5 kinds of common arthritis foolishly confused?

*For medical professionals to read and reference Different bone and joint diseases require targeted treatment after a clear diagnosis.
Bone and joint diseases refer to a type of disease that mainly affects bones and joints and causes related clinical symptoms.
(OA), rheumatoid arthritis, rheumatoid arthritis (RA), gouty arthritis, seronegative spondyloarthropathy (SpA) and other joint diseases collectively [1]
.

Such diseases are more common in middle-aged and elderly people, and the clinical manifestations are mainly joint swelling, pain, deformation and so on
.

In recent years, the incidence of bone and joint diseases has shown an upward trend year by year, which seriously affects the health and quality of life of patients
.

In order to deepen the public's understanding of bone and joint diseases, and also to facilitate the study of clinicians, we take the characteristics of bone and joint diseases as the starting point, and make a systematic summary of several common clinical bone and joint diseases
.

1.
OA ■ Overview: OA refers to a degenerative disease with joint pain as the main symptom caused by articular cartilage fibrosis, chapped, ulcer, and loss caused by a variety of factors [2]
.

The pathological features are articular cartilage degeneration and destruction, subchondral bone sclerosis or cystic degeneration, bone hyperplasia at the joint edge, synovial lesions, joint capsule contracture, ligament laxity or contracture, muscle atrophy and weakness
.

In recent years, with the deepening of understanding of OA, the classification of this disease has become more clear.
According to its characteristics and etiology, it can be divided into: degenerative OA and low-level inflammatory OA
.

The former is the degenerative changes to articular cartilage caused by factors such as heredity, age, obesity, injury, and overuse, which is our traditional understanding of OA; the latter refers to a chronic low-level inflammatory disease involving innate immunity.
Synovitis is the core of the disease as a result of the interaction between the body's immune system and various factors including local tissue damage and metabolic abnormalities [3]
.

■ Etiology: Not yet clear, its occurrence is related to age, obesity, inflammation, trauma and genetic factors
.

■ Clinical manifestations: 1.
Joint pain and tenderness: Joint pain and tenderness are the most common clinical manifestations of OA, with an incidence rate of 36.
8%-60.
7%
.

Pain can occur in all joints, with the hip, knee and interphalangeal joints being the most common
.

2.
Limitation of joint movement: common in the hip and knee joints
.

Joint stiffness and tightness when getting up in the morning, commonly known as morning stiffness, can be relieved after activities
.

3.
Joint deformities: joint swelling, with the most common and obvious interphalangeal OA, Heberden's nodules and Bouchard's nodules may appear
.

4.
Bone friction sound (sense) and muscle atrophy: more common in knee OA
.

two.
Rheumatoid Arthritis ■ Overview: Rheumatoid arthritis is an acute or chronic inflammatory disease of connective tissue that can recur and involve the heart [4]
.

The incidence in women is three times that of men
.

■ Etiology: Rheumatoid arthritis is mostly due to infection with hemolytic streptococcus, followed by allergic reactions in the whole body, and long-term involvement of various joint tissues to form acute or chronic connective tissue inflammation
.

   ■ Clinical manifestations: The typical manifestations of rheumatoid arthritis are mild or moderate fever, migratory arthritis, and the affected joints are mostly large joints such as knees, ankles, shoulders, elbows, and wrists, and often transfer from one joint to another In the joints, the lesions show local redness, swelling, burning, and severe pain.
Some patients also have several joints at the same time.
Atypical patients only have joint pain without other inflammatory manifestations
.

three.
RA ■ Overview: RA is an autoimmune disease with erosive joint damage as the main clinical manifestation, which can occur at any age [5]
.

■ Etiology: The cause of the disease is currently unknown, and may be related to infection, genetics, estrogen levels, etc.
Environmental factors (such as cold, humidity, etc.
), as well as fatigue, malnutrition, trauma, mental stimulation, etc.
can induce the disease
.

■ Clinical manifestations: 1.
Symptoms: Slow onset, often with systemic symptoms such as fatigue, anorexia, weight loss and low-grade fever
.

Symmetrical, polyarticular, and small joint swelling and pain are most common in the proximal interphalangeal joints, metacarpophalangeal joints, and wrist joints.
With the development of the disease, joint motion is gradually limited, and the finger joints are fusiform swelling, which can be deformed in the late stage.

.

The duration of morning stiffness is often consistent with the degree of disease activity
.

Common extra-articular manifestations include rheumatoid nodules, vasculitis, pleurisy, interstitial pneumonia, pericarditis, superficial lymphadenopathy, hepatosplenomegaly and other systemic injuries
.

2.
Signs: Symmetrical joint swelling, deformation, limited mobility, more common in the small joints of the limbs, or subcutaneous rheumatoid nodules, etc.
[6]
.

Four.
Gouty Arthritis Overview: Gouty arthritis refers to the excessive uric acid concentration in the blood caused by excessive uric acid metabolism in the body due to the disorder of purine metabolism in the body, and excessive uric acid deposits in the soft tissues around the joints.
A disease caused by [7]
.

