Rheumatoid arthritis (RA)

What is rheumatoid arthritis?

Watch our video about what rheumatoid arthritis is

单击以观察我们的简短动画,以了解什么是类风湿关节炎,什么是治疗选择以及您可以做什么来帮助自己。

类风湿关节炎是一种可能导致关节疼痛,肿胀和僵硬的疾病。

这就是所谓的自动免疫条件。这意味着免疫系统是人体的自然自卫系统,会感到困惑,并开始攻击身体的健康组织。在类风湿关节炎中,它的主要方式是关节中的炎症。

在英国,类风湿关节炎影响约40万名16岁及16岁的成年人。它可以影响任何年龄的人。它可能会迅速变得更糟,因此早期诊断和强化治疗很重要。您越早开始治疗,就越有效。

To understand how rheumatoid arthritis develops, it helps to understand how a normal joint works.

How does a normal joint work?

关节是两个骨头相遇的地方。我们的大多数关节旨在使骨骼在某些方向和某些范围内移动。

For example, the knee is the largest joint in the body and one of the most complicated. It must be strong enough to take our weight and must lock into position, so we can stand upright.

It also has to act as a hinge, so we can walk, and needs to twist and turn when we run or play sports.

每个骨头的末端都覆盖着软骨,具有非常光滑的表面。软骨使骨头的末端几乎没有摩擦。

The joint is held in place by the synovium, which contains thick fluid to protect the bones and joint.

The synovium has a tough outer layer that holds the joint in place and stops the bones moving too far.

Strong cords called tendons anchor the muscles to the bones.

What happens in a joint affected by rheumatoid arthritis?

If you have rheumatoid arthritis, your immune system can cause inflammation inside a joint or a number of joints. Inflammation is normally an important part of how your immune system works. It allows the body to send extra fluid and blood to a part of the body under attack from an infection. For example, if you have a cut that gets infected, the skin around it can become swollen and a different colour.

但是,在类风湿关节炎的情况下,关节中的这种炎症是不必要的,会引起问题。

When the inflammation goes down, the capsule around the synovium remains stretched and can’t hold the joint in its proper position. This can cause the joint to become unstable and move into unusual positions.

Symptoms

The main symptoms of rheumatoid arthritis are:

  • 关节疼痛
  • 关节肿胀,温暖和发红
  • 僵硬,尤其是早晨或静止呆了很长时间后的第一件事。

其他症状可能包括:

  • tiredness and lack of energy – this can be known as fatigue
  • a poor appetite (not feeling hungry)
  • 减肥
  • a high temperature, or a fever
  • sweating
  • dry eyes – as a result of inflammation
  • chest pain – as a result of inflammation.

类风湿关节炎会影响体内的任何关节,尽管首先在手和脚的小关节中感觉到它。身体的两侧通常同时同时受到影响,但这并不总是发生。

A few people develop fleshy lumps called rheumatoid nodules, which form under the skin around affected joints. They can sometimes be painful, but usually are not.

原因

以下可以在某人患风湿关节炎的原因中发挥作用:

Age

类风湿关节炎会影响任何年龄的成年人,尽管大多数人在40至60岁之间被诊断出。

首次被诊断出,大约四分之三患有类风湿关节炎的人是有效的年龄。

Sex

类风湿关节炎在女性中的普遍性是男性的两到三倍。

Genetics

类风湿性关节炎发展由于combination of genetic and environmental factors, such as smoking and diet. It is unclear what the genetic link is, but it is thought that having a relative with the condition increases your chance of developing the condition.

Weight

如果您超重,则与健康体重相比,患风湿关节炎的机会要大得多。

体重指数(BMI)是一种计算体重是否健康的度量,使用您的身高和体重。

对于大多数成年人而言,理想的BMI在18.5至24.9范围内。

如果您的BMI是:

  • 低于18.5 - 您处于体重不足范围
  • between 18.5 and 24.9 – you're in the healthy weight range
  • between 25 and 29.9 – you're in the overweight range
  • between 30 and 39.9 – you're in the obese range.

要解决您的BMI,请使用健康的体重计算器.

Smoking

Cigarette smoking significantly increases the risk of developing rheumatoid arthritis. If you would like to stop smoking, visit theSmokefree website.

Diet

有证据表明,如果您吃了很多红肉,并且不会食用太多维生素C, you may have an increased risk of developing rheumatoid arthritis.

How will rheumatoid arthritis affect me?

由于类风湿关节炎会以不同的方式影响不同的人,因此我们无法预测该病情可能为您发展。

If you smoke, it’s a very good idea to quit after a diagnosis of rheumatoid arthritis. This is because:

  • 吸烟者的类风湿关节炎可能比非吸烟者更糟糕
  • smoking can weaken how well your medication works.

体育锻炼也很重要,因为它可以改善症状并使您的整体健康受益。

Blood tests and x-rays will help your doctor assess how fast your arthritis is developing and what the outlook for the future may be. This will also help your doctor to decide which form of treatment to recommend.

