类风湿关节炎RheumatoidArthritis(RA)ppt课件

1、 郑州大学第一附属医院 类风湿关节炎Rheumatoid Arthritis (RA)By Raoul Dufy (1877-1953).OutlineDefinition and historyPrevalanceEtiology,pathogenesis and pathologyClinical featuresLaboratory findingsImagingDiagnosis and differential diagnosisManagement .RA定义An autoimmune disorder of unknown etiology characterized by sy

2、mmetric, erosive synovitis and, in some cases, extraarticular involvement. Most patients experience a chronic fluctuating course of disease that, despite therapy, may result in progressive joint destruction, deformity, disability, and even premature death-2003, American college of Rheumatology.Medic

3、ine as an artThe holy family with St. Anne(C1633C1635) by Peter Paul Rubens历史.History :Pierre-Auguste Renoir (1841-1919)On the Terrace (1878)By Pierre-Auguste Renoir.历史： Erik WaalerErik WaalerThe occurrence of a factor in human serum activating the specific agglutination of sheep corpuscles. Acta Pa

4、thol Microboil Scand 1940; 1: 172-88.Genetic Factors in RADRB1.Virus-infection Hypothesis.Sex Hormone on RA.Rheumatoid Pannus血管翳.Pannus 血管翳.Rheumatoid Arthritis: Hand, Fusiform Swelling梭形.Ulnar尺侧 Deviation and Muscle Atrophy.Swan Neck Deformity and Boutonnire Deformity钮扣花.Telescoping Sign.Arthritis

5、Mutilans残毁.Arthritis Mutilans.Hypermobility .Arthritis Mutilans.Subcutaneous Nodule, Olecranon鹰嘴.Rheumatoid Nodules.Rheumatoid Nodules in the Lung.Rheumatoid Nodule: Pathology.Scleromalacia Perforans穿孔性巩膜软化.Vasculitis and Gangrene坏疽.Extensor Tendon Rupture.Popliteal Cyst腘窝囊肿.Progressive Right PIP3 E

6、rosions in a 60-year Old Lady Suffering From RA3/19893/198911/19903/199211/19931/19956/1996.Right Wrist in the Same Patient3/198911/19903/199211/19931/19956/19963/198911/19903/199211/19931/19956/1996.Rheumatoid Arthritis: Knees.Hip, Late Erosions.Protrusio Acetabuli髋臼突出.患病率.病因 遗传要素感染要素内分泌要素.发病机理.病理S

7、ynovitis(滑膜炎VasculitisRheumatoid nodules.临床表现关节表现晨僵Morning stiffness关节痛Arthralgia 和关节压痛 tenderness关节肿 Joint swelling 关节变形 Joint deformity关节外表现A Picture is Worth a Thousand Words.关节外表现类风湿结节 Rheumatoid nodule类风湿血管炎 Rheumatoid vasculitis类风湿肺病变 Lung diseases枯燥综合征 Sjogrens syndrome心包炎 Pericarditis肾病变 Kid

8、ney diseasesA Picture is Worth a Thousand Words.实验室检查血液学异常血小板数增多炎症目的:血沉增快C反响蛋白程度升高类风湿因子 Rheumatoid factorRF抗CCP抗体.RF = RA?CategoryDiseasesRheumatic diseasesRA, SLE, scleroderma, sjogrens syndromeViral infectionsAIDS, Hepatitis, influenza, after vaccinationChronic bacterial infectionsTuberculosis, le

9、prosy, syphilis, subacute bacterial endocarditis,NeoplasmsAfter irradiation or chemotherapyOthersChronic liver or lung disease.放射学检查确立诊断 监测疾病开展监测药物治疗效果.鉴别诊断血清阴性脊柱关节病骨关节炎系统性红斑狼疮SLE风湿热Rheumatic fever.72岁女性，双膝关节痛10余年，双手指关节肿痛8个月。膝痛以上楼时为重，劳累可以诱发。近8个月来双手近端指间关节、远端指间关节疼痛明显，天气变化时加重。晨僵半小时。查血ESR 24mm/h, RF。血常规

10、正常。.处置The ultimate goals are to:Prevent or control joint damagePrevent loss of function Decrease pain.治疗方法非药物治疗药物治疗外科治疗.治疗药物种类改动病情抗风湿药 Disease Modifying Anti-rheumatic Drugs (DMARDs)糖皮质激素Glucocorticoids非甾体抗炎药Nonsteroidal Anti- Inflammatory Drugs (NSAIDs)生物制剂Biologic agents抗生素 Antibiotics？.改动病情抗风湿药(DMARDs)甲氨蝶呤 Methotrexate MTX来氟米特 Leflunomide柳氮磺吡啶 Sulfasalazine金制剂 Gold, oral or intramuscular硫唑嘌呤 Azathioprine青霉胺 D-penicillamine环孢素 Cyclosporine.目前观念一切RA患者均应采用DMARD治疗首选MTX. 严重RA患者可采用DMARD结合治疗，但方案中应包含MTX病症缓解不等于治愈.Biologics in the treatment of RA.小剂量糖皮质激素每天不超越10mg的泼尼松:有效缓解病症能够减慢关节