Treating arthritis with a combination of traditional and modern medicine

(Baonghean) - Rheumatoid arthritis is an autoimmune disease, chronic inflammation of the synovial connective tissue, mainly affecting peripheral joints. The disease progresses slowly, leading to muscle atrophy, deformity, adhesion and stiffness of the joints. At Nghe An Rehabilitation Hospital, rheumatoid arthritis is treated very effectively.

Sunbathing on the beach - one of the treatments for arthritis.

In Vietnam, the 2nd National Conference on Rheumatology in Da Lat in March 1996 unified the name rheumatoid arthritis nationwide and was officially used in teaching at medical universities. The disease accounts for 0.5 - 3% of the population, in Vietnam the general rate among the people is 0.5%, accounting for 20% of patients with joint disease treated in hospitals. The disease occurs mainly in women accounting for 70 - 80% and 70% of patients with the disease are middle-aged. Some cases are familial.

Until now, the cause of rheumatoid arthritis is still unknown. Rheumatoid arthritis is considered an autoimmune disease with the participation of many factors; including: Pathogenic factors: may be a type of epstein-barr virus localized in lymphocytes, they have the ability to disrupt the synthesis of immunoglobulin; Genetic factors: the disease is related to gender and age; Genetic factors: in rheumatoid arthritis patients, 60-70% of patients carry this antigen.

The disease often starts after a favorable factor such as: acute, subacute infection, trauma, surgery, cold, physical or nervous stress. The disease can start gradually, 70% start with inflammation of one joint, 15% start suddenly, 30% start with small arthritis: wrist, finger, proximal interphalangeal joint. The patient may have a low fever, weight loss, loss of appetite, fatigue. Inflamed joints: swelling, heat, pain; pain increases at night and in the morning, there is morning stiffness, there may be joint effusion. This period lasts several weeks, sometimes several months. The arthritis gradually increases and moves to other joints.

The external manifestation of subcutaneous nodules is a valuable symptom in diagnosis, occurring in 10 - 20% of rheumatoid arthritis cases. These are nodules or lumps that protrude from the skin surface, are firm, immobile because they adhere to the bone base, are painless, and are 5 - 10 mm in size. They are often found at the upper end of the ulna, near the elbow joint; the upper end of the tibia, near the knee joint; the number of nodules is from one to two. The skin is slightly purple, the nails are dry and brittle, and the soles of the feet and hands are dilated.

Visceral manifestations are rare and usually not severe. Splenomegaly with neutropenia occurs in Felty syndrome (5%). The heart may have pericarditis, conduction disorders, endocardial lesions, and very rarely heart valves. Iritis occurs in 1-2%, conjunctivitis with atrophy of the lacrimal and salivary glands (Sjogren's syndrome); pleural effusion, pulmonary fibrosis occurs in 1-2%; hypochromic anemia.

Nghe An Rehabilitation Hospital - address in the treatment of arthritis.

Differential diagnosis:

In the early stages: need to differentiate from acute rheumatism, reactive arthritis, Reiter's syndrome.

Late stage:

Arthritis in lupus erythematosus, gout; Pierre-Marie syndrome, psoriatic arthritis, active osteoarthritis, ankylosing spondylitis. Arthritis manifestations of digestive, neurological, blood diseases, cancer.

Rheumatoid arthritis treatment: Rheumatoid arthritis is a chronic disease, treatment must be persistent and continuous, sometimes for the patient's entire life. Use many methods: internal medicine, surgery, physical therapy, orthopedics, occupational therapy, oriental medicine and acupuncture. Depending on the stage of the disease, treatment: inpatient, outpatient, nursing, combined oriental and western medicine. Must be monitored by a doctor, must be cared for by family and society.

Medical treatment:

Stage I (mild):Use one of the following non-steroidal anti-inflammatory drugs: indomethacine, voltarel, profenid, piroxicam, meloxicam, ibuprofen, diclofenac, naprosen, nifluril, feldel.

Voltarel 25mg x 3 tablets/day divided equally morning - noon - afternoon, taken after a full meal (75mg type, take 1 tablet/day).

Delagyl (nivaquine, cloroquine): An antimalarial drug, effective in treating rheumatoid arthritis. Inhibits the release of lysosomal enzymes from inflammatory cells; take 0.2g tablets x 1-2 tablets/day after meals - take for several months.

Corticosteroids can be injected into the inflamed joint with hydrocortisone acetate or depo medrol (must be done in a sterile hospital room). 1ml of hydrocortisone acetate is equivalent to 25 mg of prednisolone. 1ml of depo medrol is equivalent to 40 mg of methylprednisolone.

Depending on the joint: large joints 1-1.5ml each time; small joints 1/2 - 1/3 ml. Each joint should not be injected more than 3 times, each time only 1-2 joints should be injected.

Hydrocortisone is injected every 2 days, and depo medrol 53-7 is injected every 7 days. Joints with effusion are flushed with 0.9% saline before injection (done at the hospital level).

After pain relief, increase movement, physical therapy, and exercise.

Stage II (moderate):

Take one of the following nonsteroidal anti-inflammatory drugs: voltaren, profenide, piroxicam, (feldene); tenoxiam (tilcotil), meloxicam (mobic), rofecoxib (vioxx).