The outlook for people with rheumatoid arthritis is improving all the time, as new and more effective treatments become available. It is possible to lead a full and active life with the condition, but it is important to take your medication as prescribed and make necessary lifestyle changes.

Diagnosis

A diagnosis of rheumatoid arthritis is based on your symptoms, a physical examination and the results of x-rays, scans and blood tests.

可能很难诊断,因为没有测试可以证明您肯定拥有它。也有很多症状相同的疾病。

您的医生会询问您的症状并进行身体检查。他们将寻找关节肿胀,并检查关节的移动程度。类风湿关节炎会立即影响身体的不同部位,因此,即使它们似乎不相关,也必须告诉医生您患有的所有症状也很重要。

如果他们认为您患有类风湿关节炎,他们会将您转介给风湿病学家,并可能安排血液检查以帮助确认诊断。

Blood tests

没有单一的血液检查可以证实您患有类风湿关节炎。但是,有一些测试可以显示该情况的可能迹象。下面概述了一些主要测试。

Erythrocyte sedimentation rate (ESR)

将红细胞样品放入液体试管中。细胞的定时,以查看它们花了多长时间才能到达管的底部。如果细胞下沉的速度比平常快,则可能的炎症水平高于正常水平。类风湿关节炎只是可能的原因之一。

C反应蛋白(CRP)

This test can show if there is inflammation in your body. It does this by checking how much CRP there is in your blood. If there is more CRP than usual, you may have inflammation in your body.

Full blood count

全血数量测量了您拥有的红细胞的数量。这些将铁携带在您的身体周围,而红细胞数量少,意味着您的铁含量低。这可能意味着您患有贫血(An-ee-me-er),在RA患者中很常见,尽管患有贫血并没有证明您患有RA。

类风湿因子和抗CCP抗体

在病情开始时,所有类风湿关节炎的患者中约有一半的流血因素。但是,每20人中有大约1人没有类风湿关节炎,也测试类风湿因子阳性。

There is another antibody test called anti-CCP that you can take. People who test positive for anti-CCP are very likely to get rheumatoid arthritis. However, not everyone that has the condition has this antibody.

Scans

扫描可用于检查关节炎症和损坏。这些可用于诊断类风湿关节炎并检查病情的发展方式。

These may include:

  • x-rays – these will show any changes in your joints
  • ultrasound scans – a picture of your joints is created using high-frequency sound waves
  • 磁共振成像(MRI)扫描 - 关节的图片是使用强磁场和无线电波制成的。

Treatment

有各种各样的治疗方法对rh可用eumatoid arthritis. The earlier that intensive treatment is started, the more likely it is to work.

有三种主要治疗类风湿关节炎的方法:

  • drugs
  • physical therapies
  • surgery

毒品

有四个主要的药物组来治疗类风湿关节炎。这些都是:

许多患有类风湿关节炎的人需要服用多种药物。这是因为不同的药物以不同的方式起作用。

您的药物治疗可能会不时更改。这可能取决于您的症状有多严重,或者是因为与您的病情有关的事情已经改变。

毒品may be available under several different names. Each drug has an approved name – sometimes called a generic name.

Manufacturers often give their own brand or trade name to the drug as well. For example, Nurofen is a brand name for ibuprofen.

The approved name should always be on the pharmacist’s label, even if a brand name appears on the packaging. Check with your doctor,rheumatology nurse specialist或药剂师,如果您不确定。

止痛药

止痛药can help to relieve the pain caused by rheumatoid arthritis, but should not be the only treatment used.

可用的止痛药有很多类型和优势 - 有些可以从药房从柜台上购买,而有些则只有处方可用。

为了指导,请询问负责您护理的医疗保健专业人员。

管理症状

Managing a flare-up

When your symptoms get worse, this is known as a flare-up. These can happen at any time, but can happen after you have been stressed or had an infection.

随着时间的流逝,您可能会更好地注意到爆发的早期迹象。

If you’re having regular flare-ups, you should mention this to your doctor. It may be that you need to review your treatment.

Here are a few things you can do to help yourself during a flare-up:

  • Keep taking your medication at the doses you’ve been prescribed.
  • 进行轻柔的练习。
  • Put heated items on the joint – these can include a hot water bottle or electric heat pad. See below for more information.
  • 将冷物品放在关节上 - 其中可以包括一碗带有冰块的冷水,一包毛巾中包裹的冷冻豌豆或保存在冰箱中的潮湿毛巾。请参阅下面的详细信息。
  • Let people around you know, so they can help and support you.

使用加热物品的提示

Heated items that could help your joint pain include a hot water bottle or electric heat pad. Wrap these in a towel, then place on a painful joint. You could also try having a hot or warm shower or bath.

Other heated items that people have found useful are wheat bag, heat pads, deep heat cream, or a heat lamp.

Make sure these items are warm but not hot, as you could risk burning or scalding yourself. Gentle heat will be enough.

