Rheumatoid arthritis and ankylosing spondylitis—January 17, 1994

Rheumatoid arthritis and ankylosing spondylitis—January 17, 1994

In October 1990, a national conference was held in Weihai City, Shandong Province, with the following summary of presentations:

1. Rheumatoid arthritis

(1) Incidence and pathogenesis: The incidence is 0.24%–0.45%, lower than in foreign countries. Joints exhibit varying degrees of synovial hyperplasia, fibrin deposition, and cartilage destruction; the hyperplasia involves the deposition of antigen-antibody complexes (observed by the General Hospital of the People’s Liberation Army). Rheumatoid factor (RF) is one of the four diagnostic indicators for this disease (joint pain and deformity, RF, X-ray, synovial pathology examination), but because 5% of healthy individuals test positive, its diagnostic significance is somewhat diluted.

(2) Treatment: ① Nonsteroidal anti-inflammatory drugs, such as ibuprofen; low doses have analgesic effects, while high doses have anti-inflammatory effects. Typically, 0.2 g each time, 2–3 times daily. ② Disease-modifying drugs: penicillamine, 0.25 g, 3 times daily; after effectiveness, reduce to 0.25 g daily, maintain for 1 year; side effects exist, but efficacy is good. Methotrexate, 10 mg, once weekly. Tripterygium wilfordii and corticosteroids can also be used.

2. Ankylosing spondylitis

Previously mistaken as a central form of rheumatoid arthritis (RA), it was completely separated in the 1980s. ① Hereditary; ② Sacroiliac joint involvement; ③ Significant cervical spine involvement in women. Treatment: Besides ibuprofen, methotrexate and sulfasalazine are effective. Penicillamine is a derivative of penicillin; due to its ability to bind with various heavy metal ions and promote their excretion, it has historically been used to treat Wilson’s disease and poisoning from heavy metals such as mercury, lead, and copper, with better efficacy than dimercaprol. Recent research has found that this drug has a clear immunomodulatory effect, essentially suppressing antigen-antibody reactions, thus making it useful for treating rheumatoid arthritis, ankylosing spondylitis, and other conditions. Methotrexate, 2.5 mg, orally, once daily or every other day, can also be used.