Gouty arthritis, as a common clinical joint disease, accounts for 2%-5% of chronic arthritis, and its lesions can be divided into acute gouty arthritis stage, intermittent stage, and chronic tophi arthritis stage
.

■ Etiology: urate crystals precipitated and deposited in the joint cavity and surrounding soft tissues caused by hyperuricemia
.

■ Clinical manifestations: Acute gouty arthritis stage: The pathological changes in the acute stage of gout are mainly synovial hyperemia, synovial fluid production, neutrophil exudation and fibrous necrosis, focal hyperplasia of synovial surface cells, and diffuse synovial membrane.
Sexual or perivascular inflammatory cell infiltration, including neutrophils, lymphocytes, and a few plasma cells
.

The patient presented with sudden joint swelling, severe pain, and limited mobility
.

Intermittent period: There are generally no obvious symptoms in the intermittent period, but the level of blood uric acid is often elevated
.

Chronic tophi arthritis stage: 1.
Tophi is formed, joint attacks become more and more frequent, the intermittent period is shortened, the pain gradually intensifies, and it cannot be completely relieved even after the attack
.

2.
The number of affected joints gradually increases.
In severe cases, the shoulder, hip, spine, sacroiliac, sternoclavicular, mandibular and other joints and costal cartilage may be involved.
Patients may have back pain, chest pain, intercostal neuralgia, sciatica and other manifestations [8]
.

five.
SpA Overview: SpA is an umbrella term for a group of interrelated multisystem inflammatory diseases affecting the spine, peripheral joints and periarticular structures, including spondyloarthropathy of unclassified (USpA) and ankylosing spondylitis (AS), psoriasis Arthritis (PsA), Rett syndrome and a series of diseases
.

■ Etiology: The etiology and pathogenesis of SpA are not fully understood
.

It is currently believed to be related to genetics, microbial infection, intestinal inflammation and other factors
.

■ Common clinical manifestations of SpA[9]: ①Inflammatory spinal pain, neck, back or sacral pain caused by spondylitis and sacroiliitis, aggravated after getting up in the morning or sitting for a long time, relieved after activity, accompanied by limited spinal movement 2) Peripheral joint synovitis, mainly in the lower extremities, mostly involving the knee, ankle, hip and other joints, most of which are asymmetric and oligoarticular; 3) Attachment inflammation, mainly spontaneous at the attachment site of the Achilles tendon or plantar fascia Sexual pain, swelling, or tenderness during physical examination; ④ Extra-articular manifestations, including eye damage (iridocyclitis, conjunctivitis), skin damage (psoriasis, necrotizing pyoderma, erythema nodosum, nail lesions, Thrombophlebitis), oral, intestinal and genitourinary tract lesions (ulcer, urethritis, balanitis, cervicitis, prostatitis); ; ⑥ Serum RF negative; ⑦ HLA-B27 positive in most patients; ⑧ X-ray examination with bilateral or unilateral sacroiliitis changes
.

Horizontal comparison of clinical features of five common bone and joint diseases The above are the clinical features of five common bone and joint diseases.
A horizontal comparison and summary was made in five aspects: way, symptoms, predisposing age, and disease development
.

■ In terms of etiology: • OA is mainly a degenerative disease caused by the wear and tear of articular cartilage and bone caused by various reasons
.

• Rheumatoid arthritis is due to infection with hemolytic streptococcus, usually with a 2-3 week prodrome of pharyngeal infection
.

• RA is an autoimmune disease
.

• Gouty arthritis is caused by the increase of blood uric acid level caused by the disorder of purine metabolism, resulting in the deposition of urate in the soft tissues of joints
.

• SpA may be related to genetics, microbial infection, intestinal inflammation and other factors
.

■ Onset mode: • OA develops slowly and repeatedly
.

• The onset of rheumatoid arthritis is insidious, and there may be obvious low-grade fever before obvious joint symptoms, and a few patients will have high fever, often accompanied by fatigue, general malaise and weight loss [10]
.

• The onset of most RAs is slow, and some of them have acute onset, repeated symptoms, mild and severe, and joint deformities gradually appear in severe cases
.

• In the acute stage of gouty arthritis, the onset is abrupt, and most patients wake up with sudden joint pain during sleep.
The disease has a long course and repeated attacks
.

• The course of SpA is slow, and the onset of AS is insidious
.

■ Symptoms: • OA: mostly unilateral joint pain, rarely morning stiffness, severe deformity and dysfunction may occur
.

• Rheumatoid arthritis: more common in large joints, such as knee, elbow, etc.
, with symmetrical distribution, migratory pain, no morning stiffness, and no deformity or dysfunction left in the affected joints
.

• RA: Mostly manifested as symmetrical small joints with redness, swelling, heat and pain, and large joints can also be involved, such as finger joints, wrist joints, ankle joints, etc.
; morning stiffness, deformity and dysfunction of the affected joints may occur
.

