Rheumatoid Arthritis Care

The core goal of rheumatoid arthritis care has never been "complete cure", but through standardized diagnosis and treatment + refined daily care, to minimize the risk of joint pain and deformity, and to retain the ability to live and work normally - current clinical data shows that as long as more than 90% of patients receive adequate care and treatment, they can completely avoid becoming disabled, and their quality of life is not significantly different from that of ordinary people.

I have been working as a nurse in the Department of Rheumatology and Immunology for almost 8 years, and I have seen too many patients who have taken detours. The one who impressed me the most was Aunt Zhang who came for follow-up consultation last year. Three years after the diagnosis, she heard from a fellow villager that there was an ancestral folk remedy that could "cut off the roots", so she secretly stopped all the methotrexate prescribed by the doctor. Less than 3 months later, the proximal interphalangeal joints of both hands were swollen like little carrots, and it was difficult to even pick up vegetables with chopsticks. Later, he went back to the hospital and adjusted the treatment plan. In addition, he followed the rehabilitation exercises we taught for 15 minutes every day. After more than half a year, he can now steam steamed buns twice a week for his grandson who is in elementary school, and it is easy to pinch the folds with his fingers.

When they were first diagnosed, many patients would chase me and ask: Should they lie down to rest or exercise more? In fact, there is no absolutely unified view in the industry on this matter - many old patients who have been ill for many years have experienced less pain by "resting" and feel that moving will hurt their joints. However, the latest "Rheumatoid Arthritis Diagnosis and Treatment Guidelines" clearly recommends moderate functional exercise during the remission period. In fact, there is no need to worry about the actual operation: if the joints are red and swollen, and the pain is so painful that you can’t touch it in the acute stage, just rest honestly. Don’t force yourself to go downstairs to dance square dance or climb stairs. Otherwise, it will only aggravate the synovial inflammation and make the recovery slower. ； When the pain is almost gone and the joint movement is no longer restricted, start moving slowly. Hold an elastic ball for 10 minutes a day to move your fingers, and walk slowly for 20 minutes after meals. As long as you don't do weight-bearing exercises that put a lot of pressure on the joints, such as mountain climbing and fast running, I have seen several patients who insist on moderate exercise. Their joint flexibility is much better than if they lie down every day, and even the dosage of subsequent medication can be gradually reduced.

There is another misunderstanding that is most frequently asked: Is it true that we can never touch cold water in this life? There was a 20-year-old girl who came for a follow-up consultation. She said that the elderly in her family would not even let her drink iced milk tea in the summer, and she would be scolded for a long time if she touched room temperature water. In fact, there is really no need to overdo it. If you are in the attack period and your joints are already inflammatory and edematous, and your blood vessels will shrink when you touch cold water and you will frown in pain, then you must try to avoid it as much as possible. ； But if the condition has been stable for more than half a year and you don't feel any discomfort at ordinary times. In summer, you can wash fruits with room temperature water, rinse your hands, or even take an occasional sip of iced drinks. There is no problem at all. You can’t boil hot water in advance every time you wash your hands for decades, right? Living a life that is too stressful can actually affect your mood. High mood swings are in themselves a predisposing factor for recurring rheumatoid disease, which many family members tend to ignore.

When it comes to recurring illness, the most common trigger is actually reducing and stopping medication without permission. Many people are afraid when they see "hormones" and "immunosuppressants" written on the medicine box. They are afraid of gaining weight, losing hair, or damaging their liver and kidneys, so they secretly stop taking the medicine, which may lead to serious problems. Last month, there was a 28-year-old young man. He was afraid that taking hormones would make him fat and would affect his ability to find a partner. He had already reduced his intake to half a tablet every other day, but secretly stopped. After only half a month, his knees became so swollen that he could not bend and could not even get out of bed. Now he had to increase the dosage and adjust the medication again, which was not worth the loss. The rheumatoid treatment drugs currently used in clinical practice have been clinically verified for decades. Doctors will also regularly ask you to check liver and kidney function and bone density. If there is a problem, the plan will be adjusted in time. You really don’t have to think about stopping the drug by yourself. I have seen too many people who have gastric bleeding and liver and kidney damage after taking those folk remedies that say “it can cure the disease without taking medicine.” I really can’t do it.

Oh, and there is also the issue of diet. Many patients ask whether they should avoid seafood, beef and mutton. The views of traditional Chinese medicine and western medicine are indeed different on this point. Traditional Chinese medicine generally recommends eating less "food" in the acute phase to avoid aggravating the inflammatory reaction. However, with western medicine, unless you clearly experience worsening joint pain or allergies after eating a certain food, there is no need to deliberately avoid food. Instead, you should eat more foods high in calcium, such as milk and eggs. After all, rheumatoid patients are three times more likely to have osteoporosis than ordinary people. If you don’t dare to eat this and that every day, if you don’t keep up with your nutrition, you will be more likely to have problems.

In fact, after doing nursing for so long, I feel that the most easily overlooked thing is emotional regulation. Many people are devastated when they are first diagnosed. They feel that they will definitely be paralyzed in the future. They cry at home every day and cannot eat well or sleep well, which may easily induce disease activity. I know an old patient who was diagnosed almost 22 years ago. Now she and her wife go hiking twice a year. Her fingers are not deformed at all. When I asked her what her secret was, she said, "Don't take this disease seriously, and don't take it seriously. It should be reviewed and rechecked, and medicine should be taken, and you should live your life as you should." This is really the truth.

After all, rheumatoid arthritis is a chronic disease in the final analysis. To put it bluntly, the essence of nursing is to coexist peacefully with it. There is no need to always think about "solving it once and for all", and don't be worried every day and dare not do anything. Finding a rhythm that suits you is better than anything else.