Talking about rheumatism (65438+February 2002 10)
Professor Yan Xiaoping is the director, chief physician and doctoral supervisor of Rheumatology Department of China-Japan Friendship Hospital. He has been engaged in clinical research and teaching of rheumatism and cardiovascular and cerebrovascular diseases for a long time. He edited more than ten books and published more than 50 papers. (Left)
Attending physician in the Department of Rheumatology of Chinese Medicine of PG One China-Japan Friendship Hospital, member of Chinese Medicine Association, specializing in the diagnosis and treatment of rheumatoid arthritis, ankylosing spondylitis, osteoarthritis and other rheumatism, participated in writing 2 papers and published more than 20 papers. (right)
Hello, audience friends! This is CCTV's live program "The Road to Health". Today we are going to talk about rheumatism.
Moderator: What is rheumatism?
PG I: Rheumatism refers not only to one disease, but also to a group of diseases. Due to various reasons, joints, bones, muscles, tendons and synovial bursa are damaged, resulting in joint pain, stiffness and even joint deformity and dysfunction. These diseases belong to the category of rheumatism, such as rheumatoid arthritis, ankylosing spondylitis, osteoarthritis, Sjogren's syndrome and so on.
Yan Xiaoping: 1983 The American Rheumatology Association divides rheumatism into ten categories according to clinical manifestations, histology and immunology. I went to Guang 'an this time and found that rheumatoid arthritis is the most common. As shown in the figure, rheumatoid arthritis usually occurs in young women, which will seriously lead to joint deformity, seriously affect physiological functions and bring great pain to life. In addition, ankylosing spondylitis is more common. As shown in the picture, the young man's spine is stiff and he can't bend over at all, and his cervical vertebra also protrudes backward, so he can't lean against the wall at all. This disease is more common among young people.
Moderator: Let's look at the situation of two patients. Patient A: "One day when it rained after work, I was carrying an umbrella, and the distance from my work to the station was less than 100 meters. I didn't feel well at night after I went home by car. The next day, my arm couldn't be lifted and my left leg couldn't walk. I was particularly scared at that time. I don't know why, I was diagnosed with rheumatoid arthritis after going to the hospital. " Patient B: "I once fell asleep at noon, left the window open, and just finished my work and broke out in a sweat." I fell asleep without covering anything and woke up feeling uncomfortable. "
PG 1: Patient A has been discharged after treatment. Patient B is still hospitalized in our hospital. He caught a cold after sweating. There are still many patients suffering from cold and rain, long-term exposure to cold environment, trauma and frequent intestinal infections, all of which are inducing factors of rheumatism.
Moderator: How should we treat it?
Yan Xiaoping: At present, there is a misunderstanding in the treatment of rheumatism. Some people are sick and go to the hospital. Some doctors give hormones, and the side effects of hormones are reflected, but they still can't control the disease. Therefore, the majority of patients are called upon to go to the rheumatology department of a regular large hospital. In addition, the treatment of rheumatism should adhere to a very complete formal treatment and be patient.
PG I: Rheumatism is a refractory disease. At present, its etiology and pathogenesis are not very clear. Therefore, patients should have this psychological preparation, must go to a regular hospital to see a doctor, and at the same time establish confidence.
Moderator: What are the early manifestations of rheumatism? How can I find it earlier?
Yan Xiaoping: For example, patient A (female) in front of her, the initial symptom is pain in a single joint, such as elbow joint and wrist joint, and then it gradually develops into symmetrical pain in two joints, and gradually develops from big joint to small joint pain. This also reminds us that we should never think that rheumatoid arthritis is just a pain problem of small joints. When joint pain occurs, you should go to a specialist in time. Patient B (male) fell asleep immediately after sweating and caught cold, then his hip joint ached and he didn't care, and then his waist became stiff. This also reminds us that in the early stage of ankylosing spondylitis, deep hip pain often occurs, which cannot be ignored. Some people have low back pain and back stiffness, which are the early manifestations of ankylosing spondylitis. Stiffness and discomfort are the same symptoms whether it is rheumatoid arthritis or ankylosing spondylitis. These conditions can only be treated in a timely and regular manner in the specialized outpatient department of a regular large hospital.
