(a) general treatment of fever and joint swelling and pain, severe systemic symptoms should be bed rest until the symptoms basically disappear. After two weeks of improvement, you should gradually increase your activities to avoid joint disuse and even promote joint stiffness after long-term bed rest. Protein and various vitamins in the diet should be sufficient, and those with obvious anemia can receive a small amount of blood transfusion. If there are chronic diseases such as tonsillitis, it should be removed as soon as the patient's health permits.
(2) drug therapy
1. Non-steroidal anti-inflammatory drugs are used in primary or mild cases, and their mechanism of action is mainly to inhibit the production of cyclooxygenase and prostaglandin, thus achieving anti-inflammatory and analgesic effects. But it can't stop the natural process of rheumatoid arthritis. Because of different metabolic pathways in the body, these drugs can interact with each other. Joint application is not recommended, and individualization is emphasized.
(1) Salicylic acid preparation: anti-rheumatic, anti-inflammatory, antipyretic and analgesic. The dosage is 2-4g per day. If the curative effect is not ideal, the dosage can be appropriately increased, sometimes 4-6g per day is effective. Generally taken after meals or combined with antacids, enteric-coated tablets can also be used to reduce gastrointestinal irritation.
(2) Indomethacin is an indoleacetic acid derivative with anti-inflammatory, antipyretic and analgesic effects. If patients can't stand aspirin, they can switch to this medicine. The usual dose is 25mg 2-3 times a day, and if it exceeds 100mg a day, it is easy to produce side effects. Side effects include nausea, vomiting, diarrhea, gastric ulcer, headache, dizziness and depression.
(3) Propionic acid derivatives: they are a kind of drugs that can replace aspirin, including ibuprofen. (Ibuprofen) The effects of naproxen and fenbufen are similar to those of aspirin, with similar curative effects and little side effects in digestive tract. Common dosage: ibuprofen 65438+ 0.2-2.4g daily, taken in 3-4 times. Naproxen 250mg each time, twice a day. Side effects include nausea, vomiting, diarrhea, peptic ulcer, gastrointestinal bleeding, headache and central nervous system disorder.
(4) antacids: o-aminobenzoic acid derivatives, which are similar to aspirin. Anti-inflammatory acid 250mg each time, 3-4 times a day. Chlordecone 200-400 mg each time, three times a day. Side effects include gastrointestinal reactions, such as nausea, vomiting, diarrhea and loss of appetite. Occasionally rash, renal function damage, headache, etc.
2. At present, gold preparation is considered to have a positive effect on rheumatoid arthritis. Gold (commonly used sodium hydrogen chrysin thiomalate. Usage 10mg intramuscular injection in the first week, 25mg in the second week. If there are no adverse reactions, 50 mg per week in the future. When the total dose reaches 300 ~ 700 mg, most patients begin to take effect, and when the total dose reaches 600- 1000 mg, the condition can be steadily improved. The maintenance capacity is 50 mg per month. Because there is the possibility of recurrence after stopping taking drugs, it is useful abroad for many years until life. The earlier the gold preparation is used, the more effective it will be. Gold preparation takes effect slowly and takes 3-6 months to take effect, so it is not suitable to be used with immunosuppressants or cytotoxic drugs. If the total amount has reached 1000mg during the treatment period, and the condition is still not improved, the drug should be stopped. The effect of oral gold preparation is similar to that of injection gold. Side effects include increased stool frequency, rash, stomatitis and kidney damage. , can be recovered after stopping the drug.
Auranofin, an oral gold preparation, is a hydroxyl compound of gold phosphide. The dosage is 6mg once a day, and it will take effect after 2-3 months. Patients with short early course of disease have better curative effect. The side effect is lighter than that of injection, and diarrhea is common, but it is transient and the effective rate is 62.8%.
3. Penicillamine is an amino acid drug containing hydrophobic groups, which has certain curative effect on chronic rheumatoid arthritis. It can selectively inhibit some immune cells and reduce IgG and IgM. Side effects include thrombocytopenia, leukopenia, proteinuria, allergic skin rash's disease, anorexia, optic neuritis, myasthenia and elevated transaminase. Usage: Take 250mg orally every day in the first month and 250mg every time in the second month, twice a day. There was no obvious effect in the third month, 250mg each time, three times a day. The maximum dose is 750mg each time. Most of the clinical symptoms can be improved within 3 months, and the symptoms can be maintained in a small amount after improvement, and the course of treatment is about one year.
