Practical Rheumatology: Diagnosis and Treatment of Arthritis

Author: Sun Ying
Publisher:
Publish Date: 2002-11-01
Features: Arthritis is an inflammatory disease that occurs in the joints of the human body. It is a common, polygenic disease with unclear etiology, complex lesions, and diverse manifestations. The term "Rheum" dates back to the 1st century BC, referring to pain in unspecified locations. During the time of Sydenham, this term was commonly used to describe conditions primarily characterized by joint and periarticular pain. However, arthritis is not a single disease; certain systemic diseases present with joint pain/inflammation as an initial symptom, while many arthritis cases begin with general malaise. For example, rheumatoid arthritis, in addition to joint swelling and pain, may also involve pharyngitis, fever, and myocarditis. Many rheumatic diseases are primarily characterized by pain (in joints, muscles, soft tissues, or nerves). However, not all rheumatic diseases involve pain. Although various forms of arthritis account for a significant portion of rheumatic diseases, they are not limited to arthritis alone. With the continuous development of biochemistry, immunology, microbiology, genetics, molecular biology, and imaging, scientists have conducted in-depth and meticulous research on arthritis from the perspectives of etiology, epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment, achieving significant progress. For instance, in the early 19th century, Brodie considered rheumatoid arthritis to be a slow-developing process originating from the synovium and capable of leading to joint cartilage destruction. Over time, through radiological imaging reports of affected joints, the use of gold preparations, and the detection of RF, it gradually became recognized that the onset of rheumatoid arthritis results from the combined action of multiple factors, with infection factors as triggers and endocrine, genetic, and immune factors as intrinsic predisposing factors in susceptible individuals. Currently, it is believed that the onset of rheumatoid arthritis may occur through ambiguous recognition between T cell receptors and HLA-DR1, leading to the development of individuals carrying HLA-DR4/DR1 or other Class II HLA genes. Previously, osteoarthritis was thought to be an inevitable part of aging. However, it is now recognized as an independent disease associated with multiple factors. Its onset is related to the apoptosis of joint cartilage cells and the length of telomeres in their intracellular chromosomes. Telomere shortening is a major cause of replicative senescence in human cells. Arthritis is a broad category of diseases that can affect individuals from childhood to old age, making it a condition frequently encountered by physicians in various clinical specialties. Mild cases of arthritis can cause joint swelling, pain, and restricted mobility, while severe cases may lead to joint deformity and loss of self-care ability, severely impacting patients' work, studies, and social interactions, causing immense physical and mental suffering. Certain arthritis conditions, such as rheumatoid arthritis, osteoarthritis, Sj?gren's syndrome, and ankylosing spondylitis, are often misdiagnosed or confused with other diseases in the early stages, leading to delayed treatment. Learning theoretical knowledge about arthritis, mastering comprehensive diagnostic and treatment skills, and better alleviating patients' suffering from the disease are the responsibilities of healthcare professionals. This book covers various types of arthritis and extensively discusses diseases related to arthritis, with a focus on the diagnosis, differential diagnosis, and treatment of arthritis. It aims to provide up-to-date and practical content, serving as a reference for clinical physicians and medical students from all specialties. The book is divided into sixteen chapters. The first chapter provides a general introduction to research progress, diagnostic techniques, and treatment principles related to arthritis, while the remaining chapters are organized based on the classification of arthritis, detailing each type of arthritis in separate chapters. Each chapter primarily includes: the concept (definition) of the arthritis type, pathogenesis, clinical manifestations, laboratory and imaging examination features, key points for differential diagnosis, diagnostic criteria, treatment, and treatment advancements.