Kaplan syndrome

　　The etiology of Kaplan syndrome is not yet fully clear. Consideration may be related to the following factors:

　　1. Immune abnormalities rarely occur in patients with rheumatoid arthritis without silicosis. Considering the 28 cases reported by Walker (1966) over 12 years, dust lung may have some promoting effect on the formation of pulmonary nodules in rheumatoid arthritis.

　　2. Genetic factors Miall (1955) conducted an epidemiological survey of males over 15 years old, and found that genetic predisposition plays an important role in the pathogenesis of rheumatoid arthritis and Kaplan syndrome.

　　Pathogenesis of Kaplan syndrome:

　　1. Siliconic acid deposited in the lungs can sensitize antibodies for a long time, leading to an adjuvant disease. Dust can promote immune reactions or be localized in the lungs to cause rheumatoid arthritis lung damage, therefore, it can be considered that the adjuvant disease of silicosis is caused by immune abnormalities, possibly due to antigenic substances released by macrophages damaged by dust, leading to the coexistence of pulmonary rheumatoid lesions and rheumatoid arthritis.

　　2. In recent years, due to the development of immunogenetics, the correlation between HLA and disease susceptibility has received attention. According to the report by Wagner et al. (1979), the Kaplan syndrome with RF positivity has a significantly higher positive rate of HLA-BW45 than the control group, while the Kaplan syndrome with RF negativity has a negative HLA-BW45.

　　2. Under the microscope, the central part of the lung lesions is composed of necrotic collagen fibers and dust.

　　There is an active inflammatory layer composed of macrophages and polymorphonuclear leukocytes from the center to the outside, a reticular layer of fibroblasts, an infiltrative layer and connective tissue layer composed of a large number of lymphocytes and plasma cells. In addition, there is also obliterative endarteritis, with many lymphocytes, plasma cells, and macrophages that have broken down dust, visible as black concentric rings under the naked eye. Circular lung damage can occasionally occur calcification or cavitation. Pathologically, the difference between Kaplan syndrome and progressive massive fibrosis caused by silicosis lies in the absence of an active inflammatory layer and rheumatoid endarteritis in the latter. The difference from silicosis tuberculosis lies in the presence of an active inflammatory layer and a fibroblast reticular layer in the former, but tuberculosis bacteria cannot be found in the active inflammatory layer.

　　1. Rheumatoid nodules

　　It is more common at the joint protuberances and areas frequently subjected to pressure, with no significant tenderness and difficulty in movement. Rheumatoid nodules can also occur in internal organs, such as the surface of the pericardium, endocardium, central nervous system, lung tissue, and sclera, etc.

　　2. Vasculitis

　　It can affect various types of blood vessels, with medium and small arteries being commonly involved. It can manifest as gangrene of the fingertips, skin ulcers, peripheral neuropathy, and uveitis, etc.

　　3. Heart

　　Pericarditis, non-specific endocarditis, myocarditis.

　　4. Pleura and lung

　　Pleurisy, pulmonary interstitial fibrosis, pulmonary rheumatoid nodules, pulmonary hypertension.

　　5. Kidney

　　Membranous and mesangial proliferative glomerulonephritis, interstitial nephritis, focal glomerulosclerosis, proliferative nephritis, IgA nephropathy, and amyloidosis, etc.

　　6. Nervous system

　　Sensory peripheral neuropathy, mixed peripheral neuropathy, multiple mononeuritis multiplex, and compressive peripheral neuropathy.

　　7. Hematopoietic system

　　Rheumatoid arthritis patients may present with normocytic normochromic anemia, and platelet count increases during the active phase of the disease.

　　The diagnosis of Kalanp syndrome can be confirmed based on the patient's occupation, history of dust exposure, respiratory system manifestations such as dyspnea, characteristic X-ray changes, joint symptoms, and positive rheumatoid factor.

　　1. Respiratory symptoms such as cough, coughing up black or brown sputum, hemoptysis, varying degrees of dyspnea, and chest pain.

　　2. Before or after pulmonary pathological changes, joint swelling and pain or other symptoms and signs of rheumatoid arthritis may occur in the bones and joints. In some cases, joint symptoms may not be obvious.

