Joint pain does not mean arthritis? What is arthritis?

Joint pain does not mean arthritis? What is arthritis?

Zheng Wenjie | Director of Pediatric Rheumatology Department, Second Affiliated Hospital of Wenzhou Medical University

Types and clinical symptoms of arthritis

Arthritis is not the same as joint pain. It is the redness and swelling of the joint surface, as well as the skin temperature. If you touch his joints, you may feel the skin temperature is hot or painful, plus the joint movement is limited. In total, these five aspects, including any two of them, can be called arthritis.

Therefore, joint pain does not equal arthritis, and limited joint movement alone does not necessarily equal arthritis. It must be combined with other factors. For some people, for example, joint swelling is not too obvious, and imaging examinations such as ultrasound and magnetic resonance imaging are used to determine whether there is joint swelling.

Arthritis actually covers many aspects. For example, it can be infection-related, tumor-related, rheumatic autoimmune disease-related, and the ones we are all very familiar with, such as injury and trauma, and metabolism-related, such as gout, abnormal bone metabolism, etc. Therefore, the clinical manifestations of different types are also very different. For example, infection-related, they will show fever, swelling and pain in the joints, and sometimes the skin surface will be red and hot, and then the pathogen can be found by doing joint effusion, and antibiotic treatment is effective.

But tumor-induced arthritis is different. The pain of tumor-induced arthritis is very prominent. Some people will be awakened by the pain at night. If you carefully check the body, you will find that it is not only joint pain, but also bone pain. So this is the pain of bone invasion caused by tumor. At this time, you need to do bone joint imaging, or even bone marrow puncture.

If a rheumatology autoimmune disease is to be diagnosed with arthritis, there is a step to exclude infection, so arthritis is a non-infectious, non-tumor arthritis. So these are still somewhat different in clinical manifestations.

The relationship between arthritis and obesity, age and gender

In adults, many studies have shown that obesity can lead to osteoarthritis. In fact, we have also found something in children, that is, in obese children, their fat cells will turn into inflammatory cells, and we have observed an increase in inflammatory indicators in many obese children.

We also see that some children with hypercholesterolemia go to the rheumatology department with arthritis as the first symptom due to high blood lipids. Therefore, the relationship between the two is increasingly gaining attention from endocrinologists and rheumatologists. There is a certain connection between the two, that is, whether weight will cause some wear and tear on the joints.

We know that when the knee joint is bent, it bears 80 times the body weight, so the pressure it actually reaches is very high. In addition, in children with obesity, the sacroiliac joint, which is a very important weight-bearing joint in the buttocks, is often observed. Back pain and buttocks pain are often related to weight and obesity.

Osteoarthritis is very common in the middle-aged and elderly, because it is a degenerative disease, just like a machine, it will wear out after you use it for a long time. Therefore, osteoarthritis is a very common disease in adult rheumatology, but we almost never see such a degenerative disease in children.

Children's joints may be more likely to be caused by exercise, injuries, and some of the metabolic factors we just mentioned. When children come for treatment, they are often found to have limited joint movement, but the swelling and pain are not too obvious. Some genetic metabolic diseases should also be suspected, and some genetic abnormalities in bone development and bone metabolism will be found to cause joint deformities and bone destruction.

Arthritis epidemic trends and diagnosis of arthritis in children

Because estrogen levels have a mediating effect on immune diseases, it has indeed been a hot topic of research. Many diseases, such as lupus erythematosus, rheumatoid arthritis, and the type of arthritis I just mentioned, except for ankylosing spondylitis, that is, rheumatic immune diseases, including osteoarthritis, are more common in women. This disease in women is often considered to be related to estrogen levels. Abnormal estrogen levels cause abnormalities in some immune cells. However, this is not one of its pathogenic mechanisms. There has been no definite conclusion so far. It is just that its incidence trend has been observed to be different in clinical practice.

There is no clear epidemiological data on the incidence of arthritis in China. For children, the incidence is about 10/100,000, so there are still many people suffering from the disease. In terms of different age trends, we take juvenile idiopathic arthritis as an example, which is divided into seven types in total.

Among the seven types, for example, the systemic type has the same male-female ratio, and is more common in children under 5 years old. But there is also a type called arthritis associated with enthesitis, which is called ankylosing spondylitis in adults. How do we relate the relationship between these two diseases? In pediatrics, it is called arthritis associated with enthesitis, and it may turn into ankylosing spondylitis in adulthood. This disease is more common in men, so it occurs in older children, men over 6 years old. The small joint type is unique to pediatrics and not found in adults. It is more common in women under 6 years old, that is, in little girls. The polyarticular type is more common in adolescent women. So the distribution of different types at different ages is still somewhat different.

How is arthritis diagnosed?

The diagnosis of arthritis is different from that of other diseases. There is no one definite method. For example, for pneumonia, we may take a chest X-ray or a lung CT scan to determine whether the patient has pneumonia. For arthritis, we basically follow these three steps:

The first step is to determine whether arthritis exists. According to the redness, swelling, heat, pain and limited movement mentioned earlier, we can determine whether it exists through physical examination of the joints and imaging of the joints.

The second step is to determine whether it is acute or chronic. Chronic diseases are different. Generally speaking, arthritis related to rheumatism and immunology is a chronic synovitis. In this case, ultrasound and magnetic resonance imaging are used to determine whether the patient has arthritis and synovial thickening.

