How Much Do You Know About Arthritis—What Type of Arthritis Do I Have?

This is the 4199th article of Da Yi Xiao Hu

Many outpatients come to the hospital with symptoms of pain, soreness, discomfort, and swelling in or around joints, and some with limited joint movement. Patients or non-professional doctors often simply refer to these diseases as "arthritis," but they are hesitant to explain what kind of arthritis it is.

Different types of "arthritis" have very different pathogenic mechanisms, diagnosis and treatment plans, so today I would like to briefly introduce the diagnosis and treatment points of the most common types of arthritis in our orthopedics department:

1. Rheumatoid arthritis

It is a chronic, systemic, autoimmune disease. It is multiple and symmetrical, often affecting the small joints of the hands and feet, especially the proximal interphalangeal joints, metacarpophalangeal joints and metatarsophalangeal joints, followed by the knees, ankles, wrists, elbows, hips and spine. It is mainly a synovial lesion, which causes the destruction of articular cartilage and joint capsule, and finally leads to joint ankylosis and deformity.

Here we need to explain to patients that there are often misunderstandings in the diagnosis of rheumatoid arthritis. Many people simply think that as long as the rheumatoid factor is positive, it is rheumatoid arthritis, and negative means it is not. In fact, this is not accurate. Rheumatoid factor positivity can also appear in other diseases such as systemic lupus erythematosus; and a small number of patients with rheumatoid arthritis have always had negative rheumatoid factor.

The specific diagnosis is based on the evaluation of the patient's specific symptoms by the physician of the Department of Rheumatology and Immunology. Once diagnosed with rheumatoid arthritis, lifelong medication is required to prevent joint damage and deformity or disability. There are many drug options for the treatment of rheumatoid arthritis, and the symptoms of most patients can be significantly improved and controlled. The most important treatment principle is early diagnosis, early treatment, and timely, systematic, regular, and combined treatment plans.

2. Gouty arthritis

Gouty arthritis is caused by the deposition of urate in the joint capsule, bursa, cartilage, bone and other tissues, which causes damage and inflammation. The first joint to be affected is usually the first metatarsophalangeal joint of the foot, but it can also occur in other toe joints, ankle joints, hand joints, wrist joints and knee joints. The cause of the disease is generally due to purine metabolism disorders and increased blood uric acid in the body.

During the acute attack of gouty arthritis, the patient's symptoms are most obvious, manifested as severe swelling and pain in the affected joints, local skin redness, swelling, and fever, most of which are induced by drinking, high-purine diet, fatigue, or cold. The key to acute treatment is not to lower uric acid but to reduce inflammation and relieve pain, and relieve arthritis symptoms. For patients with gouty arthritis, lowering uric acid is a long-term process.

3. Osteoarthritis

Osteoarthritis, also known as osteoarthritis, degenerative arthritis, hyperplastic arthritis, and senile arthritis, is a non-inflammatory chronic joint disease with unclear etiology characterized by degenerative changes in articular cartilage and secondary bone hyperplasia. It is prone to occur in heavy-loaded knee joints, hip joints, and spine. Joint pain and bone spurs are what we usually refer to as this type of arthritis. Age is its main cause. Due to age, bone aging, slow bone metabolism, bone malnutrition, increased bone wear and other reasons can cause irreversible damage to the cartilage in these joints. Necrotic and detached chondrocytes can cause a series of inflammatory reactions in the joints, such as swelling and pain. Abnormal bone hyperplasia around the joints can also stimulate inflammation in the soft tissues around the joints, leading to discomfort such as swelling and pain in the joints.

In addition to joint swelling and pain, osteoarthritis is also accompanied by symptoms such as joint enlargement and deformation, morning stiffness and tenderness. However, many patients and friends would ask me in confusion, since it is an old age disease, why do some people have it at a young age, and it is very serious, how to explain it?

Although osteoarthritis is related to age, it is also closely related to other factors. For example, obesity and excessive weight will significantly increase the bearing capacity of weight-bearing joints, causing the joints to "age" prematurely. In addition, excessive labor will cause our joints to be overused, which will also cause our joints to develop osteoarthritis prematurely. There are also some other factors such as partiality leading to malnutrition and insufficient calcium absorption; long-term use of hormones and other drugs; long-term addiction to smoking and drinking, drinking a lot of strong tea or coffee every day; endocrine system diseases; intestinal diseases leading to poor calcium absorption, etc. These factors will accelerate our bone "aging" and cause osteoarthritis to come early.

The main cause of osteoarthritis is bone aging, so the focus of treatment is to improve bone nutrition metabolism, slow down the rate of bone degeneration, and relieve inflammation symptoms. Commonly used are non-steroidal anti-inflammatory drugs (antibiotics cannot be used, it is a sterile inflammation), Chinese medicine, moxibustion, fumigation, acupuncture, physical therapy, traction, etc. Drugs that improve bone metabolism include calcium tablets, glucosamine, anti-osteophyte tablets and osteoporosis prevention drugs.

For more severe osteoarthritis, intra-articular injection of sodium hyaluronate, platelet-rich plasma, arthroscopic joint cleaning, autologous chondrocyte transplantation and autologous cartilage bone honeycomb transplantation can also be used.

The current joint replacement technology and joint materials are becoming more and more mature. Many patients with advanced and severe degenerative osteoarthritis can consider various joint replacements to improve their quality of life and restore joint mobility, and the effect is very significant. The more mature ones are hip replacement, knee replacement, hemi-knee replacement, shoulder replacement, elbow replacement, etc. Ankle replacement, interphalangeal joint replacement, wrist replacement, artificial intervertebral disc replacement, etc. are also gradually improving. I believe that in the near future, all joints in our body can be replaced with good results, which will greatly reduce the pain of patients and improve their quality of life.

4. Acute infectious suppurative arthritis

Acute infectious suppurative arthritis is an arthritis with infection or suppuration as the main symptoms, with redness, swelling, heat and pain as the main symptoms. You can feel obvious heat, swelling, severe pain and a large amount of fluid in the joints. If not treated in time, the joints will gradually accumulate with a large amount of pus spreading throughout the body and destroying the joint tissues. Most of them are caused by bacterial infections, so early and correct treatment, and incision and drainage of effusions and pus when necessary to avoid irreversible sequelae caused by massive destruction of joint tissues are very necessary.

There are some special arthritis, such as ankylosing spondylitis of the spine, traumatic arthritis, etc. These are not very common, so I will not elaborate on them here. I hope that everyone can know roughly which type of arthritis you may have through this article and take the right medicine. Don't be like a monk who is confused and feels that no matter how you treat it, it will not work.

Author: Shanghai Seventh People's Hospital

Ju Yufeng