类风湿性关节炎的一般常见症状诊断.doc

Rheumatoid arthritis of the common symptoms diagnosisReprinted annotated 1 Department of pharmacology Suzhou Health College test 09 test three 1 class 37090033 Suqian North Hospital included therheumatoid arthritis a disease name in 1858 by British physician Garrod first use. In 1896 Schaefer and Raymond the disease is independent of disease from the same year Steele on children of the rheumatoid arthritis was described in detail. In 1931, Cecil and the others find rheumatoid sera from patients with streptococcal agglutination rate is very high from 1940 Waller found rheumatoid factor. In 1945 1961 Sloven Carville, were presented with rheumatoid with pathogenesis of allergic reaction from its theory and determine. In 1941 the United States formally used rheumatoid arthritis disease. At present, except in Britain, from the United States to use rheumatoid arthritis disease outside France, Belgium, from Holland called the progression of chronic polyarthritis. Germany, Czech and Romania, known as the primary chronic polyarthritis by the former Soviet Union called infectious nonspecific arthritis by Japan is called chronic joint disease. Morning stiffness in rheumatoid arthritis symptoms from the first morning patients will find the joint of inflexible from get up morning stiffness decreased or disappeared after. At the same time, the patient will appear in joint swelling and pain may also occur from weakness, fatigue, and other symptoms have a fever. The results showed that rat rheumatoid arthritis diagnosis requires understanding the patient signs is more important for laboratory and inspection from even with rheumatoid arthritis and other diseases to distinguish diagnosis. Key words: rat rheumatoid arthritis rheumatoid factor rheumatoid arthritis laboratory examination of rheumatoid arthritis and rheumatoid from RA exergy is a etiology has not been clear chronic systemic inflammatory disease from chronic, symmetry, multiple synovial arthritis and joint lesions as the main clinical manifestations of autoimmune inflammatory diseases from. The disease occurs in the hand, wrist, foot and other small joints from repeated attacks from a symmetrical distribution. Early joint swelling heat pain and dysfunction from advanced joint can be different degrees of deformity and stiff from bone and skeletal muscle atrophy from easily disabling. From the perspective of pathological changes from rheumatoid arthritis is a major involvement of synovial later spread to the articular cartilage, bone tissue, ligaments and muscles key followed by serosa, exergy from heart, lung and ocular connective tissue extensive inflammatory disease. Rheumatoid arthritis with systemic manifestations in addition to joint lesions and from fever, fatigue, pericarditis, subcutaneous nodules, pleurisy, arteritis, peripheral neuropathy. Generalized rheumatoid arthritis in addition to joint inflammatory lesions and from extensive lesions include systemic.Detection of RF most RA patients sera containing macroglobulin antibodies from RF. RF is resistant to denaturation of IgG autoantibodies to and from human or animal degeneration IgG binding and agglutination reaction. Reality Lab determination of RF is the main method of latex agglutination from this method features simple, rapid, economic increase. About 70 90 RA in sera of patients with RF positive positive. RF RA in the detection rate and a variety of other diseases was higher than that of RF positive support from the early diagnosis of RA tendency. Although RF in patients with RA detection rate is very high but does not have the specificity from from such as lupus, rheumatoid nodules, viral infection, bacterial infection could be detected in low price from RA RF to the diagnostic difficulties. Thus RF to predict the occurrence of the disease is of little value from RF detection is not suitable as a screening of this disease in a test project. But the high titer of RF for the diagnosis of RA with relative specificity with elevated titers from RF from RF to RA in the diagnosis of specific enhancement. Rheumatoid and rheumatic concept should be distinguished. In the middle of the nineteenth Century from people often will both be confused before.With the development of science and technology from medical people on rheumatoid also recognized more and more clearly. Rheumatoid arthritis is a disease name in 1858 by British physician Garrod first use. In 1896 Schaefer and Raymond the disease is independent of disease from the same year Steele on children of the rheumatoid arthritis was described in detail. In 1931, Cecil and the others find rheumatoid sera from patients with streptococcal agglutination rate is very high from 1940 Waller found rheumatoid factor. In 1945 1961 Sloven Carville, were presented with rheumatoid with pathogenesis of allergic reaction from its theory and determine. In 1941 the United States formally used rheumatoid arthritis disease. At present, except in Britain, from the United States to use classRheumatic arthritis disease, France, Belgium, outside Holland called the progression of chronic polyarthritis. Germany, Czech and Romania, known as the primary chronic polyarthritis Soviet called infectious nonspecific arthritis Japan called chronic joint disease. Morning stiffness in rheumatoid arthritis of the first symptoms, morning patients will find joint inflexibleget up morning stiffness decreased or disappeared after. At the same time, the patient will appear in joint swelling and pain, may also appear weak, have a fever, fatigue and other symptoms. The disease is particularly easy and rheumatoid arthritis onset of confusion, the following can be distinguishedgeneral rapid onset, are sore throat, fever and increased leukocyteto extremity joints to see more, to wander the joint swelling and pain, joint symptoms disappeared and no permanent damageoften occur at the same time carditisThe serum antistreptolysin