On the whole, like high blood pressure and diabetes, this is a type of disease based on genetic susceptibility and promoted by external factors, and there is no cure for it. The so-called root cause, is to remove the cause of the disease, cure the disease, and rheumatoid arthritis cause is not clear, let alone remove. Current research suggests that rheumatoid arthritis is related to genetic factors, in addition, rheumatoid arthritis as an autoimmune disease, its pathogenesis and abnormal antigen-antibody reaction, immunosuppressants can only inhibit the antigen-antibody reaction, so that they are maintained at a low level, but can not be removed. Some patients see some advanced rheumatoid arthritis patients, due to joint deformity, ankylosis, life can not take care of themselves, the concern is very heavy, this is unnecessary. As long as there is active cooperation between doctors and patients, early diagnosis, early treatment, and perseverance, generally can control the progress of the disease and can work and live normally. Some Chinese medicines have certain efficacy on rheumatoid arthritis, such as Lei Gongteng can control joint inflammation, relieve pain, but can not stop the progression of arthropathy, some people are afraid of anti-rheumatic side effects, only take Chinese medicine treatment, and ultimately joint destruction, deformity is a case in point. Therefore, the rheumatoid arthritis can be used in a combination of Chinese and Western medicine, do not take Chinese medicine and stop using anti-rheumatic drugs that have been affirmed the efficacy of the medicine, and avoid indiscriminate treatment, so as to avoid delays in the condition of the loss of treatment time.
Common therapeutic varieties:
(1) Grapes: sweet taste, sex flat, can benefit the blood, eat to make people strong, especially raisins to make up for the power of the very much, it is appropriate to and cinnamon meat with the decoction service. Can benefit the liver and kidney, strong bones and bones, used for qi and blood deficiency palpitations, insomnia, fatigue, night sweats. It is also used for the deficiency of liver and kidney, soreness and weakness of waist and knees. Take 500 grams of raisins, 10 grams of ginseng, soaked in 800 ml of wine, sealed for 10 days, 30 ml ~ 50 ml each time, 1~2 times a day; fresh or take the juice with a little honey, served with warm water. Used for urinary incontinence, edema, short, red, astringent and painful urination. Take grape juice, lotus root juice, rhubarb juice, honey, papaya, each equal parts, decoction for dilute soup, take before eating, each time 60 ml ~ 100 ml.
(2) Jujubes: It can tonify the middle and benefit the qi, nourish the blood and calm the mind, and moderate the effect of medicine. It can be consumed as a snack or in soup. It is often used for rheumatoid patients with weak spleen and stomach, tiredness, blood deficiency, mental trance and restlessness.
(3) walnuts: nourish the liver and tonify the kidney, benefit the brain and spleen, and strengthen the muscles and bones. Daily consumption of 2~3 walnuts.
(4) pine nuts: nourish the liver and tonify the kidneys, benefit the brain and spleen, and strengthen the muscles and bones. Consume 3 grams ~ 5 grams per day.
(5) chestnuts: kidney and waist, stomach and spleen. Applicable to rheumatoid kidney deficiency, lumbar and knee weakness.
(6) fresh mulberry: for the flat tonic liver and kidney products. With 500 grams of fresh mulberry, fresh mulberry branches 2 cm long section, immersed in wine sealed for 30 days. Shake well, drink 20 ml ~ 50 ml per day. It can dispel wind-dampness, tonify liver and kidney, and benefit blood circulation.
(7) Hawthorn root (skin): use 40g ~ 50g of hawthorn root (or skin), decoct and take, also eat hawthorn fruit. It has the effect of relaxing tendons and activating collaterals. Treatment of rheumatoid paralysis.
(8) Olive: take 40 grams ~ 50 grams of fresh olive root or skin, wash and decoct the water for internal use, and also eat olive fruit. Treatment of rheumatoid paralysis, numbness of hands and feet.
(9) cinnamon: also known as longan, cinnamon meat. Taste sweet, flat, into the spleen, heart meridian. It is the key medicine to replenish blood and benefit the heart, long wisdom and benefit the spleen, into the spleen meridian work better than jujube. Used alone, it is effective in tonifying Qi and blood. It is used for the reduction of blood cells in the late stage of rheumatoid disease, weakness and anemia.