The third step is to find the cause. The causes include infection, tumor, metabolism, etc. Various blood tests and bone marrow punctures are needed to rule out infection and tumor, and to make sure it is not secondary to systemic diseases. Only then can it be confirmed that it is rheumatism and immunity. Adults call it rheumatoid arthritis, and children call it juvenile idiopathic arthritis.

So the arthritis we usually talk about is a big hat, which is subdivided into many different causes, and we need to combine different causes to make corresponding diagnostic methods.

What are the treatments for arthritis?

Drug treatments can be roughly divided into three categories:

The first category is called non-steroidal anti-inflammatory drugs. The representative of this type of drug is the well-known ibuprofen, which I believe everyone has used during the epidemic. There are others, such as Celebrex and Voltaren, which are all non-steroidal anti-inflammatory drugs. The advantage of this type of drug is that it can quickly relieve pain and inflammation, so it works very quickly, but it cannot prevent further progression of joints, so the second type of drug is needed.

The second type of drugs is called chronic antirheumatic drugs, which we call DMARD (Disease Modifying Antirheumatic Drugs). Representative drugs included in DMARD include methotrexate and sulfasalazine.

It is a slow-acting drug that takes a long time to take effect, but its advantage is that it can slow down the thickening of joints and synovium, as well as the further progression of bone destruction, and can delay the disease, so it is called a chronic anti-rheumatic drug. These drugs need to be used for a long time.

The third category is the current targeted drugs, which include biological agents and small molecule targeted drugs. For example, if the systemic inflammatory response is severe, such as fever and very high inflammatory indicators, then targeted drugs such as interleukin-6 and interleukin-1 antagonists may be used for treatment. If the inflammation of the joints is prominent, then tumor necrosis factor α antagonists or interleukin-17 receptor antagonists may be the first choice for treatment. Therefore, different targeted drugs will be selected according to different types.

What are the advantages of these targeted drugs? They take effect very quickly and can also slow down the progression of arthritis. Therefore, for patients with severe conditions and adverse factors after recovery, these targeted therapeutic drugs can be used in the early stages of the disease.

Arthritis actually has a treatment window period. The earlier the treatment is, the more likely it is to block the immune disorder mechanism, so that it will not progress further, and the chances of joint damage and joint deformity will be greatly reduced. So when a general patient comes, we will first use the first and second categories of drugs, that is, non-steroidal anti-inflammatory drugs, plus anti-rheumatic drugs and slow-acting drugs according to the condition. If the condition is more serious and there are adverse factors after recovery, we will use targeted drugs in combination. This is the drug treatment aspect.

The second aspect is physical therapy. Physical therapy can still play a very good auxiliary role, including physical therapy, infrared, moxibustion and other (therapies) can be used as auxiliary treatments. After the pain disappears in the later stage, we can also do some rehabilitation treatments and increase the intensity of exercise to help the joints recover. For this (situation) caused only by joint deformities, which cannot be reversed by drugs, such patients will consider surgical treatment. Since we can basically achieve early identification, early diagnosis, and early treatment now, the proportion of ordinary arthritis patients who undergo surgical treatment is getting smaller and smaller.

How to reduce the occurrence of arthritis?

First, I think people's eating habits nowadays are such that there are too many ways to get refined rice and flour, so many people with picky eating habits are more likely to develop rheumatic autoimmune diseases, including arthritis. So our dietary advice is to eat more fresh vegetables and fruits, eat less sweets, especially beverages. Refined rice and flour should also be reduced appropriately.

The second is the suggestion for outdoor activities. Because people now have more and more electronic products, the level of 25-hydroxyvitamin D is generally lower, and the level is relatively low. So in terms of lifestyle, it is also recommended to do more outdoor activities, get more sun, and spend less time using electronic products.

The third is the suggestion about exercise. Because during the acute pain period, you still need to limit your activities. After the pain is relieved, you can do moderate exercise and are encouraged to participate in sports activities. But among these sports activities, swimming, gymnastics, and ball games are recommended first. Roller skating and taekwondo are not recommended. For students, they should often do rope skipping exercises, but they should also pay attention to protecting their joints. Do not do high-intensity rope skipping on hard concrete floors, and pay attention to some protection of the joints.

In addition to the food I just mentioned, in the living environment, whether it is children or the elderly, it is very important to keep ventilation and dry, moisture-proof and mildew-proof. Especially in some rainy seasons, we must pay attention to the growth of mold. In this regard, dehumidification is also relatively important.

In addition, we should avoid repeated infections. Because many joints are closely related to infection. For example, we should pay attention to repeated tonsillitis in children; for older people, we should also pay attention to repeated diarrhea or constipation, and some intestinal obstructions, and make adjustments.

Finally, there is allergy. People with allergic constitutions are also prone to arthritis attacks. Therefore, for those with allergic constitutions, they also need to pay attention to screening for allergens and take some anti-allergy measures.

This article is a work supported by the Science Popularization China Creation Cultivation Program

Team/Author: Deep Science

Reviewer: Wang Jun, Chief Physician of Orthopedics, Shanghai Fifth People's Hospital, Fudan University

Produced by: China Association for Science and Technology Department of Science Popularization

Producer: China Science and Technology Press Co., Ltd., Beijing Zhongke Xinghe Culture Media Co., Ltd.