Do you know? Open the door┋How to take care of yourself scientifically if you have rheumatoid arthritis?

Contributor: Gao Cuirong, deputy chief nurse of the Department of Rheumatology and Immunology, the First Affiliated Hospital of Xinjiang Medical University;

Review expert: Luo Li, chairman of the Clinical Immunology Branch of the Xinjiang Immunology Society; vice president of the Xinjiang Uygur Autonomous Region Immunology Society; director, professor and chief physician of the Department of Rheumatology and Immunology, the First Affiliated Hospital of Xinjiang Medical University.

1. What is rheumatoid arthritis?

Rheumatoid arthritis (RA) is an autoimmune disease characterized by chronic, inflammatory synovitis, and patients need to take medication for life [1-3]. It may be related to endocrine, metabolism, nutrition, bacterial and viral infections, and genetic factors, with chronic, symmetrical, polysynovial arthritis and extra-articular lesions as the main clinical manifestations. Rheumatoid arthritis is distributed worldwide and is one of the main causes of human loss of labor and disability.

2. What causes rheumatoid arthritis?

The onset of rheumatoid arthritis may be related to multiple factors such as genetics, infection, sex hormones, decreased lysosomal membrane stability, and hydrolase overflow.

3. What are the symptoms of rheumatoid arthritis?

1. Morning stiffness: The stiffness in the joints and their surroundings after getting up in the morning is called "morning stiffness". If it lasts for more than 1 hour, it is more significant and occurs in more than 95% of patients. Morning stiffness is one of the indicators of disease activity.

2. Swelling

3. Pain: Joint pain is often the earliest symptom. It is symmetrical and persistent, but sometimes mild and sometimes severe. The painful joints are often accompanied by tenderness, and the skin of the affected joints may show pigmentation.

4. Deformity with functional impairment: more common in patients in the later stages.

4. Extra-articular manifestations General manifestations: In addition to the joints, it can cause heart involvement, respiratory system involvement, kidney involvement, nervous system involvement, blood system involvement, etc.

4. How to tell if you have rheumatoid arthritis

1. Morning stiffness ≥ 30 minutes;

2. Arthritis involving more than 3 joint areas;

3. Arthritis of the hands;

4. Rheumatoid factor positive;

5. Anti-CCP positive;

The 14 joint areas include: bilateral elbows, wrists, metacarpophalangeal, proximal interphalangeal, knees, ankles, and metatarsophalangeal joints. ≥3 joints can be diagnosed with rheumatoid arthritis;

5. How to treat

Purpose: To control symptoms, prevent joint destruction, maintain normal function and improve prognosis.

Goal: To achieve and maintain clinical remission or low disease activity over the long term.

Principles: early treatment, combination therapy and individualized plan.

Methods: general treatment, drug therapy, surgery and other treatments.

Help patients correctly understand the disease, build up confidence and patience, and cooperate with doctors in treatment.

6. Daily health care and nursing

(1) Holistic nursing principles

① Patients with obvious joint swelling and pain and severe systemic symptoms in the acute phase should rest in bed. They should not sleep on a soft mattress and their pillows should not be too high.

② Pay attention to keeping the joints warm and avoid dampness and coldness that may aggravate joint symptoms.

③ Provide a nutritious high-protein, high-vitamin diet, avoid eating too much sugary food, and appropriately control sodium salt intake.

④ Patients in the remission period should increase their activities and be guided to perform functional exercises.

(2) Joint care methods

①Observe changes in joint symptoms, such as pain, swelling, morning stiffness, deformity, and the degree and time of dysfunction.

② When joint swelling and pain are obvious, ice compress, hot compress, bath, Chinese medicine patch treatment, etc. can be used. If necessary, give painkillers according to the doctor's advice. When moving the limbs, hold the affected limb gently, support the upper and lower joints, and use splints, brackets or traction to fix or support the joints. Instruct the patient to straighten the joints as much as possible, avoid external rotation of the limbs, and put a pillow between the knees. When morning stiffness occurs, teach the patient to move the joints before getting out of bed in the morning. When resting in bed, sleep on a hard mattress and place a soft pillow under the foot to prevent foot drop.

③ For patients in the acute phase, splint immobilization can be given for a short period of time (2-3 weeks) to maintain the functional position of the joint. After the acute phase, patients can be guided to do active/passive joint movements and isometric muscle resistance exercises to prevent muscle atrophy. Patients are encouraged to get out of bed and move around more, but falls, falling out of bed, and fractures must be prevented.

(3) Functional training

Eagle claw exercise, scissors exercise, fist exercise, fortune wrist exercise

Hold each movement for 5 seconds and repeat the above movements 20 times

Daily diet should be easy to digest and nutritious

【 References 】

【1】Fowzia I, Beatriz LC, Caroline JD, et al. Optimizing treat-ment with tumour necrosis factor inhibitors in rheumatoid arthritis-a proof of principle and exploratory trial: is dosetapering practical in good responders? 【J】.Rheumatology (Oxford), 2017, 56 (11): 2004-2014.

【2】DeaneKD, kristen D, Lindsay B.et al. Genetic and envi-ronmental risk factors for rheumatoid arthritis 【J】.Best Pract Res Clin Rheumatol, 2017, 31 (1): 13-18

[3] Zheng Yuxin, Li Xinxin, Zheng Min. Improving the compliance of topical medication by analyzing the psychological characteristics of psoriasis patients [J]. Chinese Journal of Dermatology, 2018, 51(10): 766-768