This Doctor is Great

Zhang Mei and Zhou Mo heard the patient's description,

I feel that the patient is likely not to have gout, but a disease like rheumatoid arthritis, which causes severe joint pain.

Rheumatoid arthritis is an autoimmune disease that causes a disorder of one's own immune system.

At this time, your own immune system, regardless of enemy or foe, will foolishly attack your own joints.

Under the attack of the immune system, the main symptom is the erosion of symmetrical joints.

If the degree of erosion is high, the most serious may lead to joint deformity.

"Draw blood for a test, rheumatoid factor... In addition, take an X-ray of the joint."

- Rheumatoid factor, if positive, it can prove to be rheumatoid arthritis.

——X-ray, one of the inspection methods for checking joint lesions, is a little less effective than B-ultrasound and MR, but it is cheaper and faster.

As for gout check,

Usually blood is drawn to check the fasting blood uric acid level. Gout can be diagnosed as long as the male serum uric acid is greater than 420 μmol/L (7 mg/dl). (This value can be lower, and it has a certain relationship with blood pH and temperature.)

But obviously, the patient in front of me is not fasting, so there is no way to do a blood uric acid test.

Teacher Zhang Mei said: "The radiology department is off work now, so I can't give you X-rays. You can do it tomorrow... You can only draw blood..."

In fact, the radiology department of the hospital will have a doctor on duty 24 hours a day, but generally it is not particularly urgent, and no filming will be arranged.

"Can't take it? Can I use the X-film I took last time?"

"how long?"

"Two months ago."

"let me see……"

"Can you prescribe an analgesic for me?" the patient said in pain, curling up his hands and feet.

"Can."

"Then give me pain relief and blood draw."

"it is good."

Prescribe medicine.

Go get medicine and draw blood.

Teacher Zhang Mei and Zhou Mo looked at the patient's X-ray.

Soft tissue swelling, osteoporosis, and subchondral sclerosis and/or articular surface cystic degeneration, invasive bone destruction after disease progression can be seen...

From the patient's X-ray, it is likely to be rheumatoid arthritis.

Of course, it's also a bit like gout.

While the patient is away,

Teacher Zhang Mei asked Zhou Mo, "Do you think this patient is rheumatoid?"

Zhou Mo nodded: "It's possible, but gout doesn't look like it."

Teacher Zhang Mei: "Wait for the result."

Waited for over an hour,

The result is out.

- Rheumatoid factor, negative!

Zhang Mei: "..."

Zhou Mo: "..."

Rheumatoid factor is an antibody, and the vast majority of patients with rheumatoid arthritis can detect high levels of rheumatoid factor in their blood.

The patient's rheumatoid factor was negative.

This shows that there is no rheumatoid factor in the patient's blood, which goes against Zhou Mo's previous inference.

However, not necessarily patients with rheumatoid arthritis, test results are positive.

Forget it, this patient, the two of them are not sure.

Send the patient to the immunologist.

...

...

the next day,

With the results, the patient went to the outpatient department of the Department of Rheumatology and Immunology and found a director to see a doctor.

After the chief physician looked at the X-ray and the rheumatoid factor test results,

"Although it is rheumatoid factor negative, rheumatoid arthritis cannot be ruled out 100%..."

"My experience, I think it should be..."

"Since your symptoms are more serious, I suggest hospitalization, check carefully!"

"Also, don't underestimate rheumatoid arthritis. Although it doesn't sound serious, this disease is not a small disease, except that it can cause joint pain and swelling."

"It can also lead to changes in your respiratory circulatory system, leading to pulmonary fibrosis, and possibly anemia."

"Your blood routine, hemoglobin is not enough, anemia, so there may be rheumatoid arthritis."

In order to completely arouse the attention of the patient, the chief physician stated in one breath the serious consequences that rheumatoid arthritis may cause.

Hearing the cold sweat of the patient here flowed down directly and stained his forehead.

"Okay, I'm in the hospital!"

Although the patient is busy with work during this time, he still does not dare to neglect for the sake of his health.

...

An hour later, in the hospital ward.

The patient lay in bed and felt much more comfortable.

Although it was not long after taking the medicine, he felt that his joint pain had been significantly relieved.

"I really found the right person this time."

"The doctors in the big hospitals are reliable, and they can find the root cause of the disease at one time."

The patient's heart was full of sighs, and he felt that the hospital was really worthless this time.

Lying comfortably on the bed, I took out my phone and played the billiards game.

Although there is no way to go to the pool hall to play, but you can first try to solve the addiction on the Internet.

After playing a few games, the patient lay on the bed and soon fell asleep.

However, 2 hours later, the patient suddenly woke up with itching.

