain, and inflammation accompanied by redness, swelling, and fever. Usually the symptoms of acute inflammation subsides for 2 to 4 weeks. The symptoms of one joint subside, and the symptoms of another joint may appear. Several joints may occur at the same time.

Joint symptoms are greatly affected by climate change, and joint pain often occurs before the weather turns cold or rain. No joint deformation remains after the acute phase, which is different from rheumatoid arthritis.

2. Muscle pain

Patients may have symptoms such as muscle aches and discomforts, fatigue, appetite deficiency, and irritability.

3. Irregular fever

Before the onset of rheumatism, there will be irregular fever, mostly mild to moderate fever, rapid pulse, sweating, and is not proportional to body temperature.

4. Skin and mucous membrane symptoms

Subcutaneous nodules, circular erythema, etc. are common in children and rare in adults.

5. chorea

Only seen in children and more common in girls. Children with mental symptoms such as emotional restlessness, irritability, and irritability, followed by rapid movements without purpose, frowning, pouting, etc., limbs can appear straight and flexed, internal The arrhythmia of abduction and abduction, pronation and supination alternate. Fatigue and excitement are obvious, relieved during rest and sedation, and disappear during sleep.

6. Heart symptoms

Because rheumatic fever is mainly involved in the joints and heart, patients with rheumatoid arthritis are often accompanied by myocarditis, endocarditis, and pericarditis. He has palpitations, shortness of breath, and pain in the anterior region of the heart.

Rheumatoid arthritis examination

1. Increased peripheral white blood cell count

The white blood cell count increased, the proportion of neutrophils also increased significantly, and some nuclear shift left.

2. ESR and C-reactive protein increase

ESR and C-reactive protein are usually indicators of various inflammations. In the acute phase of rheumatoid arthritis, the ESR can be above 90 mm / hour; C-reactive protein is also above 30 mg / L (30 g / ml). After the acute phase (January to February) gradually returned to normal.

3. Joint fluid examination

Often exudate, the white blood cell count in the light can be close to normal, the severe can be significantly increased, most of them are neutrophils. Bacterial culture was negative.

4. Rheumatoid factor and antinuclear antibodies

All were negative.

5. Pharyngeal swab culture

Hemolytic streptococcus is often positive.

6. Anti-streptolysin "O"

80% of patients with rheumatoid arthritis have an increased "O",> 500U. After the condition recovers, this antibody can gradually decrease.

Rheumatoid arthritis diagnosis

The diagnosis of rheumatoid arthritis is mainly based on clinical manifestations plus laboratory evidence and evidence of previous streptococcal infection. If you have a history of hemolytic streptococcal infection 1 to 4 weeks before the onset of the disease, acute migratory arthritis, and other manifestations of rheumatic fever, such as myocarditis, circular erythema, subcutaneous nodules, etc., anti-streptolysin in the serum " 0 "agglutination titer significantly increased, positive swab culture and increased white blood cell count.

Differential diagnosis of rheumatoid arthritis

Migraine arthritis caused by sepsis

Signs of primary infection are often present, blood and bone marrow cultures are positive, and exudates in the joints have a tendency to purify and pathogenic bacteria can be found.

2. Tuberculous arthritis

Most of them are affected by a single joint, which is usually caused by joints that are often rubbed by hands or bearing weight.

3. Tuberculosis infection allergic arthritis

There are exact tuberculosis infections in non-joint parts of the body without bone destruction.

4. Lymphoma and granuloma

A few patients may develop symptoms of acute polyarthritis.

5. Lyme arthritis

The disease is an epidemic transmitted by ticks.

6. Gout

The incidence of gout has a significant increase trend, and early gout is easily confused with rheumatoid arthritis and rheumatoid arthritis.

7. Rheumatoid arthritis

Rheumatoid arthritis, which is small arthritis and spondylitis such as multiple symmetrical fingers, often causes joint deformities in the later stages. Rheumatoid nodules and heart, lung, kidney, peripheral nerve and eye lesions can be seen, and rheumatoid factor is positive.

Rheumatoid arthritis complications

During acute pain, patients with rheumatoid arthritis may suffer from low immunity and some complications due to prolonged bed rest, or taking hormones for too long. The following are common:

Pneumonia

Patients often suffer from pneumonia due to decreased immunity and bacterial infection.

2. Urinary system infection

Patients with rheumatoid arthritis are often prone to urinary tract infections if they do not pay attention to their daily lives or after catching a cold.

3. Cushing syndrome

If patients use hormones for too long, Cushing's syndrome is often caused by the inhibition of adrenal function in the body. Common symptoms include full moon face, buffalo back, weight gain, etc.

4. Oral ulcer

Patients with rheumatoid arthritis often have oral ulcers after taking immunosuppressants. In addition, adverse reactions such as nausea and vomiting, anorexia, rash, and loss of taste can occur.

5. Infectious diseases

Patients have suffered from this disease for too long and their autoimmune function has decreased. When certain infectious diseases are prevalent in society, they are more susceptible to infection than normal people.

Rheumatoid arthritis treatment

Anti-rheumatic 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) Salicylic acid preparation is the most commonly used drug for the treatment of acute rheumatic fever, and its efficacy is exact. Taking aspirin as the preferred drug, it can relieve fever, reduce inflammation, improve joint symptoms, and reduce erythrocyte sedimentation, but it cannot remove the basic pathological changes of rheumatism, and it cannot prevent heart damage and other complications.

Salicylic acid preparations can often cause stomach irritation such as nausea, vomiting, and loss of appetite. They can be taken with aluminum hydroxide to relieve those who cannot tolerate salicylic acid preparations, and can use clofenamic acid.

(2) Adrenal corticosteroids Corticosteroids are not necessary drugs for treating rheumatoid arthritis. Only consider use in patients with arthritis with evidence of carditis and ineffective salicylic acid preparations.

2. Resistance to Streptococcus infection

The eradication of streptococcal infection is an indispensable measure for the treatment of rheumatic fever. The preferred drug is penicillin. Those who are allergic to penicillin can use erythromycin or acetylspiramycin.

3. Chinese medicine treatment

Rheumatoid arthritis belongs to the category of paralysis of traditional Chinese medicine. It is best to remove wind and clear away heat and dampness in the acute stage, and remove wind and dispel cold and dampness in the chronic stage, which can assist the relief of symptoms.

Rheumatoid arthritis prevention

Pay attention to joint exercises during inactivity, keep warm at the joints and avoid humidity; remove streptococcal infections in the body to prevent recurrence, such as tonsillitis, repeated tonsillectomy; rheumatic activity should be intramuscularly injected with penicillin every 2 to 4 weeks 10,000 units; seek medical treatment immediately when suffering from acute pharyngitis to prevent recurrence.