　　Kalanp syndrome can be prevented in three levels as follows:

　　Level 1 prevention

　　1. Do a good job of labor protection. Avoid the invasion of adverse factors such as dust, wind, cold, and dampness.

　　2. Strengthen physical exercise, improve nutrition, live a regular life, maintain a pleasant mood, and enhance the body's immune function.

　　3. Many patients' onset is related to bacterial or viral infection, so timely and effective control of infection is an important means of preventing RA.

　　Level 2 prevention

　　Planed functional exercise of the joints to prevent joint deformity and muscle atrophy. Immunosuppressive therapy and surgery also have certain effects on some patients.

　　Level 3 prevention

　　For RA patients with functional status listed as 3 or 4, orthopedic devices and assistive devices should be used in conjunction with treatment, or orthopedic surgery can be performed to improve joint deformities. For patients with severe joint destruction and joint dysfunction in the later stage, after the condition is stable, selective artificial joint replacement surgery can be performed to reconstruct joint function.

　　Immunological examination shows that 65% of cases have positive rheumatoid factor, decreased serum albumin, increased α2 and γ-globulin, and β-globulin increases with the progression of the disease, and IgG and IgM increase.

　　Chest X-ray examination shows characteristic shadows with single or multiple lesions, which can be round or elliptical dense shadows with clear edges, varying in size, with a diameter of 0.5-1.5 cm, occasionally up to 3-5 cm. They are often located in the middle and outer zones of the lower lung fields. Multiple lesions are very similar to metastatic tumors, but central necrosis forms thin-walled cavities, generally without fluid levels, and a few may have calcification.

　　What kind of food is good for Kalanp syndrome patients to eat:

　　Eat more white foods, such as radishes, pears, lilies, silver ear, lotus root, and so on. Consume animal blood, eggs, fish, shrimp, snake meat, soy products, potatoes, beef, chicken, and cow's kidney meat in moderation, which are rich in histidine, arginine, nucleic acids, and collagen.

　　What foods should Kaplan syndrome patients avoid:

　　1. Reduce the intake of dairy products such as milk and goat milk, peanuts, chocolate, millet, cheese, and sugar, which contain tyrosine, phenylalanine, and tryptophan.

　　2. Reduce the intake of fatty meat, high animal fat, and high cholesterol foods. Reduce the intake of sweets.

　　3. Reduce the intake of alcohol and coffee, tea, and other beverages.

　　Traditional Chinese medicine treatment for Kaplan syndrome:

　　1. Acupuncture: There are reports that acupuncture therapy can alleviate pain in RA patients, reduce erythrocyte sedimentation rate, and help improve function and return to work, but there are also ineffective cases. Some scholars suggest that for RA patients who are difficult to treat and have not received acupuncture treatment before, they should try treatment with qualified acupuncturists.

　　2. Massage: Acupoint massage as an auxiliary therapy for pain relief and reducing muscle tension is commonly used in clinical practice.

　　3. Qigong: Practice relaxation exercises and use positive self-hypnosis to reduce pain and recover health, which has certain effects on physical and mental relaxation, alleviating pain symptoms, improving self-perception, saving energy consumption, replenishing vital energy, and enhancing physical fitness.

　　4. Tai Chi: Practice simplified Tai Chi, or even use only some simple movements, and pay attention not only to physical exercise but also to mental exercise, which is conducive to relaxation and cultivating a tranquil state of mind and self-cultivation, promoting overall health through mental health.

　　5. Relaxation therapy and mental health: Physical and mental relaxation helps reduce the self-perception and response to pain. Studies have shown that using Chinese relaxation exercises or using electromyographic biofeedback to guide muscle relaxation and mental relaxation can alleviate pain. In recent years, there have been reports that after RA patients appreciate relaxing music, their joint pain threshold increases and pain can be reduced. If RA patients have pain or recurrent illness that affects their mental and psychological state, leading to symptoms such as depression and anxiety, it is advisable to undergo psychological counseling and cognitive-behavioral therapy to reduce the self-perception of pain, change the perception of pain, and improve their sense of well-being and health.