O , antistreptokinase and anti hyaluronidase were positive, but negative in RFThe preparation of salicylic acid is often rapid and significant curative effectAbout 80% of the patients with age of onset in 20 at the age of 45, to young adults, men and women for the ratio of 1 2 4. The primary is slow, with a few weeks to several months tired, weight loss, poor appetite, fever and hand and foot numbness tingling and prodromal symptoms. The subsequent occurrence of a joint pain, stiffness, swelling after joint is pain. At the beginning of may one or two joint involvement, often wandering. After the development of symmetric polyarthritis, joint involvement is usually from the distal extremities of the small joints, involvement of other joints start again. Proximal interphalangeal joint most often in children, a fusiform enlargement followed by MP, toe, knee, wrist, elbow, ankle, shoulder and hip joint. Morning joint stiffness, muscle soreness, moderate activity after rigid phenomenon can be reduced. The degree of stiffness and duration, and disease activity with the degree of disease activity, which can be used to estimate. As a result of joint pain and swelling and movement restrictions, around a joint stiffness and atrophy is increasingly significant. Even after the acute inflammation due to an intra-articular has dissipated, hyperplasia of fibrous tissue, tissue around the joints become stiff. With the development of lesions, patients with irregular fever, rapid pulse, significant anemia. Arthropathy finally become stiff and deformity of knee, elbow, wrist, fingers, are fixed in flexion. Finger often at the metacarpophalangeal joint to the outer side of subluxation, and form the characteristic of ulnar deviation deformity, the daily life of patients need help. Joint involvement were more patients are always does not leave the bed mattress, unable to move and agony. About 10% 30% patients in the joints of the bulge area, such as upper extremity of the olecranon, wrist and leg ankle and subcutaneous nodules, such as a hard rubber. Subcutaneous nodules are not easy to be absorbed, subcutaneous nodules appear usually indicates disease in severe stage.In addition a few patientsapproximately 10% in active stage of the disease lymphadenopathy and splenomegaly. Eye with scleritis, keratoconjunctivitis. Cardiac involvement with clinical manifestations are less, according to autopsy found about 35%, main effect of mitral valvular disease, caused by. Pulmonary manifestations in patients with a variety of forms, pleurisy, diffuse interstitial pulmonary fibrosis, rheumatoid pneumoconiosis. Peripheral neuropathies and chronic leg ulcers, amyloidosis, may occasionally be found. Pathogenesis is not completely clear. Rheumatoid arthritis is an environment, cells, viruses, genetic, hormonal and nervous mental state and other factors are closely related to the disease. In 1, the bacterial factors: experimental studies show that group A Streptococcus and bacteria wall peptidoglycan peptidoglycanRA may be the onset of a continuous stimulation of the originalgroup A streptococcal persist in the body become persistent antigen, stimulate the generation of antibodies, immune pathological injury and disease. The manufacture of Mycoplasma arthritis animal model and humanSimilar to RA but does not produce the exergy RA unique RF rheumatoid factor at. In RA patients the synovial fluid and synovial tissue has never been found in bacteria or bacterial antigenic material supply prompt bacteria may and RA onset but a lack of direct evidence about exergy. 2, viral factors from RA and virus exergy especially EB virus is the relationship between the domestic and foreign scholars pay attention to the problem of. Research shows that the exergy of EB virus infection induced arthritis with different RA RA patients on EB virus than normal people have a strong reactivity. In RA patient serum and synovial fluid in continuous high anti EB virus membrane antigen antibody exergy but so far in the serum of RA patients have not found EB virus nuclear antigen or antigen antibody. 3 genetic factors from the disease in certain families with higher prevalence in a population survey found that exergy exergy of human leukocyte antigen HLA -DR4 and RF positive patients about. HLA studies showed that DW4 is related to the pathogenesis of RA patients in 70%HLA-DW4 positive patients with exergy exergy is the point of the susceptibility genes in exergy therefore genetics may play an important role in the pathogenesis. 4, sex hormone from RA research shows that the incidence of male and female is in the ratio of 1 2 4 gestational disease to reduce exergy exergy pill female incidence reduction. Animal models show LEW/n female rats on arthritis susceptibility high exergy male low incidence of male rats after castration or supply with - estradiol treatment included the occurrence of arthritis cases with female rats as exergy description of sex hormones in RA play a role in the pathogenesis of. In 5, the pathogenesis is not completely clear exergy think RA is an autoimmune disease has been generally acknowledged. With HLA-DR4 and DW4 antigens were included on the external environmental conditions, bacteria, virus, neuropsychiatric and endocrine factors stimulation with higher sensitivity exergy exergy changed when attacks the body when the antigenic determinants of HLA exergy which has HLA nucleated cells become immune suppression. Because HLA gene produces portable T cell antigen receptor and antigen immunologically related to the properties of the stimuli were included when macrophage recognition exergy generated T cell activation and a series of immune mediators on the release of exergy resulting in immune response. Interactions among cells to B cells and plasma cells activated to generate a large number of immunoglobulin and rheumatoid factor RF results led to the formation of immune complexes in exergy exergy