• Gouty arthritis: more common in the first metatarsophalangeal joint (90%), followed by the dorsum of the foot, ankle, hand, wrist, knee, elbow, shoulder, hip, spine and other vertebral joints are rarely involved; no morning stiffness, As the disease progresses, dysfunction, deformity, and disability may occur
.

• SpA: Inflammatory spinal pain, peripheral joint synovitis mainly involving the lower extremities, mostly involving knees, ankles, hips and other joints, most of which are asymmetrical and oligoarticular; AS has obvious morning stiffness; most patients have various Characteristic extra-articular manifestations, such as ocular lesions, skin lesions, oral, intestinal, and genitourinary lesions
.

■ Age characteristics of the predisposing population: • OA: It is more common in middle-aged and elderly people, and the older the age, the higher the incidence rate
.

• Rheumatoid Arthritis: More common in adolescents
.

• RA: can occur at any age, with a high incidence between the ages of 30 and 50 [11]
.

• Gouty arthritis: The incidence is generally high after the age of 40, and the older the age, the higher the incidence
.

• SpA: young men under the age of 40 [12]
.

■ Disease progression: • OA: OA is a degenerative disease of the joints, in which patients may develop joint twisting in the middle stage of the disease, and in the advanced stage, the limitation of joint motion is aggravated, and eventually leads to disability
.

• Rheumatoid Arthritis: Acute inflammation usually subsides in 2 to 4 weeks without any sequelae, but it often recurs
.

If rheumatic activity affects the heart, myocarditis and even valvular disease may be left behind [4]
.

• RA: The basic pathological manifestations are synovitis, pannus formation, and gradual destruction of articular cartilage and bone, eventually leading to joint deformity and loss of function, with a high disability rate, and can be complicated by lung disease, cardiovascular disease, and malignant tumor.
and depression, etc.
[4]
.

• Gouty arthritis: From the acute gouty attack stage to the chronic tophiarthritis stage, in severe cases, kidney function is damaged
.

• SpA: chronic progressive joint destruction, high disability rate, AS spine rigidity occurs from bottom to top, and the later stage shows a "bamboo-like" change, and the disease cannot be reversed
.

Summary OA and some SpA have a slow onset and gradually aggravate, rheumatoid arthritis and AS have an insidious onset, and some patients with RA and gouty arthritis have an acute attack in the acute phase; RA is an autoimmune disease, and OA is a joint Degenerative diseases, rheumatoid arthritis is caused by hemolytic streptococcus infection, gouty arthritis is caused by hyperuricemia, SpA may be related to genetics, microbial infection, intestinal inflammation and other factors; OA may have morning stiffness , mostly mild and short-lived, rheumatoid arthritis is not accompanied by morning stiffness, AS in RA and SpA has obvious morning stiffness; OA does not directly affect other organs, rheumatoid arthritis can affect the heart, RA not only damages the joints, but also It can involve the lungs, liver, heart and other systemic organs.
Gouty arthritis can damage kidney function.
SpA has extra-articular damage such as eye damage, skin damage, oral, intestinal and genitourinary tract lesions
.

Finally, it should be reminded that the above summary is only an overall overview of the five bone and joint diseases, and cannot be used as a basis for diagnosis.
The specific clinical diagnosis should also be comprehensively judged based on clinical manifestations and related medical examinations
.

Different bone and joint diseases require targeted treatment after a clear diagnosis.
Among them, the most destructive RA needs to be treated with traditional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), such as methotrexate (MTX).
Control disease activity and prevent joint deformities
.

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Clinical application of rehabilitation nursing in patients with bone and joint diseases [J].
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[2] Orthopaedic Branch of Chinese Medical Association Joint Surgery Group.
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[3] Chen Shiju, Shi Guixiu.
New perspectives on old diseases: osteoarthritis - low Horizontal Inflammatory Diseases[J].
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[4] Liu Chunfeng.
Observation on the Clinical Efficacy of Traditional Chinese Medicine in Treating Rheumatoid Arthritis [J].
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[5] Rheumatology Branch of Chinese Medical Association.
2018 Guidelines for Diagnosis and Treatment of Rheumatoid Arthritis in China [J].
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[6] Chinese Association of Traditional Chinese Medicine.
Rheumatoid Arthritis Guidelines for Diagnosis and Treatment of Inflammation [J].
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[7] Gaiqifu.
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China Continuing Medical Education , 2017, 9(9): 208-209.
[8] Li Changgui.
Practical goutology [M].
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[9] Xiang Yang.
Seronegative spondyloarthropathy [J].
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[10] Hou Yuanyuan and Yu Hong.
Application and influence of joint care in patients with rheumatoid arthritis [J].
Hebei Medicine, 2016, 38(15): 2382- 2387.
[11] Wu Huaxiang, Zhu Liang.
Interpretation of 2010 Guidelines for Diagnosis and Treatment of Rheumatoid Arthritis in China [J].
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[12] Wang Lan, Li Huiyuan, Liu Yongming, etc.
Seronegative spine 43 cases of arthropathy [J].
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