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The pathogen of rheumatoid arthritis is Group A streptococcus, and the route of infection is crucial. Infection of the streptococcus through the respiratory tract is a necessary condition for the onset of the disease.
The molecular structure of certain components of Group A Streptococcus may be similar or identical to that of the synovium and joint fluid, leading to cross-immune reactions that cause joint damage.
Between the pharyngeal infection with streptococcus and the appearance of typical symptoms, mild or brief prodromal symptoms often occur.
Prodromal symptoms
Prodromal symptoms generally appear 1-6 weeks before typical symptoms, often showing signs of upper respiratory tract streptococcal infection such as fever, sore throat, enlargement of submandibular lymph nodes, cough, etc. Irregular fever is present in more than half of the patients, with mild to moderate fever being more common.
Typical symptoms
Manifest as migratory, polyarticular arthritis, mainly occurring in large joints such as the knees, ankles, elbows, wrists, and shoulders.
Locally, redness, swelling, heat, pain, and tenderness may occur, sometimes with effusion, but no purulent symptoms.
Joint pain rarely persists for more than a month, typically subsiding within 2 weeks.
After remission, there is usually no apparent joint degeneration, but relapses are common.
Exacerbation of joint symptoms is associated with cold and damp conditions.
Atypical symptoms
Inflammation reactions occurring in only one or a few joints, which may affect uncommon joints such as the hip, finger, temporomandibular, sternoclavicular, and costosternal joints.
This disease shares similarities with rheumatoid arthritis, reactive arthritis, tuberculous allergic arthritis (Poncet's disease), subacute infective endocarditis, and viral myocarditis. Specialist physicians make differential diagnoses based on clinical presentations and laboratory test results.
Rheumatoid arthritis
Onset is gradual, with a long course, often affecting symmetrical small joints, accompanied by morning stiffness, elevated rheumatoid factor, and anti-cyclic citrullinated peptide antibody titers.
Reactive arthritis
History of gastrointestinal or genitourinary tract infections, primarily affecting the lower limb joints. Accompanied by enthesitis, lower back pain, and HLA-B27 positivity.
Tuberculous allergic arthritis (Poncet's disease)
History of tuberculosis infection, positive tuberculin skin test, poor response to non-steroidal anti-inflammatory drugs, and effective anti-tuberculosis treatment.
Subacute infective endocarditis
May present with progressive anemia, petechiae, splenomegaly, embolism, and positive blood cultures.
Viral myocarditis
Presents with prodromal symptoms of nasal congestion, rhinorrhea, and tearing, significant increases in virus neutralization tests and antibody titers, and pronounced and refractory arrhythmias.
Avoid triggers: Cold and dampness are important triggers for this condition and can exacerbate or induce symptoms. Measures should be taken to ensure warmth and prevent dampness according to environmental changes.
Rest and care: During an outbreak of rheumatoid arthritis, bed rest is advised, gradually resuming activity as the condition significantly improves.
Enhance physical fitness: Avoid exhaustion, engage in appropriate exercise, maintain a cheerful disposition, and ensure adequate sleep.
Pay attention to warmth and prevent dampness, avoid exhaustion, and ensure sufficient sleep.
If secondary preventive medication is used, it should strictly adhere to medical advice, and the medication should not be changed or terminated without authorization.
Follow-up at the rheumatology and immunology outpatient clinic, regularly recheck blood routine and other indicators.
Primary (first-level) prevention and secondary prevention of rheumatic fever can significantly reduce the incidence of rheumatoid arthritis.
Primary prevention:
Interrupt the spread of Group A Streptococcus infection.
Improve living environment, enhance ventilation, avoid dense populations.
Prevent malnutrition, engage in appropriate physical exercise, enhance physical fitness, and improve disease resistance.
Carry out cold and dampness prevention and actively prevent upper respiratory tract infections.
Strengthen health education.
Vaccination against streptococcal infections.
Secondary prevention:
Actively prevent the recurrence of rheumatic fever or secondary rheumatic heart disease by using secondary preventive medications.