and deposits in synovial tissue on Exergy exergy generated multiple simultaneous activation of complement anaphylatoxin C3a and C5a chemokine. Local from monocytes, macrophages produced factors such as IL-1, a, tumor necrosis factor and leukotriene B4 exergy can stimulate nucleation of colostral leukocytes into the synovium. Local produce prostaglandin E2 vasodilative effect can also promote inflammatory cells into sites of inflammation can supply phagocytic immune complexes and release of lysosomal exergy including neutral protease and collagenase exergy destruction of collagen elastic fiber exergy to the synovial surface and articular cartilage damage. RF is also visible in the infiltration of the synovial membrane of the flash cell included hyperplasia of lymphoid follicles and synovial cells within exergy can also see IgG-RF complexes exergy so even if the infection factors there is no exergy can still continue to generate RF exergy lesions make response to seizures become chronic inflammation.Diagnosis and late rheumatoid patients included have appeared more joint lesions and typical deformity of exergy diagnosis more difficult. But the disease early and small joint involvement a case exergy diagnosis often have difficulty. The current supply for the diagnosis of rheumatoid arthritis exergy countries have different standards. The 1958 American College of Rheumatology proposes revised diagnostic criteria included 1 many countries adopt this standard. Introduce as follows now from 1, morning stiffness. In 2, at least one joint activities of pain or tenderness. In 3, at least one joint swelling within the soft tissue hypertrophy or effusion rather than bone hyperplasia Exergy for doctors to see.In 4, at least one other joint swelling in by doctors see two joint involvement is the interval of time should not exceed 3 months at. In 5, the symmetry of joint swelling in by doctors see simultaneously impinge on two sides of the body with a jointif violations of the proximal interphalangeal joint, metacarpophalangeal joint or metatarsophalangeal joints without completely symmetricdistal interphalangeal joint involvement can not meet this standard. 6, bone ridge or around a joint extensor subcutaneous nodules in by doctors see . In 7, the standard X-ray seeexcept bone hyperplasia external must have joint near the osteoporosis exist . In 8, rheumatoid factor positive. In 9, the synovial fluid in the mucin poor solidification. 10, has the following synovial pathological changes in three or more of the exergy obvious villous hyperplasia of synovial cell hyperplasia from surface and fence-shaped from obvious chronic inflammatory cells in primary lymphocytes and plasma cells within the infiltration and formation of lymph node from the trend surface or interstitial dense cellulose deposition from focal necrosis. 11, subcutaneous nodules in the histological change should display the center cell necrosis around palisading macrophages and hyperplasia of the outermost layer of the chronic inflammatory cell infiltration.Laboratory 1, blood cell sedimentation rate in most patients blood cell sedimentation rate increases quickly especially during acute period. 2, hemoglobin content slightly below normal advanced cases, mild anemia may occur hemoglobin content in mostly 810g. 3, antistreptolysin O in ASO , RF typical of rheumatoid factor in rheumatoid patients can appear antistreptolysin O test positive for rheumatoid factor positive. Because of rheumatoid factor itself is produced by the body in response to modified immunoglobulin G as antigen in a first due to autoantibodies in a patient with rheumatoid arthritis are found in the serum so called rheumatoid factor. The 5% 10% in normal human serum can also detect rheumatoid factor positive but with lower titers only titers in 1 64 above have 4, the diagnosis of immunoglobulin IgM examination in IgG is approximately 70% in rheumatoid patients can appear abnormal IgM IgG was. 5, joint fluid examination in the damaged joint out of joint fluid in multicomponent turbid but no bacterial joint fluid viscosity than normal for low. Microscopic examination showed no crystals in synovial fluid. 6, X in X ray plain film can be found the following changes in 1 included within the soft tissue swelling of joint capsule shadow increased exergy display. In 2 within the joint space narrowing due to a defect in cartilage involvement and exergy. In 3 departments of periarticular osteopenia exergy display around the joint bone in the trabecular thinning, atrophy and reduction. 7, other imaging CT and MRI imaging technique can be selected as appropriate especially for early case. Auxiliary examination1, are generally mild to moderate anemia included positive cells with iron deficiency anemia rack ones brains by exergy exergy can be hypochromic microcytic anemia. White blood cell count is mostly normal exergy in active stage can be increased slightly included occasional eosinophils and thrombocytosis. Anemia and thrombocytosis associated with disease activity. Most cases of erythrocyte sedimentation rate in active lesions often increased Exergy for disease activity index. Serum iron, ferritin levels often reduce. 2, lower serum albumin globulin increased exergy. Immune protein electrophoresis showed IgG, IgA and IgM increased. C reactive protein activity period can be increased. In 3, rheumatoid factor and other serological examination from rheumatoid factor including IgG RF, IgM RF, IgA RF and IgE RF and other types of exergy. Current clinical more confined to the detection of IgM-RF exergy currently widely applied is polystyrene latexExperience at LAT and sheep red blood cell agglutination test at SCAT exergy of the two methods of IgM-RF specific exergy exergy larger higher sensitivity and reproducibility of IgM-RF detection in adult patients with RA positive 3/4. IgM-RF high titer positive patients included lesion activity weighs disease progr