Symptom >> Internal Medicine >> Division of Rheumatology

Heat pain

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Heat pain is one of the main manifestations of rheumatoid arthritis. Rheumatoid arthritis, also known as rheumatoid arthritis (RA), is a chronic systemic inflammatory disease whose etiology is not yet known. Rheumatoid arthritis is currently recognized as an autoimmune disease. May be related to differences in endocrine, metabolism, nutrition, geography, occupation, psychology and social environment, bacterial and viral infections and genetic factors, with chronic, symmetrical, multiple synovial arthritis and extra-articular lesions as the main clinical Performance, belonging to autoimmune inflammatory diseases.

Cause

Cause

Rheumatoid arthritis is a very common disease, also known as rheumatoid arthritis (RA). It is a chronic systemic inflammatory disease whose cause is not known. It is mainly chronic, symmetrical, synovial arthritis and extra-articular lesions. Clinical manifestations, belonging to autoimmune inflammatory diseases. The disease occurs in small joints such as hands, wrists, and feet. It is repeated and appears symmetrically.

In the early stage, there are joint redness, swelling, heat pain and dysfunction. Late joints may have different degrees of stiff deformity, accompanied by atrophy of bone and skeletal muscle, which is easily disfigured. From the point of view of pathological changes, rheumatoid arthritis is a major joint synovial membrane (which can affect the articular cartilage, bone tissue, joint ligament and muscle bond), followed by serosal, heart, lung and eye connective Tissue extensive inflammatory disease. The systemic manifestations of rheumatoid arthritis include fever, fatigue, pericarditis, subcutaneous nodules, pleurisy, arteritis, and peripheral neuropathy. In addition to inflammatory lesions at the joint site, generalized rheumatoid arthritis also includes extensive lesions throughout the body.

It is worth noting that many people tend to regard rheumatoid and rheumatism as the same disease. In fact, this idea is wrong. Before the middle of the 19th century, people often confuse the two. With the development of science and technology, people are more and more aware of rheumatoid arthritis. For the difference between rheumatoid arthritis and rheumatoid arthritis, please refer to other relevant contents of this book. The name rheumatoid arthritis was first used by British doctor Garrod in 1858. In 1896, Schaefer and Raymond identified the disease as an independent disease. In the same year, Steele described the child-type rheumatoid arthritis in detail. In 1931, Cecil et al found that the agglutination rate of serum and streptococcus in rheumatoid patients was very high. In 1940, Valer discovered rheumatoid factor. In 1945, Cavillti and Slefen in 1961 proposed the theory of autoimmune reaction of rheumatoid pathogenesis, and were determined.

Examine

an examination

Related inspection

X-ray lipiodol angiography blood test bone palpation

Experimental examination

Most active patients have mild to moderate positive cell hypochromic anemia, most of the white blood cell count is normal, sometimes eosinophils and thrombocytosis are seen, serum immunoglobulin IgG, IgM, IgA can be elevated, serum complement levels are mostly normal or Mildly elevated, 60%-80% of patients have high levels of rheumatoid factor (RF), but RF positive is also seen in chronic infections (hepatitis, tuberculosis, etc.), other connective tissue diseases and normal elderly. Other autoantibodies such as anti-keratin protein antibody (AKA), anti-perinuclear factor (APF) and anti-cyclic citrullinated peptide (CCP) have high diagnostic specificity for the diagnosis of rheumatoid arthritis, but the sensitivity is only About 30%.

X-ray examination

In order to clarify the diagnosis, disease and development of the disease, X-ray films of both wrists and hands and/or bipedal X-rays, as well as other affected joints, should be taken at the beginning of the disease. Early X-ray films of RA showed swelling of soft tissue around the joints, mild osteoporosis near the joints, followed by joint space stenosis, joint destruction, joint dislocation or fusion. X-ray changes were classified into stage IV according to the degree of joint destruction.

Phase I (early)

1, X-ray inspection without destructive changes

2, visible osteoporosis

Phase II (interim)

1, osteoporosis, may have mild cartilage destruction, with or without mild subchondral bone destruction

2, visible joint activity is limited, but no joint deformity

3, adjacent muscle atrophy

4 related to extranodal soft tissue lesions, such as nodules and tenosynovitis

Phase III (severe period)

1. Osteoporosis plus cartilage or bone destruction

2, joint deformity, such as subluxation, ulnar deviation, no fibrous or bony rigidity

3, extensive muscle atrophy

4, there are extra-articular soft tissue lesions, such as nodules or tenosynovitis

Stage IV (end stage)

1, fibrous or bony rigidity

2. Articles in the Phase III standard

Diagnosis

Differential diagnosis

Bipedal redness and heat pain: caused by erythematous limb pain disease, under certain incentives, paroxysmal clinical manifestations of bipedal redness, swelling, heat, pain, etc., is a clinical feature of erythematous limb pain . Erythromorphic erythromelalgia is an autoimmune disease characterized by paroxysmal vasodilatation of the distal extremities, elevated skin temperature, flushing of the skin, and intense burning pain. Erythromelalgia is an unexplained peripheral vasomotor dysfunction. The clinical features are red, swollen, painful, and hot skin of the extremities. It occurs in both feet. The youngest age is 8 years old. The 52-year-old. More common in young adults, it is a rare disease. Epidemiology: In 1878, Mitchell first reported a disease characterized by red, swollen, hot, and painful skin of the fingertips, and was named erythematous limb pain. In 1964, Babb et al. classified the disease into two categories: primary and secondary. In the past 30 years, China's Nanjing, Tibet, Guizhou, and Guangdong and Guangxi regions have experienced a large number of epidemics among healthy people. In 1995, Professor Wang Jiajui defined a type of erythematous limb pain that mainly occurred in southern China as idiopathic erythema limb pain.