Rheumatism is a large group of diseases that affect bones, joints and their surrounding soft tissues, a total of more than a dozen categories, more than 100 kinds of diseases. Degenerative osteoarthropathy in the elderly is one of the rheumatism. Rheumatoid arthritis is the most common rheumatoid disease affecting young and middle-aged men and women.
Rheumatoid arthritis has unknown etiology and is a chronic, symmetrical, destructive, systemic disease with facet joint involvement, which can be accompanied by extraarticular organ involvement such as pulmonary interstitial lesions, kidney, heart, nervous system damage, etc. The clinical manifestations are morning stiffness, swelling and pain of the wrist joint, metacarpophalangeal joint, and proximal interphalangeal joint, limited joint movement, and even joint deformity.
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Its onset may be related to genetics, infection, sex hormones, and environment. In the state of inflammation, the disease continues to progress, cartilage and bone tissue are constantly eroded and destroyed, and joint deformities and even disability often occur in severe cases if not systematically treated.
In mainland China, the prevalence of rheumatoid arthritis is 0.4%, the number of people reaches 7 million, the male to female ratio is about 1:4, and the disability rate of 1~5 years, 5~10 years, 10~15 years and more than 15 years is about 19%, 44%, 48% and 61%, respectively. It can be seen that rheumatoid is one of the main diseases that cause labor loss and quality of life.
Anti-rheumatism, "can't eat hot tofu in a hurry"
The treatment purpose of rheumatoid arthritis is mainly to reduce joint inflammation, inhibit the development of lesions and irreversible bone destruction, protect joint and muscle function as much as possible, strive for remission and improve the quality of life of patients. Specifically, it involves multiple aspects, such as patient education, early treatment, combination medication, individualized treatment plan, functional exercise and psychological support and other comprehensive treatment measures. Of course, drug therapy is the most important means.
The drug treatment plan should follow the principle of individualization, and the treatment drugs mainly include nonsteroidal anti-inflammatory drugs, glucocorticoids, disease-modifying drugs (methotrexate, leflunomide, hydroxychloroquine, sulfasalazine tablets, etc.), biological agents (etanercept, adalimumab, rituximab, etc.) and phytomedical preparations (triptovine, penisine, white peony total glycosides, etc.).
Many people have been ill for many years, and various drugs have been tried, not only have they not been cured, but they are getting more and more serious. Why can some people cure the same disease and the same medicine, but they have not been cured again and again? Sorting out the medication treatment experience of these patients, it is found that there are the following misunderstandings, which may also be the reason why their condition is not well controlled.
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Myth 1: Frequent dressing changes.
There is a saying called "can't eat hot tofu in a hurry", rheumatoid drugs generally have a slow effect, such as methotrexate, leflunomide are slow-acting drugs, and it takes a while to take effect. The onset of action varies from person to person, and it can even take 6 months for individual patients to start the effect. For example, the onset of methotrexate is generally 1~2 months, and the onset of TwHF takes 3 months.
Some patients do not know much about this, and after taking a period of time, they feel that the medicine is not good, and want to try other special drugs. Such blind dressing change not only does not have a therapeutic effect, but delays the disease, resulting in the progression of the disease becoming more and more difficult to treat.
Myth 2: Stop the drug without authorization.
After a period of medication, the joint swelling and pain are eliminated, and some patients think that the disease is better, so they stop or reduce the drug without authorization. In fact, it is only the beginning of remission, and it is easy to relapse when the drug is stopped.
Joint swelling and deformation are visible conditions, but indicators such as erythrocyte sedimentation rate, CRP (C-reactive protein), and anti-CCP (cyclic citrullinated peptide) antibodies are invisible to the naked eye. When you think that the swelling and pain are gone, the disease is better, in fact, those invisible inflammatory indicators are still at a high level, and the consequences of stopping the drug at this time are very serious. After the treatment is met, the drug should be discontinued according to the doctor's advice and gradually carried out as appropriate.
Given the many poor prognosis of rheumatoid arthritis, a chronic disease, it is not recommended to completely discontinue traditional antirheumatic drugs.
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Myth 3: Multi-drug combination.
Some patients do not control the disease well, causing great harm to the body and mind, in order to see faster results, see different doctors at the same time, combine multiple drugs without authorization, and even increase the amount of drugs without authorization, which is more likely to lead to repeated diseases.
Rheumatoid treatment is a slow process, can not be said to stop the drug immediately without pain, let alone believe in the composition of the unknown home remedies, even if the drug is stopped, according to the recovery situation in accordance with the doctor's advice to slowly reduce the drug, the patient's immune function also needs to slowly adapt in the process of drug reduction. Those patients with well-controlled rheumatoid have their immune function slowly improved, and after treatment, they have been followed up for many years and basically do not relapse.
Myth 4: There is no regular review.
Follow-up or follow-up is important in chronic disease control because:
First, to see the body's responsiveness to drugs, whether the disease progression has been effectively controlled, convenient for subsequent adjustment of medication, methotrexate continues to maintain or need to increase the dose, corticosteroids can not be eaten for a long time, according to the results of the review to decide whether to reduce or stop the dose.
Then check whether adverse drug reactions have harmed human health. Many drugs need to be metabolized in the liver, and if the drug breaks the liver, it will cause big trouble for the body.
In addition, such drugs can sometimes cause severe bone marrow suppression, and review can help everyone detect and prevent these serious adverse reactions early.
Author丨Deputy Chief Pharmacist of Zhoupu Hospital Affiliated to Shanghai Health Medical College Xu Nongzhang
Dr. Li Dongdong, Chief Pharmacist and Chief Pharmacist of Huashan Hospital Affiliated to Fudan University
Source丨Family Medicine, Issue 7, April 2023
Editor丨Li Jiahua
Proofreader丨Zheng Ke
Second instance丨Zhang Yue
Final judge丨Liu Huiying Zhang Ruxian