4. Chloroquine has certain anti-rheumatic effect, but the effect is very slow, and it usually takes 6 weeks to 6 months to reach the maximum effect. It can be used as salicylic acid preparation or auxiliary medicine to reduce the dose of corticosteroids. Take 250-500mg orally twice a day. Many gastrointestinal reactions such as nausea, vomiting and loss of appetite often occur during the treatment. Long-term application should pay attention to retinal degeneration and optic atrophy.
5. Levamisole can relieve pain and shorten the time of joint stiffness. The dose is 50mg in the first week,/kloc-0 once a day, 50mg twice a day in the second week and 50mg three times a day in the third week. Side effects include dizziness, nausea, allergic skin rash, decreased vision, lethargy, neutropenia, thrombocytopenia, liver function damage, proteinuria, etc.
6. Immunosuppressants are suitable for patients with severe rheumatoid arthritis who are ineffective in other drugs, as well as patients who stop taking drugs or have decreased hormones. Commonly used are azathioprine, 50mg each time, 2-3 times a day. Cyclophosphamide 50mg each time, twice a day. After the symptoms or laboratory tests have improved, gradually reduce the dosage. The maintenance dose is 65438+ 0/2-2/3 of the original therapeutic dose. Continuous use for 3-6 months. Side effects include bone marrow suppression, leukopenia and thrombocytopenia, hepatotoxic damage and digestive tract reaction, alopecia, amenorrhea, hemorrhagic cystitis and so on.
Methotrexate (MTX) has immunosuppressive and anti-inflammatory effects, and can reduce erythrocyte sedimentation rate and improve bone erosion. By intramuscular injection or oral administration, 5- 15 mg per week, 3 months as a course of treatment. Side effects include anorexia, nausea, vomiting, stomatitis, alopecia, leukopenia or thrombocytopenia, drug-induced interstitial pneumonia and rash. It may become another palliative drug after gold and penicillamine.
7. Adrenocortical hormone Adrenocortical hormone has a rapid effect on joint swelling and pain, controlling inflammation, diminishing inflammation and relieving pain, but its effect is not lasting and has no effect on etiology and pathogenesis. Once the drug is stopped, it will recur in a short time. Radio frequency, ESR and anemia did not improve. Long-term application can lead to serious side effects, so it is not used as routine treatment, and it is limited to those who have severe vasculitis and affect the function of important organs. For example, eye complications may lead to blindness, central nervous system diseases, heart block, synovitis with persistent joint activity, etc. Can be used for a short time, or after treatment with NSAIDS, penicillamine, etc. , the effect is not good and the symptoms are serious, affecting daily life. On the basis of the original drug, a small dose of corticosteroids can be added. If not, it can be increased as appropriate, and gradually reduced to the minimum maintenance after symptom control.
Hydroprednisone acetate suspension can be used for local intra-articular injection, which is suitable for some difficult diseases of a single big joint, with 25-50mg intra-articular injection each time to prevent intra-articular infection and bone destruction. Triamcinolone acetonide acetate is a long-acting corticosteroid suitable for intra-articular administration, with a single dose of 10mg and a knee joint of 30mg.
8. After many years of clinical application and experimental research in China, tripterygium wilfordii has a good effect. It has non-steroidal anti-inflammatory, immunosuppressive or cytotoxic effects, and can improve symptoms and reduce ESR and RF titer. Tripterygium wilfordii polyglycoside 60mg/d, 1-4 weeks can have clinical effect. Side effects include irregular menstruation and menopause in women, decreased sperm count in men, rash, leukopenia and thrombocytopenia, abdominal pain and diarrhea. It can be eliminated after drug withdrawal.
Tripterygium wilfordii has a similar effect, 2-3 tablets each time, 3 times a day. The course of treatment is 3-6 months or more. Side effects: dizziness, dry mouth, sore throat, anorexia, abdominal pain, amenorrhea.
9. Other therapies such as thymosin and plasma exchange have yet to be explored.
(3) The purpose of physiotherapy is to increase local blood circulation and relax muscles by hyperthermia, so as to achieve the effects of diminishing inflammation, reducing swelling and relieving pain. At the same time, exercise is used to maintain and enhance joint function. There are several physical therapy methods: hot water bag, hot water bath, wax bath, infrared ray and so on. Massage combined with physical therapy can improve local circulation and relax muscle spasm.
The purpose of exercise is to preserve the activity function of joints and enhance the strength and endurance of muscles. After the symptoms in the acute phase are relieved and subsided, as long as patients can tolerate it, they should do active or passive joint exercises regularly in the early stage.
