Rheumatism is a group of diseases that invade joints, bones, muscles, blood vessels and related soft tissues or connective tissues, most of which are autoimmune diseases. The onset is mostly hidden and slow, with a longer course, and most of them have genetic tendencies.
Diagnosis and treatment are both difficult; different autoantibodies can be detected in the blood, which may be related to different HLA subtypes; it has good short-term effects on non-steroidal anti-inflammatory drugs (NSAID), glucocorticoids and immunosuppressants Or long-term relief response.
Broadly speaking, all diseases that cause bone, joint and muscle pain can be classified as rheumatism. Continuing, so far in the classification of rheumatism, there are more than 100 diseases in a broad sense, including infectious, immune, metabolic, endocrine, hereditary, degenerative, neoplastic, endemic, toxic, etc. Causes of diseases. In a narrow sense, it should be limited to dozens of diseases in the fields of internal medicine and immunity. Some of these diseases are interdisciplinary, such as gout, osteoarthropathy, infectious arthritis and so on.
1. Mainly arthritis: such as rheumatoid arthritis (RA), Stir's disease is divided into juvenile and adult, ankylosing spondylitis (AS), psoriatic arthritis.
2. Related to infection: such as rheumatic fever, Lyme disease, Wright syndrome, reactive arthritis.
3. Diffuse connective tissue disease: systemic lupus erythematosus (SLE), primary Sjogren’s syndrome (pSS), systemic sclerosis (SSc), polymyositis (PM), dermatomyositis (DM), mixed Sexual connective tissue disease (MCTD), vasculitis.
1. Immune response: The body's stimulation of exogenous or endogenous antigens directly or presented by macrophages activates the corresponding T-cells, and some T-cells produce a large number of inflammatory cytokines, causing various tissues and organs to varying degrees Part of the T-cells then activates the B-cells to produce a large number of antibodies, directly or combined with antigens to form immune complexes, causing tissues or organs to be damaged or destroyed. In addition, monocyte chemotactic proteins (such as MCP-1) produced by monocytes can also participate in the inflammatory response. Most rheumatic diseases, or exogenous antigenic substances produced by infection, or endogenous antigenic substances produced in the body, can initiate or aggravate this autoimmune response, and a variety of antibodies can appear in the serum.
2. Genetic background: Recent studies have proved that some rheumatic diseases, especially connective tissue diseases, heredity and patient susceptibility are closely related to the expression of the disease, and have a certain significance for the early or atypical cases and prognosis of the disease; Among them, HLA (Human Tissue Leukocyte Antigen) is the most important.
3. Infective factors: According to researches over the years, a variety of infectious factors, antigens or superantigens produced by microorganisms, can directly or indirectly stimulate or initiate an immune response.
4. Endocrine factors: Studies have shown that the imbalance of estrogen and progesterone is related to the occurrence of a variety of rheumatism.
5. Environmental and physical factors: For example, ultraviolet rays can induce SLE.
6. Others: Some drugs such as procainamide and some oral contraceptives can induce SLE and ANCA-positive small vasculitis.
1. Rheumatism mostly has joint disease and symptoms, which can be as high as 70-80%, and about 50% have only pain. The most serious are red, swollen, hot, painful and functional impairment and other comprehensive inflammation manifestations; most of them are multiple joint involvements. The size of the affected joint varies depending on the type of disease.
2. Heterogeneity, that is, the same disease has different subtypes. Due to the genetic background, the cause of the disease is different, and the mechanism is also different, so the type of clinical manifestations, symptoms, severity and treatment response are also different.
3. Rheumatism is mostly a disease that invades multiple systems. The pathology of many diseases overlaps and the symptoms are similar. For example, MCTD is a typical manifestation of this kind.
4. A variety of antibodies and immune complexes (CIC) appear in the serum, and they can be deposited in tissues (skin, synovium) or organs (kidney, liver) to cause disease.
5. Raynaud's phenomenon often occurs in this type of diseases, such as SLE and MCTD.
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American Academy of Rheumatology/European Anti-Rheumatism Alliance Gout Classification Standard", abstract translation. "Chinese Journal of Clinical Immunity and Allergy", 2015
Zhang Bingqing, Sheng Feng, Gu Junjie, Yang Dan, etc. Translation of "2015
American Academy of Rheumatology/European Anti-Rheumatic Alliance Gout Classification Standard". "Chinese Journal of Clinical Immunity and Allergy", 2015