(10) yam: it has the effect of benefiting qi and nourishing yin, tonifying the kidney, spleen and lungs. It is suitable for thirst, weakness and sweating after rheumatoid disease.
(11) black beans: tonifying the kidney and yin, invigorating the spleen and inducing dampness, dispelling wind and removing paralysis. Apply to rheumatoid paralysis, limb contracture, liver and kidney deficiency. This mouth with Job's tears, papaya with better results.
(12) wolfberry: for rheumatoid liver and kidney yin deficiency, dizziness, lumbar and knee weakness, body weakness, long service can be strong bones, cold and heat resistance, benefit the essence of blood, people live long. Can be eaten fresh, with white chrysanthemum infusion tea, but also with rice porridge to eat.
(13) ginger: also known as ginger, taste pungent, slightly warm. It has the effect of relieving the wind and dispersing cold, warming and stopping vomiting and detoxification. Ginger contains a kind of curcumin, the heart, blood vessels have a stimulating effect, can make the heart beat faster, blood vessel expansion, blood flow acceleration, so that the whole body feels warm, sweating. Rheumatoid patients can be eaten as a vegetable, or as an ingredient in a dish. Can also be matched with 60 grams of ginger, 100 ml of vinegar, decoction soup wash and dip the affected limbs. Or use fresh ginger to crush and apply externally or take the juice to apply externally. Can also be used ginger, fresh onion, coriander 30 grams each, calamus 15 grams, **** chopped and mashed, add 50 ml of white wine, mixing the affected area.
(14) chili pepper: has the effect of warming the cold, external use can make the local skin vasodilatation, promote blood circulation, on the prevention and treatment of rheumatoid have certain therapeutic effects.
(15) lotus seed: taste sweet and astringent, flat, with clear heart, nourish the spirit and benefit the role of the kidney. According to the "Compendium of Materia Medica" records, lotus seed has "heart and kidney, solid essence, strong muscles and bones, make up for the deficiency, thick stomach and intestines, ears and eyes, in addition to cold and dampness" and other effects. Can be eaten fresh, can also be dried fruit peeled, inner cooking porridge and other food.
(16) bone broth: available pigs, cows, sheep, dogs and other joint bones or vertebrae soup, put a few drops of vinegar before simmering, the acute stage of rheumatoid disease, subacute, chronic osteoarthritis decalcification, osteoporosis has a good compensation and regulation.
The above fruits and vegetables can be consumed regularly in moderate amount without further restriction, which is beneficial to the body and the recovery of the disease.
What are the dietary considerations for patients with rheumatoid arthritis and ankylosing spondylitis?
1) Reasonable diet. We should pay attention to over eating high protein, high vitamin, medium fat, medium calorie, low sugar, low salt, small amount of meals, less stimulating food. Cooking
Food should be good in color, aroma and taste, and easy to digest. The ratio of sugar, protein and fat in the diet should be 3:2:1. Use more vegetable oils,
such as salad oil, corn oil, olive oil, sunflower oil, soybean oil, rapeseed oil and so on. The ratio of vegetable and animal oils is 2:1. Dietary calorie distribution is 30% for breakfast, 40% for lunch, 10% for lunch, and 20% for dinner. Fruits should be decided according to individual dietary habits and condition.
(2) Vegetables are the mainstay of the diet, and about 100 grams of fruit should be consumed after meals. Vegetables such as leafy greens, tomatoes, radishes, celery, leeks, parsley, papaya
, cucumbers, bean sprouts, potatoes, seaweed, kelp, black fungus, onions and so on. Animal meats such as snake, dog, lamb, beef and fish are used. Moderate
Eat more animal blood, eggs, fish, shrimp and so on.
(3) dietary nutrition should be comprehensive, do not avoid and partiality, some foods should be limited, but not taboo, such as milk, goat's milk, milk sugar, cheese, chocolate
, peanuts, millet, etc., less fatty meat, high action fat and high cholesterol food, less sweets, less alcohol and coffee, tea and other beverages.