(4) Surgical treatment In the past, it was always thought that surgery was only suitable for cases of late deformity. At present, only 1-2 joint is seriously injured, and those who are ineffective in salicylate treatment can try early synovectomy. Osteotomy is feasible for cases with static lesions and obvious joint deformities in the later stage. Arthroplasty and artificial joint replacement can be used for cases with stiff or damaged joints. Weight-bearing joints can be used for joint fusion and so on.
The available Chinese herbal medicines are as follows:
(1) loop blocked
Main symptoms: joint pain of limbs, wandering uncertainty, unfavorable joint flexion and extension, or aversion to cold and fever, thin white fur and floating pulse.
Treatment principle: expelling wind and dredging collaterals, dispelling cold and removing dampness.
Prescription: Fangfeng decoction.
Radix Saposhnikoviae, Herba Ephedrae, Radix Angelicae Sinensis, Radix Gentianae Macrophyllae, Cortex Cinnamomi, Radix Puerariae, Poria, Rhizoma Zingiberis Recens, Fructus Jujubae and Radix Glycyrrhizae.
Notopterygium Rhizoma, Radix Angelicae Dahuricae, Radix Clematidis, Curcuma Rhizome, and Rhizoma Chuanxiong can be added for relieving pain due to joint pain of upper limbs such as shoulder and elbow. Eucommia ulmoides, Herba Taxilli, Herba Epimedii, Radix Morindae Officinalis, and Radix Dipsaci should be added as appropriate for patients with lumbodorsal joint pain. Knee joint and ankle joint are the main soreness, and Radix Angelicae Pubescentis, Radix Achyranthis Bidentatae, Radix Stephaniae Tetrandrae and Rhizoma Dioscoreae can be added. Hey? Activating collaterals, eliminating dampness and relieving pain.
(2) Joint pain
Main symptoms: severe pain, local pain, reduction of hot pain, aggravation of cold pain, joint inflexibility, local skin color is not red, touch is not hot, fur is thin and white, and pulse is tight.
Treatment principle: Warming meridians to dispel cold, expelling wind and removing dampness.
Prescription: Aconitum soup.
Radix Aconiti Lateralis Preparata, Herba Ephedrae, Radix Paeoniae Alba, Radix Glycyrrhizae, Radix Astragali, Asari and Ramulus Cinnamomi.
Please refer to the related contents of arthralgia syndrome for the addition and subtraction of drugs.
(3) Joint pain
Main symptoms: heavy limbs and joints, pain or swelling, local pain, heavy hands and feet, inconvenient movement, insensitive skin, white greasy fur and slow pulse.
Treatment principle: eliminating dampness and dredging collaterals, expelling wind and dispelling cold.
Prescription: Coix seed soup.
Coicis Semen, Rhizoma Atractylodis, Notopterygii Rhizoma, Radix Angelicae Pubescentis, Radix Saposhnikoviae, Radix Aconiti, Herba Ephedrae, Ramulus Cinnamomi, Radix Angelicae Sinensis, Rhizoma Chuanxiong, Rhizoma Zingiberis Recens and Glycyrrhrizae Radix.
The joint is swollen. Can you add it? ⒛ ⒛ ⒔? Yellow pear water reduces swelling. If the skin is not kind, you can add pittosporum bark and? What about anthracene? hostage
(4) Heat arthralgia
Main symptoms: joint pain, local burning and swelling, mild cold, touching pain, or combined with fever, bad wind, thirst, irritability and other systemic symptoms, yellow and dry fur, slippery pulse.
Treatment: clearing heat and dredging collaterals, expelling wind and removing dampness.
Prescription: Baihu Guizhi Decoction is flavored.
Gypsum Fibrosum, Rhizoma Anemarrhenae, Ramulus Cinnamomi, Glycyrrhrizae Radix, Caulis Lonicerae, Fructus Forsythiae, Cortex Phellodendri, Cortex Erythrinae, Curcuma Rhizome, Radix Clematidis, Radix Stephaniae Tetrandrae and Ramulus Mori.
For patients with erythema, Cortex Moutan, Radix Rehmanniae and Radix Paeoniae Rubra are added to cool blood and eliminate spots. For those with induration, silkworm excrement, Coicis Semen and Semen Phaseoli are added to eliminate dampness and disperse the knot. Artemisia annua and cortex Lycii are added for people with hot flashes in the afternoon or fidgety at night.