What is rheumatoid arthritis?
There is one layer of synovial membrane in the normal joint cavity, and it could secrete synovial fluid to lubricate and protect joint. When patients suffering from rheumatoid arthritis, synovial membranes react inflammatorily; and accumulated inflammation cells would inflict reddish painful hot swellings around the joint.
RA is one kind of chronic systemic disease, and the cause of the disease is yet to be investigated; generally it is thought to be a kind of antigen-immune response, possibly induced by bacterium or virus. The disease often occurs within people aged from 40 to 60 and women are highly affected.
Which kind of people would get rheumatoid arthritis?
According to the epidemiology investigation, the prevalence rate for Chinese is approximately 0.4%, compared to Caucasian’s 1%, Chinese are less affected by the disease. It also estimates that there are around one hundred thousand Taiwanese with rheumatoid arthritis, and the male and female ratio is 1: 3; with middle-aged woman as the highly affected group.
Symptoms:
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Reddish, stiff, painful hot swelling of the joint.
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Initially affected areas are fingers, wrists, knees, and hip.
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It is often chronic and symmetric
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Swelling and destructed joints often incur joint deformity
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Patients sense painful stiffness joint mostly in the morning.
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Organ damage:
Vasculitis of artery
Neuropathy
Liver & spleen enlargement
Pericarditis
Nephropathy
Systemic symptoms: anemia, fever, body weight loss.
2010 ACR/EULAR Classification
Criteria for Rheumatoid Arthritis (Score-Based Algorithm for Classification in an Eligible Patient [Cutpoint for RA: ≥6/10])
|
Joint involvement (0-5) |
|
|
1 medium to large† joint |
0 |
|
2-10 medium to large joints |
1 |
|
1-3 small‡ joints (with or without involvement of large joints) |
2 |
|
4-10 small joints (with or without involvement of large joints) |
3 |
|
>10 joints§ (at least one small joint) |
5 |
|
Serology (0-3) |
|
|
Negative RF AND negative ACPA |
0 |
|
Low-positive RF OR low-positive ACPA |
2 |
|
High-positive RF OR high-positive ACPA |
3 |
|
Acute Phase Reactants| 1 |
|
|
Normal CRP AND normal ESR |
0 |
|
Abnormal CRP OR abnormal ESR |
1 |
|
Duration of Symptoms (0-1) |
|
|
<6 weeks |
0 |
|
≥6 weeks |
1 |
Examination:
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Blood exam:
*Rheumatoid factor positive (RF)
*ESR elevation
*CRP level increased
*Anti-cyclic citrullinated peptide antibody positive (anti-CCP)
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Radiographic
Daily care:
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Pain relief:
*The cold compress has the analgesia effect
*The hot compress may relax stiff and pain
*Massages the muscle to reduce pain(not to have it in joint and inflammation place)
*When sits for rest both foot could put unbends evenly
*Bed rest when acute stage
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Increase the exercise of joint & muscle:
*Swimming is the best exercise
*Avoid the intense exercise, like basketball, badminton
*Avoids the long-term maintenance identical posture, and slightly exercise the four limbs before stand up
*Adequate exercise and rest
*Avoid overtiredly
*Avoid to raise the heavy item
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Daily life:
*Balanced meals and avoid obese
*Avoid fry food and ice-cold
*Avoid staying up late and weary
*May hot compress before sleep
*Use comfortable hard mattress
*Take slightly exercise before sleep
*Maintenance mood to be happy
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Brace: lightens the joint burden
*Assistance equipment: May promote patient's independence, eg. the stick, walking aid.
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Psychological support and occupation counselling
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Regular follow up
*Follow up the inflammation status
*Follow up the hepatic & renal function
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After the acute stage, proceed long-term rehabilitation, maintains the joint function.
中國醫藥大學附設醫院
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