Rheumatoid arthritis latest biological treatment
The hot spot of rheumatoid arthritis (RA) treatment is the application of biological agents. Currently, the main biologics in clinical use are tumor necrosis factor (TNF) inhibitors, cytotoxic T-lymphocyte-associated antigen-4 fusion protein (CTLA-4Ig), CD20 human-mouse chimeric monoclonal antibody rituximab (RTX), and anakinra.
Rituximab
Day 1 featured almost exclusively basic and clinical studies on the effectiveness and safety of anti-CD20+ monoclonal antibodies in combination with other anti-rheumatic drugs in the treatment of autoimmune diseases, the newest area of interest in the treatment of autoimmune diseases. Our hospital reported the preliminary results of the efficacy and safety of RTX in the treatment of refractory rheumatoid arthritis. In this phase III clinical trial, RTX was given at a dose of 1000mg per dose by intravenous infusion, followed by a second infusion at 14-day intervals, *** twice, and coadministered with methotrexate. At 24 weeks, the proportion of the RTX group achieving ACR20, 50 and 70 was 51%, 27% and 12% respectively, compared with 18%, 5% and 1% in the placebo group, and the improvement of HAQ index and SF-36 value in the treatment group was significantly better than that in the placebo group. It was reported that with the prolongation of RTX treatment, the efficacy of RTX increased accordingly, and the side effects did not increase significantly. Paul reported that serum rheumatoid factor or anti-cyclic citrullinated peptide antibody-positive and negative patients responded to RTX treatment, and found that serum antibody-positive patients were more effective than negative patients. Ceara observed the synovial tissue changes before and after RTX treatment, 2 out of 3 cases of CD20+B cell reduction, that the efficacy and synovial tissue CD20+B cell reduction is related.
Aabatacept
Aabatacept is a fusion protein composed of CTLA-4 extracellular functional region and human IgG, which can inhibit the further activation of T cells and inhibit the production of antibodies by binding to B7 molecules on the surface of T cells.
In ATTIN, AIM, ASSURE and other clinical trials, abatacept is used to treat patients with RA who are refractory to or have not responded to disease-modifying anti-rheumatic drugs (DMARDs) or TNF inhibitors, and it is administered intravenously once on days 1, 15, and 29, and then once every 4 weeks at a dose of 10mg/kg body weight. Each dose was 10mg/kg body weight.
The results showed that, compared with placebo, the abatacept treatment group achieved a significantly higher proportion of ACR20, 50 and 70, and the HAQ index was significantly improved; it was well tolerated by the patients. The incidence of serious adverse events in the treatment group and the placebo group was 13.6% and 12.3%, respectively; serious infections were 3.0% and 1.9%, respectively; and the incidence of lung cancer was 0.2% and 0%, respectively. The combination of abatacept with TNF inhibitors is not currently recommended because it resulted in a significantly higher incidence of infections (63%) and serious infections (4.4%) than TNF inhibitors alone (43% and 0.8%, respectively) without improving efficacy. The use of abatacept in patients with COPD should be closely monitored.
TNF inhibitors
TNF inhibitors have been in clinical use for many years and are characterized by a rapid onset of action in most patients, significant efficacy, and the ability to delay bone erosion. The indications are expanding, and approved indications include RA, juvenile RA, Crohn's disease, ankylosing spondylitis, and psoriatic arthritis.
However, with the prolongation of the treatment period, it was found that 1/3 of the patients failed the treatment, the number of co-infections increased, and there were cases of severe infections and even death. The incidence of lymphoma has also increased, but it is not certain whether the increase in lymphoma is caused by the disease itself or by the influence of drugs. In addition, biologic therapy and hepatitis B activity
Dimitrios Vassilopoulos reported on biologic agents and hepatitis B virus activity. He pointed out that immunosuppressive therapy in rheumatologic patients infected with hepatitis B virus may lead to hepatitis B activity, hepatitis, and even hepatic decompensation. We suggest that screening is needed for 1) high-risk patients who come from areas with a high prevalence of hepatitis B, have high-risk sexual behavior, use drugs intravenously, receive hemodialysis, and have a history of HBV exposure, and 2) high-risk therapies such as high-dose glucocorticosteroids, methotrexate, leflunomide, TNF inhibitors, and RTX.
