Rheumatoid arthritis renal damage

　　The etiology of this disease is not yet clear, and it may be related to infectious factors (such as EB virus, mycoplasma, etc.) and genetic susceptibility. The incidence rate of patients with positive white blood cell antigen (HLA)-DR4 is 3 to 4 times higher than that of normal people. Some amino acid sequences of HLA-DR4 are similar to gene fragments of pathogens (EB virus), so HLA can act as a receptor for pathogens or autoantibodies, and be damaged by immune injury, stimulating B lymphocytes to produce rheumatoid factors (antibodies in the IgGFc segment). The rheumatoid factor of IgG binds to autoantigens to form in situ or circulating immune complexes, activate cell immunity, release a large number of cytokines (such as IL-1, IL-6, tumor necrosis factor TNF-α, etc.), causing synovitis of joints, gradually destroying articular cartilage, leading to osteoporosis, bone destruction, and ligament sclerosis, ultimately resulting in joint deformity and disability.

　　This disease often leads to involvement of multiple organs, with the main complications being joint destruction and deformation, the appearance of subcutaneous nodules of varying sizes at the joint prominences; involvement of the central nervous system can cause acute or chronic cerebral infarction or hemiplegia. Patients often suffer from multiple mononeuritis, subcutaneous infarction, pulmonary effusion, pancreatitis, intestinal bleeding, severe renal insufficiency, and most patients with this disease die from disseminated intravascular coagulation (DIC).

　　Rheumatoid arthritis renal damage has a history of chronic and recurrent joint synovitis, characterized by fever, redness, swelling, deformation, and dysfunction of the limbs and joints. Some patients experience an exacerbation of renal damage quickly when taking non-steroidal anti-inflammatory drugs or gold preparations, presenting with nephrotic syndrome, chronic nephritis syndrome, or even acute renal failure. If the medication is stopped promptly and appropriate treatment is initiated early, the condition can be restored to a better state. Some patients develop direct chronic renal damage or concomitant renal immune damage after long-term use of these drugs, which can lead to varying degrees of proteinuria and microscopic hematuria. Some patients may experience edema, hypertension, and renal damage. Increased nocturia often indicates severe renal damage in patients with chronic interstitial nephritis, secondary renal amyloidosis, or necrotizing vasculitis, which often progresses to chronic renal failure.

　　Rheumatoid arthritis is a systemic disease mainly characterized by joint inflammation. The renal damage in rheumatoid arthritis is mainly caused by chronic inflammation and the toxicity of drugs used to treat rheumatoid arthritis. Although the exact cause of rheumatoid arthritis is still unknown, it is important to have the concept of prevention being better than treatment. Effective prevention of rheumatoid arthritis can prevent the occurrence of renal damage.

　　1. Strengthening physical exercise: Regularly doing physical exercises, practicing Qigong, Tai Chi, or walking can enhance resistance and reduce the likelihood of illness.

　　2. Avoiding colds and dampness: Try to avoid catching a cold, being drenched in the rain, or getting damp. For example, do not wear wet clothes, shoes, or socks, do not live in overly damp places, and do not drink cold water excessively.

　　3. Avoiding overexertion: In addition to maintaining a balanced diet, one should try not to overwork to prevent diseases. Understand the importance of a moderate balance between work and leisure.

　　4. Maintaining a cheerful mood: Patients with rheumatoid arthritis sometimes suffer from this condition due to psychological or spiritual stress or excessive sadness, so mood regulation is very important.

　　5. Preventing and controlling infections: Rheumatoid arthritis often occurs after infections such as tonsillitis, sinusitis, or dental caries, so it is important to prevent various diseases and treat them early once they occur.

　　The diagnosis of rheumatoid arthritis kidney damage generally requires the following examination measures, which patients can refer to.

　　First, laboratory tests

　　1. Urinalysis shows varying degrees of proteinuria or hematuria.

　　2. Renal function tests are normal or have varying degrees of abnormalities, with chronic interstitial nephritis mainly characterized by urinary concentrating dysfunction.

　　3. Erythrocyte sedimentation rate is fast, rheumatoid factor is positive, and in a few patients, serum complement C3 decreases.

　　4. Renal biopsy can determine the nature and extent of the lesion.

　　Second, blood tests

　　1. Serum rheumatoid factor (RF) has 3 types of RF: IgG, IgM, and IgA. The latex agglutination method currently used detects IgM RF, with 50%-80% positive in the active phase and a low positive rate in the remission phase.

　　2. In the active phase, C-reactive protein is positive and erythrocyte sedimentation rate is accelerated.

　　3. In some RV patients, serum ANCA may be positive, with P-ANCA as the target antigen or other antigens.

　　4. Joint fluid examination shows cell count of 2000-75000/mm³, mainly neutrophils, with low viscosity.

　　Some foods are beneficial for alleviating arthritis symptoms, such as vegetables and fruits, which can meet the body's needs for vitamins, trace elements, and fiber, and at the same time have the function of improving metabolism, can play a role in clearing heat and detoxifying, reducing swelling and pain, thereby helping to alleviate arthritis symptoms. Foods such as yam, broad bean, tofu, celery, bitter melon, luffa, and mushrooms, black fungus, etc., can help alleviate local redness, swelling, heat, and pain symptoms, and patients can eat more appropriately.

　　The treatment of this disease mainly focuses on the treatment of the primary disease. For associated kidney damage, such as proteinuria caused by gold preparations or penicillamine and other drugs, it is necessary to stop using them. For amyloidosis, the efficacy of corticosteroids is poor, controlling the inflammatory response can alleviate symptoms, and reduce proteinuria. Severe kidney lesions caused by rheumatoid vascular inflammation require active treatment with hormones and cyclophosphamide. For chronic renal insufficiency and other severe kidney damage that has become irreversible, dialysis treatment should be performed.