He sat up abruptly, scratched his skin, and found that the itch was getting worse.

I noticed some red rashes on my skin.

Some of the rashes also expanded into red patches with abnormal itching.

"Isn't this a drug allergy?"

The patient stared at the erythema on his body and muttered to himself.

Suddenly he didn't dare to neglect, and quickly contacted the nurse on duty.

"What's wrong?"

A few minutes later, a slightly plump female nurse walked in.

"Doctor, I have a lot of red spots on my body, and it's very itchy."

Saying that, the patient raised his hand to let the nurse see the erythema on his body.

"I took some rheumatoid drugs today, and I wonder if it may be a drug allergy."

"Let me see!" The nurse carefully looked at the red plaque on the patient's body.

After thinking for a while, she decided to contact the doctor for a solution.

"Wait a moment, I'll contact your doctor, and let him come over to help you deal with it later."

"Okay. Okay."

Soon,

The patient felt that the itching on his body was getting heavier and he couldn't help scratching it twice with his hands.

"Don't scratch, it's easy to cause cross-infection."

Nurse Li stretched out her hand to block the road.

"I don't want to scratch it, but it's so itchy that I can't help it." The patient frowned and said in pain.

Soon, Dr. Chen on duty opened the door and walked in.

"what's the situation."

"I was woken up by itching when I was just sleeping, and I saw a lot of red patches on my body."

Said the patient pointed to the red plaque on his body.

"Is it a drug allergy?"

Dr. Chen on duty had some doubts in his heart, and felt that it might be a drug allergy. In that case, the dosage would need to be reduced or another drug should be replaced.

Thoughts surging in his heart, while thinking, carefully observe the patient's skin condition.

It was found that the red plaques on the patient's body had the performance of desquamation.

"and many more……"

desquamation?

Doctor Chen's expression changed, and he secretly thought that it was not good.

He felt that his teacher was probably misdiagnosed, and the patient might not be rheumatoid arthritis.

Thinking of this, he hurriedly removed the patient's hair, and found that the patient's hair was also damaged.

Seeing this, Dr. Chen on duty can basically conclude that he was indeed misdiagnosed.

"The joint pain in your body isn't gout, and it probably isn't rheumatoid arthritis."

"It's not rheumatoid arthritis, but this medicine does work for me."

Hearing this, the patient was stunned, staring, and some did not believe his ears.

"If it wasn't for rheumatoid arthritis, then why the medication for rheumatoid arthritis, the symptoms were relieved."

"That makes no sense at all."

"Your rash is not an allergy, how can there be allergies like this."

"And the most important thing is that allergic rashes are impossible to desquamate. You have made it clear that it is psoriasis, which is what people often call psoriasis."

"How could I have psoriasis? Impossible."

When hearing about psoriasis, the patient is still a little unclear.

However, when he heard the three words psoriasis, he immediately panicked.

As far as he knows, the disease is very difficult to cure.

"Your rash, although I am not a professional dermatologist, I can recognize at a glance that this is a very typical psoriasis."

"And you've got a rash on your head, so that's pretty obvious."

Saying that, Doctor Chen on duty sighed slightly, with a complicated look on his face.

"Also I suspect that your arthritis may also be caused by psoriasis."

"Not regular rheumatoid arthritis."

Doctor Chen on duty kept talking more and more slowly.

"There are several types of psoriasis, the most common being psoriasis vulgaris, which is generally an uncomfortable skin condition."

"But in addition to that, there are a small number of patients who also have joint pain, which we call joint psoriasis."

"More importantly, arthropathy-type psoriasis, rheumatoid factor negative!"

The voice fell, and Doctor Chen on duty showed a look of pity.

Arthropathic psoriasis, like this, is more painful for the patient, because in addition to itchy skin, there will be pain in the joints.

And now the patient, there is a high possibility of arthropathy-type psoriasis.

Hearing the words of Dr. Chen on duty, the patient felt that all his symptoms were in line with his current symptoms, and all his thoughts were lost.

Doctor Chen on duty also sighed heavily.

"Most patients with arthropathy-type psoriasis have a pre-existing rash followed by an arthritic manifestation."

"However, a small number of patients also have the reverse, with arthritis first, then rash, and there are cases of simultaneous occurrence."

Doctor Chen on duty explained softly.

"The odds of a person having both psoriasis and rheumatoid arthritis are minimal, because the odds of having both autoimmune diseases at the same time are so low."

"However, a person with arthritic psoriasis, which has joint and then skin lesions, is much more likely to have both psoriasis and rheumatoid arthritis."

"Combining with your previous performance, I think you have joint psoriasis, not rheumatoid arthritis."