Evaluation strategy: Measure HBsAg, anti-HBc antibody, anti-HBs antibody. If HBsAg+, antiviral treatment and refer to hepatologist; if HBsAg-, anti-HBc+, anti-HBs ± close monitoring and individualized treatment; if HBsAg-, anti-HBs-, anti-HBs- recommend vaccination.
Treatment strategy for active hepatitis B in combination with rheumatic diseases: If receiving short-term immunosuppressive therapy, start lamivudine 100mg/d 1 week before the start of treatment, and continue to take it for 3-6 months after stopping immunosuppressive therapy. For long-term immunosuppressive therapy, start lamivudine or adefovir 10mg/d 1 week before treatment. Whether or not receiving prophylactic antiviral therapy, alanine aminotransferase, HBVDNA
Treatment of rheumatoid arthritis with traditional Chinese medicine
Rheumatoid arthritis is a common chronic systemic autoimmune disease characterized by non-infectious inflammation of the joints and periarticular joints, which can lead to severe deformities of the joints. Belonging to the category of Chinese medicine paralysis, modern medical sages called paralysis, intractable paralysis and other disease names. Its cause and effect mechanism and general "wind, cold and damp three gas mixed to the combined and paralysis" paralysis is different, in the study of ancient and modern medical sages treatment of paralysis on the basis of the thesis, combined with the clinical practice, the etiology and pathogenesis of the disease and the main points of treatment put forward the following insights.
1. Liver, spleen, kidney, qi and blood deficiency for the disease of wind, cold, dampness, heat, phlegm and stasis for the disease
Rheumatoid arthritis condition Lingering recurrent, the course of the disease is long, and its pathological factors at the beginning of the endowment is mainly for the vegetative deficiency of the liver and kidney deficiency, yang qi insufficiency, the coupling is not dense, the guard outside the solid, so that the wind, cold and dampness enter into the deficiency, the flow of meridians and joints, impede the operation of qi and blood and the onset of the disease. Su Wen - paralysis theory, "the disease for a long time and does not go, within the house in the joint also", "bone paralysis has not been, and again in the evil, within the house in the kidneys." Kidney is the master of bone, liver is the master of tendon, tendons and joints are dependent on the liver and kidney essence and blood nourishment. Evil guest sinews and bones, tendon damage to the liver, bone damage to the kidney, liver and kidney damage, sinews and bones are not nourished, muscle is not full, resulting in joint constriction pain, flexion and extension of unfavorable, or even lead to muscular atrophy, tendon shrinkage, bone loss, deformity of the joints and stiffness, action is difficult and other serious dysfunctions. Spleen is the master of muscle, transportation of water and dampness, spleen deficiency is phlegm and dampness, dampness and phlegm mutual knot, wreak havoc, flow of muscle meridians can be seen body weight knuckle swelling, joint effusion, etc., so the liver, kidney, spleen, qi and blood deficiency is the main intrinsic factor of this disease. And because of the lingering condition, recurrent episodes, there must be an external evil for the trigger, wind, cold, dampness and heat of the repeated invasion of the evil, deep into the meridian tunnel, bone joints, meridians unfavorable to become blood stasis, dampness and viscidity into phlegm, phlegm and blood stasis, stay in the joints, stasis blockage of the meridians, the formation of joints, stiffness and swelling, deformity, and day-to-day difficult to recover. Therefore, it is said that this disease to liver, spleen and kidney deficiency for its own, wind, cold, dampness, heat, phlegm and stasis for its symptoms, paralysis of the meridians is not conducive to the blockage of qi and blood stagnation and blockage of the pathology, the mechanism of the lesion can be summarized as "false, evil, stasis" three.
