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Rheumatoid arthritis (RA) is an autoimmune disease characterized primarily by erosive arthritis, with synovitis as its pathological basis. The initial symptoms of the disease include morning stiffness, swelling, and pain in the affected joints. Ultimately, joint deformities can occur, leading to loss of normal joint function. The ancient Chinese medical text "Jin Gui Yao Lue" by the medical sage Zhang Zhongjing named a similar condition "Li Jie Feng," which closely resembles the description in modern medicine.
RA is an ancient disease, and its existence has been recognized by humans for a long time. Whether it's the description of "rheuma" in the 4th century BC in the complete works of Hippocrates on human anatomy, the systematic discussion of the etiology, pathogenesis, symptoms, and treatment of rheumatoid arthritis in the "Yellow Emperor's Inner Canon" over 2,000 years ago, or the discovery of the oldest evidence of rheumatoid arthritis to date in the skeletal remains of Native Americans in Tennessee dating back to 4500 BC—symmetrical erosive arthritis—these all indicate the long history of rheumatoid arthritis.
Autoimmunity
The patient's immune system mistakenly identifies normal joint tissues as a threat and attacks them, leading to a series of inflammatory reactions in cartilage, synovium, ligaments, and tendons.
Genetics
RA has a familial clustering feature, and it is closely associated with genetics. Current research shows that the genetic susceptibility of RA is closely related to human leukocyte antigen (HLA) genes, including hundreds of allele loci such as DRB1*0401, DRB1*0404, and DRB1*0405. However, their impact on the occurrence of the disease varies among different races. Recent studies have found that HLA-DQα1:160D is a highly correlated genetic risk factor for RA in the Han population of China, with a higher susceptibility risk than the known susceptibility gene HLA-DRB1. Carrying RA susceptibility genes increases the likelihood of developing RA, but it does not necessarily mean that the disease will occur.
Rheumatoid arthritis often has a slow and insidious onset. Joint pain and tenderness are the earliest symptoms, most commonly affecting the wrists, palms, and fingers, followed by the toes, knees, ankles, elbows, and shoulders. The painful joints often have tenderness as well.
Rheumatoid arthritis has an insidious onset, typically beginning with small joints such as the proximal interphalangeal joints, metacarpophalangeal joints, and wrists, gradually progressing to involve multiple joints symmetrically. Eventually, typical inflammatory changes in the joints, such as prolonged morning stiffness, swelling, and pain, can lead to severe joint deformities.
Rheumatoid arthritis is an autoimmune disease that may involve organ damage in addition to joint involvement.
Interstitial pulmonary fibrosis: The most common pulmonary complication of rheumatoid arthritis, presenting as shortness of breath after activity.
Nodular changes: Rheumatoid nodules can form in the lungs, and these nodules can liquefy, leading to the coughing up of cavities.
Caplan's syndrome: A disease in which coal miners have numerous lung nodules, also known as rheumatoid pneumoconiosis, which can suddenly worsen with joint symptoms. The nodules can undergo central necrosis and contain dust.
Pleurisy: Approximately 10% of patients may have pleurisy, with varying degrees of pleural effusion on one or both sides.
Pulmonary arterial hypertension: Mainly due to rheumatoid involvement of the pulmonary arteries or interstitial lung disease.
Pericarditis: More common in patients who are positive for rheumatoid factor and have rheumatoid nodules, but generally asymptomatic. A small amount of pericardial effusion can be found on echocardiography.
Gastrointestinal damage: Mainly due to long-term use of non-steroidal anti-inflammatory drugs for rheumatoid arthritis, rather than the rheumatoid disease itself. It can present as upper abdominal discomfort, pain, nausea, poor appetite, and even gastrointestinal bleeding, manifested as melena.
Neurological complications: Mainly due to joint deformities or local tissue swelling causing compression, such as compression of the median nerve at the wrist leading to carpal tunnel syndrome, presenting as numbness, reduced sensation, and decreased muscle strength in the fingers and palm; compression of the spinal cord can lead to abnormal sensations in both hands, decreased muscle strength, and increased tendon reflexes.
Anemia: Anemia may be caused by gastrointestinal bleeding due to anti-rheumatic drugs or by inflammation itself. It can improve when the inflammation is controlled.
Thrombocytosis: Mainly related to rheumatoid activity, and it can gradually resolve when the condition is controlled.
Felty's syndrome: Refers to the combination of splenomegaly, neutropenia, and, in severe cases, anemia and thrombocytopenia in patients with rheumatoid arthritis. Some patients may also have lower limb ulcers, subcutaneous nodules, joint deformities, as well as systemic manifestations such as fever, fatigue, and weight loss.
Diet
It is recommended that patients follow a Mediterranean diet, consuming more fish, vegetables, fruits, and olive oil. Overweight or obese individuals should control their total food intake to avoid weight gain, which can exacerbate joint burden.
Dietary recommendations
Diet should be diverse: Daily diets should include a variety of fruits, vegetables, meat, eggs, dairy products, seafood, soy products, and nuts. Staple foods can be whole grains or starchy foods.
Appropriate eating habits: Overeating should be avoided. For example, according to the "Chinese Dietary Guidelines for Residents," the recommended daily food intake for adults is 250-400g of starchy foods, 50-150g of grains (including legumes), 300-500g of vegetables, 200-350g of fruits, 40-75g of meat, 40-50g of eggs, 40-75g of seafood, 25-35g of soy products and nuts, and 300g of dairy and dairy products.
Moderate intake of salt and fat
Combination of coarse and fine food: Some of the food should be minimally processed, such as whole grains.
Limit sweet consumption: Excessive consumption of sweets can increase the risk of cavities, diabetes, and obesity, so excessive intake should be avoided.
Balanced meals: It is recommended to arrange three meals a day, and skipping breakfast should be avoided as much as possible.
Heat therapy and cold compress
Heat therapy: Taking a hot bath can help relax the patient's muscles, but heat therapy during the acute phase may exacerbate the condition.
Cold compress: Cold compresses can be applied to the affected joints during the acute phase to relieve pain.
Mind-body relaxation
Mind-body relaxation helps alleviate pain. Short-term rest or sleep can relieve fatigue and joint stiffness caused by RA. Avoiding tension and anxiety and maintaining a positive attitude may lead to improvement in joint and overall health.
Rheumatoid arthritis can involve numerous organs and tissues in addition to the joints, leading to serious consequences. Therefore, once diagnosed, it will change the patient's lifestyle, requiring long-term treatment to control symptoms and reduce joint damage.
Patients should take this disease seriously and actively cooperate with treatment to alleviate symptoms and prevent disease progression.
Patients should also pay attention to joint protection in daily life, including maintaining good posture, balancing work and rest, and using larger joints when exerting force to protect smaller joints.
During treatment, patients should strictly follow up as directed by their physician. If there is an exacerbation of joint-related symptoms or the emergence of new symptoms, timely medical attention is necessary.
