This doctor is great

Chapter 232 The Notorious Psoriasis? (two in one)

Zhang Mei and Zhou Mo heard the patient's description,
I felt that the patient was probably not gout, but a disease such as rheumatoid arthritis, which caused severe joint pain.

Rheumatoid arthritis is an autoimmune disease that causes a disorder of the own immune system.

At this time, your own immune system, regardless of whether it is an enemy or an enemy, will attack your own joints foolishly.

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

If the degree of erosion is high, it may lead to joint deformity in the worst case.

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

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

——X film, one of the inspection methods that can check joint lesions, is less effective than B-ultrasound and MR, but it is cheaper and faster.

As for the gout test,
Blood is usually drawn to check fasting blood uric acid levels.Gout can be diagnosed as long as the blood uric acid in men is >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 him is not fasting, so he can't do a blood uric acid test.

Teacher Zhang Mei said: "The radiology department is off work now, so there is no way to give you an X-ray. You can do it tomorrow...you can only draw blood..."

In fact, there will be doctors on duty in the 24-hour radiology department of the hospital, but generally it is not particularly urgent, and no filming will be arranged.

"Can't take it? Then can I use the X-ray I took last time?"

"how long?"

"2 months ago."

"let me see……"

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

"can."

"Then give me pain relief and draw blood."

"it is good."

Prescribe medicine.

To get medicine, draw blood.

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

Soft tissue swelling, osteoporosis, subchondral sclerosis and/or cystic degeneration of the articular surface, aggressive bone destruction can be seen after the disease progresses...

Judging 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 it doesn't look like gout."

Teacher Zhang Mei: "Just wait for the result."

Waited for over an hour,

The result came out.

——Rheumatoid factor, negative!
Zhang Mei: "..."

Zhou Mo: "..."

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

The patient's rheumatoid factor was negative.

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

However, it is not necessarily true for patients with rheumatoid arthritis that the test results are all positive.

Forget it, this patient, both of them are uncertain.

Let the patient go to the immunology department.

……

……

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

After the chief physician saw the X-ray and the results of the rheumatoid factor test,
"Although the rheumatoid factor is negative, rheumatoid arthritis cannot be ruled out 100%..."

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

"Since your symptoms are more serious, I suggest that you be hospitalized and check carefully!"

"In addition, don't underestimate rheumatoid arthritis. Although it doesn't sound serious, this disease is not a minor disease, except that it causes joint pain and swelling."

"It may also cause lesions in your respiratory system and circulatory system, leading to pulmonary fibrosis, and may also cause anemia."

"Your blood routine, hemoglobin is not enough, anemia, so there is a possibility of rheumatoid arthritis."

In order to arouse the patient's attention, the chief physician spoke out the serious consequences of rheumatoid arthritis in one breath.

Hearing this, the patient's cold sweat flowed down directly, soaking his forehead.

"Okay, I'm hospitalized!"

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

……

An hour later, in the ward of the hospital.

The patient lay on the bed and felt much more comfortable.

Although it wasn't long before he took the medicine, he felt that his joint pain had been significantly relieved.

"This time I really found the right person."

"It's just that the doctors in the big hospitals are reliable, and they found the root cause of the disease in one go."

The patient sighed in his heart, feeling that the hospital really didn't come in vain this time.

Lie comfortably on the bed, took out the phone and started the billiard game.

Although there is no way to go to the pool hall to play, but you can first come to the Internet to relieve your addiction.

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

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

He sat up suddenly, scratched his skin, and then found that the itching was getting worse.

I found that my skin actually had some red rashes.

Some of the red rash parts also expanded into red plaques with abnormal itching.

"It's not a drug allergy, is it?"

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

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

"what happened?"

Within a few minutes, a fat female nurse walked in.

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

As he spoke, the patient raised his hand to let the nurse see the erythema on his body.

"I took some rheumatoid medicine today, and I wonder if it might 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.

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

"Okay. Okay."

Not long after,
The patient felt that the itching on his body was getting heavier and 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 stop her.

"Doctor, I don't want to scratch, but it's too itchy, I can't bear it." The patient frowned tightly, with a painful expression on his face.

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

"what's the situation."

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

As he spoke, the patient pointed to the red spots on his body.

"Is it a drug allergy?"

Dr. Chen on duty was a little skeptical, thinking that it might be a drug allergy, in which case he needed to reduce the dosage or change to other drugs.

Thoughts surged in his mind, and he carefully observed the patient's skin condition while thinking.

The red plaques on the patient's body were found to be desquamated.

"and many more……"

Desquamation?

The face of Doctor Chen on duty changed, and he secretly thought that something was wrong.

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

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

Seeing this, Doctor 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 my medicine does work."

