Different types of arthritis patients have different dietary principles. At present, there is no conclusive evidence to prove that nutritional deficiency is necessarily related to arthritis, but nutritional deficiency may aggravate arthritis, while overnutrition and obesity can induce or aggravate arthritis such as gouty arthritis and osteoarthritis. Patients with rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis often suffer from malnutrition such as anemia and emaciation due to systemic inflammatory reaction. Other infectious arthritis will also cause body consumption due to acute inflammation, which is not conducive to the recovery of arthritis. The above patients should supplement daily nutrition as much as possible, and give gastrointestinal nutrition when necessary to improve the body's disease resistance. Contrary to the above situation, patients with osteoarthritis and gout are often overweight, especially those with gout, often accompanied by metabolic disorders such as hyperglycemia, hypertension and hyperlipidemia. Excessive serum uric acid level can induce and aggravate arthritis. Therefore, patients with osteoarthritis, hyperuricemia and gouty arthritis should control their diet, lose weight and reduce joint burden. It is suggested that patients with hyperuricemia and gout should reduce the intake of high-purity foods such as animal viscera and aquatic products, eat more alkaline foods such as rape, cabbage, carrots and melons, and strictly limit alcohol consumption, mainly liquor and beer. There is no evidence that red wine can induce gout. On the contrary, drinking a moderate amount of red wine may help to reduce uric acid, while drinking tea, coffee and milk may also help to reduce uric acid.
2. Avoid environmental factors that induce arthritis.
The relationship between arthritis and environment, especially infection, can not be ignored. Arthritis, reactive arthritis and infectious arthritis after streptococcal infection are directly related to infection. Pathogenic infection may also be one of the inducing factors of autoimmune diseases such as rheumatoid arthritis and systemic lupus erythematosus. Streptococcus is one of the main pathogens leading to arthritis. Other microorganisms that may be related to arthritis include Epstein-Barr virus, cytomegalovirus (CMV), parvovirus B 19, Shigella dysenteriae, Klebsiella pneumoniae, Mycobacterium tuberculosis and some mycoplasma and chlamydia. Humid environment is conducive to the growth of some pathogenic bacteria and has a certain relationship with the onset of arthritis. Therefore, we should pay attention to hygiene at ordinary times, maintain good indoor ventilation, prevent moisture and keep warm, avoid the spread of pathogenic bacteria, especially streptococcus, strengthen physical exercise, improve disease resistance and nip in the bud.
In recent years, it has been found that smoking has a significant correlation with the onset of rheumatoid arthritis. The probability of smokers suffering from rheumatoid arthritis is obviously increased, and smoking will affect the therapeutic effect of patients with rheumatoid arthritis. Therefore, quitting smoking has become one of the preventive measures for rheumatoid arthritis.
In addition, other environmental factors, such as ultraviolet rays and exposure to certain chemicals, may lead to abnormal immune response in some susceptible people, leading to different arthritis.
3. Patience education, mental and psychological adjustment
The stability of the immune system is related to emotions. Clinically, many patients show signs of autoimmune diseases after experiencing bad life events, so maintaining an optimistic and stable attitude is conducive to preventing rheumatic diseases. It is of great significance for the treatment of arthritis to guide patients to keep optimistic mood, eliminate depression and fight the disease with a positive attitude.
4. Functional exercise and lifestyle adjustment
Long-term joint diseases will lead to limited joint activity and muscle atrophy, and functional exercise is an important method to restore and maintain joint function. Pay attention to the timing, type and intensity of functional exercise. In the acute stage of joint swelling, joint activity should be restricted, the affected limb should be raised to reduce edema, and bed rest should be carried out when necessary until the joint swelling and pain are improved. After the swelling and pain are improved, the flexion, extension and rotation of the joint are carried out to increase the range of motion of the joint without increasing the pain. Weight-bearing arthritis such as knee arthritis and hip arthritis should avoid weight-bearing exercise. The types of joint movements are different. Patients with knee arthritis can choose swimming, walking and other sports to avoid walking Otawa down the stairs. Patients with waist and neck arthritis can choose the rotation of local joints to avoid sitting at the desk and looking up for a long time; For patients with ankylosing spondylitis, swimming is the best whole body exercise. Patients with hand osteoarthritis can choose knitting, rope knitting, plasticine kneading, paper cutting, calligraphy, typing, gardening and other activities. No matter what kind of exercise you choose, you should start from a small amount and step by step to avoid joint pain after exercise, otherwise you need to adjust the exercise intensity and reduce the exercise time. In conditional hospitals, the above-mentioned functional exercises should be carried out under the guidance of rheumatologists and rehabilitation specialists. In addition, patients should pay attention to lifestyle adjustment. For example, patients with ankylosing spondylitis should stand upright, sleep on a hard bed, stay in the supine position, avoid flexion contracture, and keep the pillow low. Once the upper thoracic and cervical vertebrae are involved, the use of pillows should be stopped. Patients with knee arthritis should avoid wearing high heels.
5. Physical therapy
Physical therapy mainly includes the following types: direct current therapy and drug iontophoresis, low-frequency pulse electrotherapy, medium-frequency current therapy, high-frequency electrotherapy, magnetic field therapy, ultrasonic therapy, acupuncture and phototherapy, that is, infrared ray, ultraviolet ray and cold therapy. On the basis of drug therapy, choosing appropriate physical therapy according to the position and nature of joint involvement can better relieve joint symptoms and promote functional recovery. In acute arthritis stage, ultraviolet radiation can reduce joint inflammation, while in subacute and chronic stage, hyperthermia is the main method.