After explaining it, Dr. Chen on duty came to a conclusion.

Hearing the explanation from Dr. Chen on duty, the patient had already believed most of them, but he still had doubts.

"But doctor, after I took the medicine you gave, my joints don't hurt so much."

There is still a fluke in the patient's heart, and he never believes that he is psoriasis.

Mainly because the notoriety of psoriasis among the common people is too deep, and it is even rumored that it is an immortal cancer, which is frightening.

If he really got psoriasis, it is estimated that he will not be able to live in peace for the rest of his life.

"You have to know that psoriasis, or psoriasis, is an autoimmune disease."

"It just so happens that rheumatoid arthritis is also an autoimmune disease, which means that both diseases are related to the body's autoimmune disorder."

(In fact, the cause of these two diseases is not clear, and it is possible that the same gene segment is expressed.)

"And the medicine I gave you just happened to have the effect of changing the immune system, so the symptoms of arthritis were relieved by yin and yang."

Speaking of which, Dr. Chen on duty let out a sigh of relief, with a complicated expression.

"But for the treatment of rashes, this medicine has no effect, and further examinations are needed."

"That way, the nurse does a dermoscopy for the patient."

Doctor Chen on duty said softly.

Although according to the current judgment, the patient is likely to have psoriasis.

However, the final conclusion should be determined according to the examination results, not only by the doctor's experience and judgment.

"Okay, let's do an inspection then."

The patient should also come down.

He still has a fluke mentality in his heart. After all, Dr. Chen on duty has misdiagnosed once before, and it is not without the possibility of misdiagnosis again.

Or check it better, in case it is misdiagnosed again?

The patient's test results came out soon.

"It's over."

Doctor Chen on duty looked at the test results and secretly said that it was a pity.

Judging from the patient's examination results, it is 100% psoriasis.

The patient is not only scaly, but also may have arthropathy-type psoriasis.

Arthropathy-type psoriasis is not at all lighter than rheumatoid arthritis, and joint deformities will also occur if regular treatment is not received for a long time.

I heard the words of Dr. Chen on duty.

The patient's face suddenly became silent, and his eyes became a lot duller.

Unexpectedly, after going around for a few months, the joint pain turned out to be caused by psoriasis.

"Doctor, how did my disease come about?"

The patient looked up and asked, wondering how he got the psoriasis.

"The etiology of psoriasis is unknown, and so far there is no conclusive conclusion in the medical community."

"Considering that it is likely to have a certain relationship with genetic factors and the environment."

"Many factors can trigger psoriasis, such as infections, stress, alcoholism and smoking, etc."

Saying that, Dr. Chen on duty gently shook his head.

Even now science and medicine are developing rapidly.

However, the cause of many diseases cannot be determined, let alone cured.

Humans are still a little too small in the face of disease.

Thinking of this, Dr. Chen on duty shook his head.

"Then can my psoriasis be cured?"

After hearing that the cause could not be determined, the patient raised his head and continued to ask.

Doctor Chen on duty shook his head again.

"If any hospital can tell you that it can be cured, it's all a scam, you can call the police directly."

After a pause, he added.

"After all, we haven't figured out the cause yet. How can we talk about cure? Are you right?"

The patient was pale and lay motionless on the bed.

All the fantasies he had in his heart before were broken by Dr. Chen on duty at this moment.

He has an incurable disease.

Looking at the patient who had lost his fighting spirit, Dr. Chen on duty couldn't help comforting him.

"Don't be too pessimistic, although there is no cure for psoriasis right now."

"However, with appropriate medication, controlling your behavior, not smoking, not drinking, staying in a good mood, etc."

"A considerable number of patients can relieve their condition and lead a more or less normal life."

"That is to say, if you cooperate with our hospital's treatment, you can also not affect your work and life, and it is not much different from normal people."

"By the way... about the treatment of psoriasis ~www.readwn.com~ recently launched a new biological agent. Although there is no way to cure it, the control effect is very good."

"It's called a monoclonal antibody, which can saturate a certain factor in the pathogenesis of psoriasis, and the effect is particularly good."

At this time, Dr. Chen on duty suddenly said.

He just remembered it.

This medicine is relatively expensive. It is about 20,000 to 30,000 yuan for one time, at least three or four times a year.

That is to say, the drug is about 100,000 yuan a year.

This amount of money is a very large expense for ordinary families.

Because many people's salary is more than 3,000 yuan a month, and a year without food or drink is more than 30,000 yuan, and the cost of about 100,000 yuan this year is really too high.

…………

ps: This case is over. I don't feel like it's written well, it's a bit messy. In the next few cases, take a look at diseases such as gout and rheumatism.

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