Delagyl 0.2 x 1 - 2 tablets/day, use for many months.

Hydrocortisone or depo-medrol can be injected into the joint; or moderate doses of steroids can be used. Prednisolone 5mg x 6 tablets/day, then reduce the dose and stop, do not use for a long time. Treatment is indicated when other anti-inflammatory drugs are ineffective.

Can be treated in combination with methotrexate tablets 2.5 mg, 5 mg every week using one tablet 7.5 mg or 3 tablets 7.5 mg and 10 mg 2.5 mg each time, 1 tablet each time, 12 hours apart.

Instruct patients on passive exercise in the treatment of arthritis.

Stage III, IV (severe, progressive):

Prednisolone 1-1.5mg/kg/24h is used for patients with rapid and severe progression with high fever, anemia or organ damage. Use high doses, gradually reduce, then stop - continue treatment as in stages I and II above. At the same time, use one of the following measures:

Methotrexate tablets 2.5 mg and 7.5 mg are incompatible with folic acid. The drug is effective in treating rheumatoid arthritis, psoriatic arthritis, and neutropenia in Felty's syndrome. Take 7.5 mg once a week. The drug usually takes effect after 1 month of treatment. If no effect is seen, the dose can be increased to 20 mg per week. The drug has anti-inflammatory and immunosuppressive effects - the drug is used for several months.

Salazopyrin 500 mg tablets x 2 tablets/day, after 10 days take 4 tablets/day. Use for several months.

D. penicillamine tablets 300 mg (Trolovol kuprep) has the effect of destroying immune complexes, rheumatoid factors. The drug treats severe forms, and other drugs are ineffective in treating rheumatoid arthritis.

How to use: take 1 pill per day for 1 - 2 months; if it doesn't work, take 2 pills per day, continue for 2 - 3 months, if it doesn't work, stop taking the medicine.

Side effects: dermatitis, allergies, digestive disorders, nephritis, leukopenia, thrombocytopenia, erythrocytopenia.

During treatment, you must monitor and stop taking the medicine if there are any side effects.

Passive exercise in the treatment of arthritis.

Immunosuppressants:

Reduces immune response, inhibits immune cells used to treat severe cases, conventional drugs cannot stop the progression of the disease. When using, the patient must be closely monitored, blood tests monthly. Use low doses and increase gradually.

Cyclophosphamide (endoxan) 50 mg tablets. Starting dose 1.5-2 mg/kg/24 hours, drink plenty of water to avoid cystitis, bleeding

Azathioprine tablets 50 mg. Starting dose 1.5 mg/kg/24 hours if well tolerated, after 2-3 months increase dose to 2 mg/kg/day, when disease subsides, gradually reduce dose.

Surgical treatment:

Surgical treatment is indicated in cases of prolonged inflammation of some joints where medical treatment is ineffective, joint inflammation and effusion; usually surgical removal of the synovial membrane; Surgical treatment to restore function of some severely deformed and destroyed joints by methods such as artificial joint replacement, bone end resection, joint orthopedics, or fusion of some joints to avoid dangerous complications; Treatment with physical therapy and rehabilitation: In rheumatoid arthritis, treatment with physical therapy and rehabilitation is an important and mandatory measure to minimize sequelae and restore the patient's ability to work.

Measurement of joint range of motion in the treatment of arthritis.

After using pain medication, physical therapy and exercise therapy must be combined.

Include:Hot baths, warm water baths, paraffin wraps, infrared and ultraviolet lamps on inflamed joints, mud baths... these methods have the effect of dilating blood vessels, increasing blood circulation, increasing sweating, relaxing muscles and reducing local pain.

Using direct current, alternating current, high frequency electricity, ultrasound with different intensities and wavelengths is a method of using energy for treatment; Massage and acupressure: the doctor performs and guides the patient to perform, massage has the effect of improving blood circulation, reducing pain, increasing skin elasticity, reducing skin and ligament fibrosis; Exercise therapy and rehabilitation: instructing the patient to exercise appropriately: Exercise with bare hands, exercise with rehabilitation tools: exercise with a stick, weights, climbing stairs, stretching, pulling, pedals.

Mineral spring water, sea water and therapeutic mud:

Mineral water: when the water source has a solubility of 1 gram of solid or more in 1 liter of water, or hot water > 300C stable. Whole body hydrotherapy: Very good in rehabilitation of rheumatoid arthritis.

Treatment of rheumatoid arthritis according to traditional medicine + Traditional medicine generally calls joint diseases as "syndrome" including: rheumatism, coldness, heat, and wind. Prescribe according to each type of disease combined with acupuncture and acupressure.

Medicinal plants and herbs with anti-inflammatory and pain-relieving effects in joint diseases are used such as: Atractylodes Rhizome, Smilax glabra, Acanthopanax gracilifolium, Coix, Angelica dahurica, Saposhnikovia divaricata, Saposhnikovia divaricata, Achyranthes bidentata, Piper lolot...; Animal extracts (tiger, python, snake, monkey, deer...); Mimosa pudica, Strychnos nux-vomica seeds have anti-inflammatory effects in rheumatoid arthritis.

PV