Symptom >> Internal Medicine >> Division of Rheumatology

Swollen joints

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Most of the joint swelling is seen in rheumatoid arthritis. Rheumatoid arthritis is an allergic disease and is one of the main manifestations of rheumatic fever. Most cases with acute fever and joint pain, typical manifestations of mild or moderate fever, migratory polyarthritis, the affected joints are mostly knee joints, shoulders, elbows and other large joints, often transferred from one joint to another Joints, lesions appear red, swollen, burning, severe pain Some patients also have several joints at the same time, atypical patients only have joint pain and no other inflammatory manifestations, acute inflammation usually disappears in 2-4 weeks without sequelae, but often repeated attack. If rheumatism affects the heart, it can cause myocarditis and even left heart valve disease.

Cause

Cause

According to Western medicine, rheumatism is caused by a systemic disease characterized by non-infectious inflammation of the tissues surrounding the joints and joints. Many scholars believe that it is related to the autoimmune response of genetic factors. In short, it is not clear that Western medicine has the pathogenesis of etiology.

Traditional Chinese medicine believes that there are four general reasons for the cause of the disease and the pathogenesis of the disease:

1. Visceral yin and yang internal injuries:

According to the view of the Chinese medicine yin and yang five elements, the five internal organs are the main blood vessels of heart, liver, spleen, lung and kidney: liver main rib, spleen main muscle, lung main fur, and kidney main bone. The occurrence of rheumatism is mainly due to internal injury of the liver, spleen and kidney. The kidney is the congenital essence. The essence of the marrow, the marrow, and the bone in the body are the officials of the strong; the liver is the foundation of the muscles, the blood, the gluten, the joints and muscles The spleen is the foundation of the day after tomorrow, the source of qi and blood biochemistry, the muscles of the main limbs, and the yin and yang of the human body. It is necessary to maintain balance. If the yin and yang are not balanced, there will be partial stagnation and decay, and the evil will invade. Therefore, rheumatism is a symptom of heat and cold.

2, the feeling of six kinky evil:

Six sinful evils refer to the six normal gases of the cold and dry fire. The gas that invades the body's body to cause disease is called evil. Rheumatism occurs when the wind, cold and dampness invade the body. The winner of the wind is the shackle; the chill is the sorrow; the winner is the sputum. Wind, cold and dampness block the meridians and joints. If it doesn't work, it hurts, so it causes joint swelling and pain.

3, turbid blood stasis endogenous:

Turbidity and blood stasis are the pathological products of the human body under the influence of disease and evil, and can also act on the human body as a cause. Most of rheumatism has a chronic process. When the disease has been in the disease for a long time, the disease is caused by the disease, which is light and heavy, leading to dysfunction of the viscera, and the result of dysfunction of the viscera produces turbidity and blood stasis. It is the root cause of the lingering and refractory rheumatism.

4, camp gas and blood disorders:

Chinese medicine speaks of qi, Weixue, Yingqi, and Zhongweiwei, and the yin and yang are inter-pulmonary. The air-regulating blood is smooth, the limbs are full of viscera and viscera, the camping and regulating gas are outside, the body surface is protected from evil spirits and invades the body, the camp is not harmonious, and the evil spirits take advantage of it. Therefore, the camp Wei is an important factor in the incidence of rheumatism. one.

Examine

an examination

Related inspection

Rheumatoid factor (RF) joint cavity fluid examination

The diagnosis of rheumatoid arthritis is mainly based on: history of hemolytic streptococcal infection 1-4 weeks before onset, acute migratory arthritis, often accompanied by other manifestations of rheumatic fever, such as myocarditis ring erythema, subcutaneous nodules, etc. The serum anti-streptolysin 0 agglutination titer is significantly increased, throat swab culture positive and leukocytosis, etc., anti-chain (anti-streptolysin) is the body appears in the serum after infection with group A hemolytic streptococcus An antibody, nearly 85% of patients with rheumatoid arthritis, has an anti-chain increase, usually above 1:800. Of course, this antibody can gradually decrease after the recovery of rheumatoid arthritis. In addition to the anti-chain increase of rheumatoid arthritis, laboratory tests can also find the following abnormalities:

(1) Peripheral blood white blood cell count increased, mostly above 10 × 10 ⁹ / liter (that is, 10000 / cubic millimeter), the proportion of neutrophils also increased significantly, up to 80-90%, and some nuclear left shift phenomenon.

(2) ESR and C-reactive protein are elevated, ESR and C-reactive protein are usually indicators of various inflammations. In the acute phase of rheumatoid arthritis patients, ESR can reach 90 mm/hr or more, and C-reactive protein is also At 30 mg / liter (30 g / ml) or more, after the acute period (about January to February) gradually returned to normal.

(3) Joint fluid examination is often exudate. The white blood cell count can be close to normal, and the weight can reach 80×10 ⁹ /L (80000/cm 3 ) or more. Most of them are neutrophils, and the bacterial culture is negative.

(4) Both rheumatoid factor and antinuclear antibody were negative.

Diagnosis

Differential diagnosis

The disease needs to be differentiated from the following diseases:

1, rheumatoid arthritis is multiple, symmetrical palm and other small arthritis and spondylitis.

2, tuberculous arthritis is mostly involved in a single joint, occurs in the joints of regular active hand friction or weight bearing.

3, tuberculosis infection allergic arthritis.