6. Drug therapy
When choosing therapeutic drugs, we should pay attention to the following points: 1) Types and symptoms of arthritis; 2) the patient's age, whether accompanied by other diseases, whether using other drugs, whether pregnant; 3) Efficacy, tolerance, safety, dosage and compliance of drugs; 4) Drug price and patient's tolerance.
Therapeutic drugs for rheumatoid arthritis mainly include non-steroidal anti-inflammatory drugs (NSAIDs), glucocorticoids (gs), slow-acting anti-rheumatic drugs (DMARDs), botanical drugs and biological agents. Non-steroidal anti-inflammatory drugs (NSAIDs) are first-line anti-rheumatic drugs, which can quickly relieve joint symptoms, but can't stop the progress of the disease. They should be used in combination with other drugs as appropriate. Gs is the strongest anti-inflammatory drug. If used correctly, it can quickly relieve inflammation and control the disease, but it cannot be abused. It is suitable for extraarticular manifestations, transitional treatment and local application. 20 10 Chinese journal of rheumatology guidelines for the treatment of rheumatoid arthritis suggest that the principle of using Gs for rheumatoid arthritis is short-term, low-dose, combined with vitamin D3 and calcium, and intra-articular injection. For patients with rheumatoid arthritis, early, combined and individualized use of DMARDs can control the disease at an early stage, obviously slow down the progress of the disease and improve the prognosis. These drugs mainly include methotrexate (MTX), sulfasalazine (SASP), leflunomide (LEF) and hydroxychloroquine sulfate (HCQ). However, the effect of DMARDs in relieving pain is poor, and it will take some time to take effect, so NSAIDs or Gs should be combined in the acute stage of arthritis. Infection by hemolytic streptococcus group A and group B can cause arthritis manifestations of rheumatic fever. Penicillin is the most effective drug to control acute streptococcal infection, and long-term use of antibiotics in patients with acute rheumatic fever can prevent the occurrence of long-term rheumatic carditis. Prevention for adults should not be less than 5 years, and children should be at least 18 years old. Tuberculous arthritis and fungal arthritis need to be combined with the above treatment on the basis of active and effective anti-tuberculosis or antifungal drugs, while viral arthritis does not need antiviral treatment. Reactive arthritis is also related to microbial infection, but the course of most patients is self-limited, usually disappearing in 3-5 months. The course of some patients is as long as 1 year. At present, there are different opinions on whether anti-infection treatment is needed. Botanical drugs can assist in the treatment of arthritis, but no research has confirmed its exact effect in delaying bone destruction. The emergence of biological agents is the gospel of patients with rheumatic arthritis, which can significantly improve the prognosis of patients. However, the indications and contraindications should be strictly screened before use, and the advantages and disadvantages should be weighed.
The treatment of ankylosing spondylitis is mainly based on NSAIDs and DMARDs(SASP, MTX), and biological agents, especially tumor necrosis factor (TNF)-α antagonists, have the best effect, especially in patients with axial joint involvement who have poor response to DMARDs.
In addition to symptomatic analgesia (acetaminophen, NSAIDs), the treatment of osteoarthritis can also be applied with hyaluronic acid locally. Glucosamine and diacerein can delay the disease progression in the treatment of osteoarthritis, so it is recommended to use them for a long time.
The treatment of gouty arthritis includes anti-inflammatory and analgesic in acute stage (NSAIDs are preferred) and uric acid reduction in remission stage. Specific drugs should be selected according to the patient's renal function and whether there is kidney calculi. Drugs for reducing uric acid mainly include drugs for inhibiting uric acid production (allopurinol) and drugs for promoting uric acid excretion (benbromarone). The latter is usually the first choice.
7. Immunization and biotherapy
This kind of treatment is aimed at the onset of arthritis and the main links that lead to disease progress, such as targeted molecular therapy of cytokines, plasma exchange, immune purification, immune reconstruction, mesenchymal stem cell transplantation and so on. It is mainly used for other patients with severe arthritis that is ineffective, rapid and refractory, mainly rheumatoid arthritis.
8. Surgical therapy
Surgical treatment mainly includes joint cavity puncture, synoviectomy, joint replacement, joint correction and joint fusion. Not every patient needs joint cavity puncture, and the clinical indications should be strictly controlled. Arthritis has been diagnosed, but there are many stagnant water in the joint cavity of individual joints, and when the joint function of patients is affected, they can puncture the joint cavity and inject drugs into the cavity. Glucocorticoid, methotrexate and hyaluronic acid are commonly used for intra-articular injection. The first two are mostly used for rheumatoid arthritis. Among them, there is no limit to the number of injections of hormones in the same joint puncture, but if the effect is not good after injecting 1-2 times, the injection should not be continued. Hyaluronic acid is the first choice for patients with osteoarthritis. Avoid excessive joint movement after joint cavity injection to avoid local swelling caused by drug exudation.
Synoviectomy is suitable for patients who can't be diagnosed by clinical, imaging and laboratory examination, and have no obvious improvement after half a year of drug treatment. Before the operation, patients need to make full mental and psychological preparation and preoperative drug treatment preparation. Arthroplasty and joint replacement are used for patients with joint deformity and severe functional limitation. Arthrodesis can artificially cause joint stiffness to relieve pain, stop pathological changes or provide joint stability.
To sum up, arthritis has different causes and treatments. Correct diagnosis of different arthritis is the premise of treatment. In the process of treatment, the etiology, course of disease and individual differences of patients should be fully considered, and comprehensive treatment should be given to achieve the best treatment purpose. According to different etiology, its prognosis is also different.