应将毛巾放在加热物品和皮肤之间以保护。定期检查皮肤,以确保不会燃烧。

Tips for using ice packs

有些人发现使用冰袋可以帮助他们的关节疼痛。您可以从药房购买一个,也可以通过将冰块包裹在塑料袋或湿茶巾中来制作一个。

Here’s how to apply the ice to your skin:

  • Rub a small amount of oil over where you’d like the ice pack to go. Any type of oil can be used. If your skin is broken – for example, if you have a cut – don’t use the oil and cover the area with a plastic bag. This will stop the cut getting wet.
  • Put a cold, wet flannel over the oil.
  • 将冰袋放在绒布上,将其握在那里。
  • 五分钟后,检查皮肤的颜色。如果您的皮肤变成鲜艳的粉红色或红色,请卸下冰袋。如果还没有,请再将其持续5到10分钟。
  • 您可以将冰袋放置20-30分钟。不要再保留它了,因为如果将皮肤遗留时间太长,您可能会损坏皮肤。

Living with rheumatoid arthritis

Occupational therapy

职业理疗师can help you keep doing the activities you need or want to do – at home or at work. They will work with you to find different ways of doing things.

The benefits of seeing an occupational therapist include:

  • 提高了信心
  • being able to do more things, at home or at work
  • being able to live independently at home
  • 允许您返回或继续工作。

向您的全科医生询问您本地的职业治疗师。如果您定期看到社会工作者,护士或其他医疗保健专业人员,他们可以通过健康或社会服务来帮助您与职业治疗师联系。

你有准备描述任何困难and how they are affecting your life, or the lives of those who care for you.

您可能想知道要有多长时间才能预约,所以请记住询问是否有等待名单。

You can also see an occupational therapist privately. You will be able to get an appointment quicker, but it will cost you money.

寻找一名私下工作的职业治疗师皇家职业治疗师网站. All occupational therapists should be registered with theHealth & Care Professions Council (HCPC).

研究和新发展

Here, we round up some of the latest developments in rheumatoid arthritis research.

Our previous research has:

  • led to the development of a new type of drug. These drugs are called ‘biological therapies’ and have transformed the lives of people with rheumatoid arthritis over the past 20 years.
  • 强调了在症状开始的12周内开始早期,强化治疗炎症性关节炎的重要性。这也导致了为类风湿关节炎的人引入最佳练习关税,这意味着人们被更快地诊断出来。

We're currently funding research projects to find out what causes rheumatoid arthritis, and to develop new and improved treatments. For example:

  • 我们的遗传学和基因组学中心试图了解遗传因素如何确定某些人是否有患炎症性关节炎的风险,以及当他们做什么时会发生什么
  • our rheumatoid arthritis pathogenesis centre of excellence is looking at why rheumatoid arthritis starts, why it attacks the joints, and why the inflammation carries on rather than switching off
  • 调查在我们的皮肤和肠道中生活的生物如何在类风湿关节炎的患者中有所不同,以及这如何影响一个人对治疗的反应。

Keri的故事

我在21岁时被诊断出患有类风湿关节炎。

I was in my third year of university, studying to be a primary school teacher. Suddenly, one morning, my thumbs became very painful. Then my elbows became stiff and sore, and I couldn’t straighten my arms.

At first I only had symptoms in the morning, but eventually I had them all the time. Quite a few of my joints were stiff and painful, which meant I couldn’t get around very well. I was also tired a lot. When this happened, my GP referred me to a rheumatologist.

I graduated from my teacher training course two years later than planned, but have not been able to work as a teacher yet, due to my arthritis. However, I have used my teaching skills to volunteer for Versus Arthritis, leading self-management courses in Northern Ireland, which I find extremely enjoyable and rewarding. I am also the Chairperson of my local Versus Arthritis support group.

Baking is one of my hobbies, although using certain kitchen equipment can be difficult. Being social is important to me too and I enjoy going to cafés to catch up with my friends. When I’m in pain, I can distract myself by reading or listening to music.

Exercise is important to me too, as I find that doing some gentle exercises makes my joints less painful. There are a few chair-based exercises I do regularly and I also enjoy going for short walks.

游泳也很棒,我发现在水疗池的加热水中进行锻炼会使我感到不那么僵硬和酸痛。

Medication-wise, I’m currently using a biological injection called Enbrel. I’ve been using it for five years and inject myself once a week. It’s really helped to control my condition and my flare-ups happen less often.

目前,我没事。有好日子和坏日子。我仍然每天都会遇到疼痛,但是比第一次被诊断出来的要好得多。我的爆发量更少,这表明我正在使用的药物确实在帮助我。

My advice to anyone who has recently been diagnosed with rheumatoid arthritis would be to join a support group. Talking to another person who has the same condition as you and knows what you’re going through is really useful and reassuring. It’s helped me a lot in my journey.

I’d also say that getting a good night’s sleep is important, as it can help your body recover from the effects of your arthritis. It’s also important for me to learn more about my condition, as it helps me to understand what my body is going through. I really do believe that knowledge is power!