Hepatitis B viral arthritis

Introduction to Hepatitis B Virus Arthritis Hepatitis B virus is a double-stranded circular DNA virus. The virus has three important antigens, including surface antigen (HBsAg), core antigen (HBcAg) and e antigen. In addition to causing hepatitis, hepatitis B virus infection can also cause A variety of rheumatic diseases, including nodular polyarteritis, dermatomyositis and polymyositis, Raynaud's disease, etc., but the most common is serum-like arthritis dermatitis syndrome. basic knowledge The proportion of sickness: 0.01% Susceptible people: no special people Mode of infection: blood transmission Complications: nodular polyarteritis dermatomyositis polymyositis

Causes of hepatitis B virus arthritis

(1) Causes of the disease

Hepatitis B virus arthritis is caused by the infection of hepatitis B virus in the human body. The virus is largely replicated in the body, and the body's resistance is reduced and an immune reaction occurs.

(two) pathogenesis

The pathogenesis is caused by HBsAg in the blood immune complex (IC) of the jaundice over the HB antibody. In addition to HBsAg and HB, there are other immunoglobulins (Ig) and complement components in the IC: Ig is an IgG subtype, mainly It is type I and type III, and is combined with complement, accompanied by blood complement, especially with C4 and CH50. As the antibody gradually increases, IC disappears, arthritis and rash also resolve, which is the same as experimental serum disease caused by injection. The excessively formed IC is limited to the onset of the inflammatory response caused by the activation of the complement system by the target tissue.

Hepatitis B virus arthritis prevention

Population prevention

(1) screening of diseases: HBsAg, anti-HBs, anti-HBc is the infection index of HBV, the sum of these three markers is the total number of HBV infection in the population, but the detection rate is positive by different methods. The difference is very large, according to the sensitivity, followed by radioimmunoassay (RIA) > enzyme-linked immunosorbent assay (ELISA) > reverse passive hemagglutination test (RPHA), the most widely used HBsAg, anti-HBs and anti-HBc, RIA, ELISA reagent sampling results show that some products in the main performance, sensitivity and other major performance has approached or reached the international advanced level, can meet domestic needs, such as economic conditions, it is best to test the population of hepatitis B 3 indicators However, if the economy is difficult, HBsAg and/or anti-HBc can be detected to roughly judge the HBV infection rate in the population.

(2) Measures for storage of the host:

1 Isolation of patients: Patients with acute hepatitis B are generally isolated from HBsAg, but if the clinical recovery has been made, HBsAg has not been negative, and is treated as HBsAg carriers.

2HBsAg asymptomatic carriers: HBsAg asymptomatic carriers can not donate blood, can not engage in diet, drinking water and child care work.

3 Blood donor screening: Screening serum alanine aminotransferase (ALT) and HBsAg in the most sensitive way for all blood donors. One of them is not allowed to donate blood.

(3) Measures for the route of transmission:

1 Prevention of iatrogenic transmission: HBV iatrogenic transmission plays an important role in HBV infection in Chinese population. According to the survey, when the one-person-one-needle-sterilization syringe is strictly implemented, the HBsAg positivity rate of the experimental group is lower than that of the control group within one year. 50%, therefore, all levels of medical and health units should strengthen disinfection and protection measures, strictly implement the "one person, one needle and one tube" and "one use one disinfection" method, blood stations and biological products and other units in the production of blood and body composition For biological products, HBsAg and ALT should be detected by sensitive methods. Those who are positive should not use it. For hemodialysis wards, organ transplant rooms, stomatology, and laboratory, the health management and disinfection and isolation systems should be strengthened.

2 Block mother-to-child transmission: All devices in the delivery room should be strictly disinfected. For infants born to HBsAg-positive pregnant women, hepatitis B immunoglobulin (HBIG) and/or hepatitis B vaccine can be used.

(4) Population Immunization Program:

1 Active immunization: Hepatitis B vaccine is composed of purified HBsAg particles, which has good immunogenicity, but no infectivity. Hepatitis B vaccine is divided into two categories: blood source vaccine and genetic engineering recombinant vaccine. In addition, there are Recombinant vaccinia vaccine, peptide vaccine and anti-idiotype antibody vaccine, etc. At present, China's hepatitis B vaccine is mainly a blood source vaccine and a genetic engineering recombinant vaccine.

During the Seventh Five-Year Plan period, pilot surveys of four provinces and cities in Heilongjiang, Hebei, Hunan and Guangzhou showed that the prevalence of hepatitis B was 58.4%, and the positive rate of HBsAg in children under 3 years old reached the highest peak (12.5%). Since January 1, 1991, all newborns in China have been vaccinated with hepatitis B vaccine as an integral part of planned immunization.