Hearing this, the patient was stunned, his eyes widened, and he couldn't believe his ears.

"If it's not rheumatoid arthritis, then why is the drug used to treat rheumatoid arthritis, and the symptoms are relieved."

"It doesn't make any sense at all."

"Your rash is not an allergy. There is no allergy like this."

"And the most important thing is that allergic skin 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 confused.

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 it as a very typical psoriasis at a glance."

"And you also have a rash on your head, which is very obvious."

As he spoke, Doctor Chen on duty sighed slightly, with a complex look on his face.

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

"Instead of plain rheumatoid arthritis."

Doctor Chen on duty spoke more and more slowly.

"There are several types of psoriasis, and the most common is psoriasis vulgaris, which generally means uncomfortable skin."

"But in addition, a small number of patients have joint pain at the same time. We call this joint disease arthritic psoriasis."

"More importantly, the rheumatoid factor is negative for arthritic psoriasis!"

After the words fell, Doctor Chen on duty showed a look of pity.

Arthropathy-type psoriasis like this is more painful for patients, because in addition to skin itching, joint pain will also appear.

And now the patient is very likely to be arthropathic psoriasis.

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

Doctor Chen on duty also sighed heavily.

"Most patients with arthritic psoriasis have a rash followed by arthritis."

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

Doctor Chen on duty explained softly.

"It's very unlikely that a person will have both psoriasis and rheumatoid arthritis because the odds of having both autoimmune diseases are so low."

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

"Combined with your previous performance, I think you have arthritic psoriasis, not rheumatoid arthritis."

After an explanation, Dr. Chen on duty came to a conclusion.

Hearing the explanation of Dr. Chen on duty, the patient believed most of it in his heart, but still had some doubts.

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

There is still a fluke mentality in the patient's heart, and he still does not believe that he is psoriasis.

The main reason is that psoriasis has such a deep reputation among ordinary people that it is even rumored that it is an immortal cancer, which makes people frightened.

If he really got psoriasis, he would probably be miserable for the rest of his life.

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

"And coincidentally, rheumatoid arthritis is also an autoimmune disease, which means that both diseases are related to the body's autoimmune disorders."

(Actually, the cause of these two diseases has not been clarified. It may be that the same gene fragment is expressed.)
"And the medicine I gave you happened to have a certain immune-altering effect, so it relieved the symptoms of arthritis by accident."

As he spoke, Doctor Chen on duty let out a breath of foul air, with a complicated expression on his face.

"But for the treatment of the rash, this medicine is useless, and further examination is needed."

"In this way, the nurse will do 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 test results, and cannot be concluded solely by the doctor's experience and judgment.

"Okay, let's do a check."

The patient also responded.

He still has a fluke mentality in his heart. After all, Dr. Chen on duty has misdiagnosed him once before, and it is not impossible to misdiagnose him again.

It is better to check it, 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 it was a pity.

Judging from the results of the patient's examination, it is confirmed that it is [-]% psoriasis.

The patient is not only scaly, but also may have arthropathic psoriasis.

Arthropathy-type psoriasis is no less severe than rheumatoid arthritis at all, and joint deformities will also appear if regular treatment is not received for a long time.

I heard the words of Dr. Chen on duty.

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

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

"Doctor, how did I get this disease?"

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

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

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

"There are many factors that can trigger psoriasis, such as infection, stress, alcohol and smoking, etc."

As he spoke, Doctor Chen on duty shook his head slightly.

Even now science and medicine are developing rapidly.

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

Human beings are still a little too small in the face of diseases.

Thinking of this, Doctor 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 slightly again.

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

After a pause, he added.

"After all, the cause of the disease has not been clarified yet, so how can we talk about cure? Are you right?"

The patient's face was pale and he lay motionless on the bed.

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

He has an incurable disease.

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

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

"However, through appropriate drug treatment, controlling one's behavior, not smoking or drinking, maintaining a happy mood, etc."

"A considerable number of patients can live a normal life with remission."

"That is to say, you can cooperate with our hospital's treatment without affecting your work and life. There is no big difference from normal people."

"By the way... Regarding the treatment of psoriasis, a new biological agent has recently been launched. Although it cannot be cured, the control effect is very good."

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

At this time, Doctor Chen on duty said suddenly.

He just remembered it.

This medicine is relatively expensive, about [-] to [-] for a single dose, at least three or four times a year.

That is to say, the annual medication is about 10 yuan.

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

Because now many people’s wages are more than 3000 yuan a month, and more than 3 yuan a year without food or drink, and the cost of about [-] yuan a year is too high.

…………

ps: This case is over.It doesn't feel well written, it's a bit messy.In the next few cases, let’s take a look at the diseases of gout and rheumatism.

.

(End of this chapter)