PG 1: Not everyone will get sick after catching a cold, which is related to everyone's physique, age, sex, genetic factors, endocrine and metabolism.
Moderator: What are the early inspection methods?
PG One: including erythrocyte sedimentation rate, C-reactive protein and other blood laboratory tests, both of which are signs of inflammatory activity in rheumatism. Other tests include rheumatoid factor and immunoglobulin.
Yan Xiaoping: With the development of science, some antibodies are also very important for early diagnosis, and some genetic tests are also very important, which can play a very positive role in early detection of diseases.
PG I: Other imaging examinations are also very important in the diagnosis of rheumatism, such as X-ray, CT and magnetic resonance examination of joints.
Moderator: What do you think?
Yan Xiaoping: At present, comprehensive treatment is advocated. The first is the education of patients, so that patients can understand the condition and cooperate with the treatment. In addition, exercise therapy is very effective for patients to maintain normal joint position and prevent further damage to joint function. This is a very important treatment. Then there is medication. Western medicine treatment is to relieve symptoms and pain with some antipyretic, analgesic and anti-inflammatory drugs such as voltarin and fenbid. The second kind of drugs are drugs that can control the disease, such as methotrexate. The third kind of drugs are drugs that inhibit immunity, that is, hormones, which must be applied under the guidance of doctors. Others have some immunotherapy. Traditional Chinese medicine mainly pays attention to strengthening the body resistance in treatment, which refers to the congenital kidney and the acquired spleen, and then affects the liver and lungs. Lift up the vital qi of zang-fu organs and let them resist the attack of diseases themselves. In addition, it is very important to treat evil. As far as the main treatment principle is concerned, rheumatism should never be ignored. In addition, we should pay attention to syndrome differentiation and adopt different treatment methods for different individuals.
Moderator: So can rheumatism be cured? What is the standard of cure?
Yan Xiaoping: Rheumatism is characterized by a long course of disease, which often recurs and is difficult to cure. So far, only some factors causing rheumatism have been found, but the real cause has not been found. Patients must pay attention to peace of mind, cooperate with treatment, and do not be impatient. If a person pursues radical cure, he may take many detours.
PG I: Besides medicine, physical exercise is also an important method to treat rheumatism, which can not be ignored. Physical exercise is not only the exercise of joint function, but also plays the role of adjuvant therapy, which is very good for patients to maintain normal joint position and prevent further damage of joint function. Go to a regular hospital and take regular exercise methods under the guidance of a doctor.
Moderator: Ms. Li from Shaanxi, 36 years old. My child 12 years old. She got ankylosing spondylitis in March this year and was treated for 8 months. The effect is not very good. My feet and knees are sore and there is still water in my knees. How to treat it?
Yan Xiaoping: First of all, we should remind patients that they must go to a regular hospital for treatment to see if their condition is active. If so, we have a cure. If you are not active, we have other symptomatic treatments.
Moderator: Ms. Wang from Beijing, 30 years old. I got rheumatoid arthritis after giving birth. Now my knee hurts and my legs are not hard to eat. What should experts think?
PG I: Chinese medicine can treat patients according to their specific conditions. If it is acute, you can also choose painkillers that have little damage to gastrointestinal tract, blood system and liver and kidney function to relieve the pain in acute stage. Then, Chinese medicine (decoction) should be treated according to syndrome differentiation, and patients should adhere to a long-term treatment, which should last at least one year.
Moderator: Ms. Kong from Guangxi, 56 years old. My son is thirty years old. Suffering from ankylosing spondylitis 12 years. In recent months, my illness has been repeated, I can't go to work, my back hurts, I can't turn over at night, and my erythrocyte sedimentation rate is particularly fast. He is so ill, can he be cured?
Yan Xiaoping: The patient's condition is very serious, and some progress can be made through the treatment of integrated traditional Chinese and western medicine. We have treated similar patients before. After treatment, the symptoms and signs improved obviously, the laboratory indexes gradually returned to normal, and the functional activities gradually recovered. As shown in the picture on the left, the patient tried his best, but his hands still couldn't touch the ground. After comprehensive treatment of traditional Chinese and western medicine, the picture on the right shows the situation when the patient comes back from the hospital for reexamination, and his fingers can touch the ground like normal people.