According to the assessment, with 0,1,6 months immunization program, 10g three-needle immunization for all the children, the comprehensive protection rate is 80%, the most cost-effective, the first needle of the HBsAg positive mother's first child 30g, the second and third needle With 10 g, and 10 g three-needle for newborns with HBsAg-negative mothers, the total protection rate can reach 85% to 90%, but the cost is higher.

2 Passive immunization: HBIG passive immunization has a protective effect on post-exposure prophylaxis of HBV. In general, newborns with HBsAg and HBeAg double-positive mothers can be injected with 0.5 ml of HBIG within 6 hours after birth, and adults should be injected with HBIG 1~2 ml within 24 h after exposure. Re-vaccination with hepatitis B vaccine.

2. Personal prevention

(1) Primary prevention: develop good personal hygiene habits, strengthen physical exercise, enhance physical fitness, and prevent HBV infection. The effective method is to use hepatitis B vaccine, especially medical personnel who are exposed to blood, laboratory workers, HBsAg. Spouse and children of positive patients.

(2) Secondary prevention: Patients suspected of hepatitis should be diagnosed as soon as possible. After diagnosis of hepatitis B patients, the epidemic report should be immediately reported and isolation treatment. Generally, the acute acute hepatitis B has a good prognosis and can self-heal. Medicine should be simple, early bed rest, avoid excessive fatigue, diet should be easy to digest, foods rich in vitamins and protein, alcohol is forbidden, selective use of drugs to prevent the development of chronic and severe hepatitis B.

(3) Tertiary prevention: It is estimated that 10% to 20% of chronic hepatitis B will eventually be converted into cirrhosis and primary hepatocellular carcinoma (referred to as liver cancer). Therefore, treatment of chronic hepatitis B cannot be ignored, but There are no satisfactory special effects treatments at present. At present, most scholars advocate the joint application of anti-hepatitis B virus drugs and biological therapy.

1 antiviral therapy: interferon is superior, positive for HBV replication index, and the combination of interferon and adenosine can improve the efficacy. Some people think that combination therapy with hormone and antiviral drugs can be used.

2 Biological Therapy: The study of biological treatment of chronic HBV infection is in its infancy and is rapidly evolving, including cellular immunotherapy and gene therapy.

Hepatitis B viral arthritis complications Complications nodular polyarteritis dermatomyositis polymyositis

Can be complicated by nodular polyarteritis, dermatomyositis and polymyositis, Raynaud's disease.

Hepatitis B virus arthritis symptoms Common symptoms Big Sanyang single ALT increased rheumatoid arthritis hypothermia sore throat edema

Typical cases are sudden onset of symmetry involving many joints, especially in small joints, but can also be asymmetrical in different joints, migratory seizures, joint symptoms lasting weeks to 6 months, most weeks, inflammation The degree varies depending on the condition, and there are tendonitis and synovitis. In a few cases, there are subcutaneous nodules on the forearm extension. The biopsy is similar to rheumatoid nodules. In most cases, there is no jaundice. Even if it occurs, arthritis has subsided. Half of the cases are accompanied by pruritic rash, most commonly urticaria; can also be rash, papules or blemishes, rashes occur in the lower leg, can also be seen in the arms, trunk and face, and can cause angioedema in the toes, In the period from 1 day to 12 weeks before the onset of arthritis, there may be discomfort, sore throat, loss of appetite, nausea, vomiting, chills, fever or myalgia, accompanied by symptoms of hypothermia and skin lesions.

Examination of hepatitis B virus arthritis

1. HBsAg is positive in the blood of most arthritis patients, and can also be positive in joint fluid. When arthritis subsides, HBsAg is negative but antibody is positive.

2. The cold agglutinin is positive in some patients, which contains a large number of complex combinations of immune complexes, possibly HBsAg, HB antibodies, immunoglobulins with M, G, A, complement components C1q, C3, C4, C5 and Dane particles (HB virus).

3. C4 decreased and CH50 decreased significantly when arthritis began to attack, C3 decreased slightly to normal low level, HBsAg increased with C4, C1q decreased, but there were also arthritis patients with normal complement during onset, complement activation can be through traditional and side Road route.

4. Hemoglobin and white blood cell counts are normal, there are relative lymphocytosis and abnormal lymphocytes, and there may be significant anemia and leukocytosis.

5. Antinuclear antibodies and rheumatoid factors are often negative.

6. The synovial fluid examination began as non-inflammatory, but the variation was later, and the white blood cell count was higher, mainly polymorphonuclear leukocytes.

7. Suspected virus particles can be seen by electron microscopy.

8. Choose to do an X-ray or CT examination of the joint.

Diagnosis and diagnosis of hepatitis B virus arthritis

According to the above clinical manifestations and laboratory tests can be diagnosed.

Clinically differentiated from rheumatoid arthritis and other infectious arthritis.

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