2. Nourishing the liver and kidney, tonifying the spleen and stomach, regulating qi and blood as the main method of treatment
Since this disease is stubborn and has a long course, the cause of this disease is deficiency of the liver, spleen and kidney as the root cause of the disease, wind-cold, dampness-heat, phlegm and blood stasis as the symptom, and paralysis of meridians is unfavorable, and stagnation of qi and blood is not accessible as the pathology of this disease, the main treatment is to nourish the liver and kidney, tonifying the qi and blood, regulating and tonifying the spleen and stomach, and supplementing with clearing the heat and toxins, dispelling dampness and turbidity, eliminating stasis and blood stasis, resolving phlegm and turbidity, searching for wind, and picking out the evils, The main treatment method is to clear heat and toxin, eliminate dampness and blood stasis, dissolve phlegm, search for wind and remove evils, and promote paralysis and pain. Nourishing the kidney with immortelle, immortal spleen, ants, eucommia, cuscuta, hyssop is the mainstay, while recognizing the deficiency of yin and yang and selecting and adding respectively, adding chasteberry and tortoise board for yin deficiency, adding slices of adenophora, cinnamon and bone marrow for yang deficiency; nourishing the liver with ripened earth, angelica sinensis, white peony, papaya, chickweed vines, mulberry parasol; strengthening the spleen and benefiting qi, choosing astragalus, atractylodes macrocephala, radix et rhizoma, radix et rhizoma ginseng, and Chinese yam. Liver, spleen and kidney with health, then the paralysis from the annihilation; wind with Wei Ling Xian, whole worm, snake, Gui Zhi, etc.; clearing heat and toxins to dispel dampness and turbidity should be used to prevent, Coix lacryma, gypsum, Zhi Mu, Cangzhu, cypress, etc.; remove blood stasis and new phlegm with Angelica, Rhizoma Ligustici, Salvia divinorum, chickweed vine, white mustard seed, silkworms, etc.; to activate and relieve pain with the Luo Shi Teng, Hai Feng Teng, Qingfeng Teng, and even more so with the use of Musk, Strychnos, Centipede, Scorpion, Hosokote and so on.
After many years of clinical screening, the self-proposed Fuzheng remission soup, the therapeutic effect is satisfactory. Prescription: Astragalus 30 grams, ginseng 10 grams, Atractylodes macrocephala 12 grams, Angelica sinensis 10 grams, Semen cuscutae 10 grams, Cuscuta chinensis 30 grams, Spleen 10 grams, Paeonia lactiflora 15 grams, Cinchona sinensis 30 grams, Wilsonia 15 grams, Fenghui 12 grams, Cinnamon twig 15 grams, Radix et Rhizoma Glycyrrhizae 10 grams, Ginger 10 grams, Jujubes 5 pieces. Fixed pain; ginger and jujube and Yingwei, in order to facilitate the blood; roasted licorice firm sinews, long muscles, times the gas, but also moderate the nature of the drug, and the mediation of all drugs. The whole formula *** play warm tonic liver and kidney, strengthening the spleen and qi, dispersing cold, wind and dampness, remove blood stasis and pain.
Adding and subtracting: if the pain is severe, add two centipedes, 3 grams of scorpion (for the end of the punch); partial wind prevalence plus wind, snake, Qiangwu, Duhong 10 grams each; partial cold prevalence plus 10 grams of cooked epiphyllum, 6 grams of fine Xin, or even add the system of the Chuanwu, system of the Caowu 10 grams each; partial dampness prevalence plus Cangzhu 12 grams, Coix seed 30 grams, HaiTongPi, Papaya 10 grams each; partial heat prevalence plus Gypsum 30 grams, ZhiMu, gentian and Dilong 10 grams each, Loxidou 10 grams each; kidney deficiency is obvious plus broken paper 30 grams, antler cream 15 grams; stubborn paralysis for a long time discretionary addition of leeches, Lupus, andrographis paniculata, turtle shells, Millennium Jian 10 grams each; flexion and extension of unfavorable discretionary addition of extensile 15 grams of grass, LuLutong, papaya 12 grams; numbness discretionary addition of silkworms, half-summertime, southern star, white mustard 10 grams each; erythema, nodules discretionary addition of danpi 10 grams, Dangshen 20 grams, saponin spines, nail pearl 10 grams each; pain in the lower limbs add Cangshu 12 grams. Each 10 grams; lower limb pain plus Sichuan hyssop, Duhuo; shoulder and arm pain discretionary addition of Tianxian vine, tablets of turmeric; neck pain discretionary addition of Pueraria lobata, Qiangwu; dorsal spine pain plus the dog spine, deer horns cream in order to draw the meridian.
Finally, I wish my mother good health!