内科学教学课件：Rheumatology

Rheumatology101ContentsWhat

isrheumatology?1Howtodiagnose

arheumaticdisease2Medication

forrheumaticdiseases3Opportunitiesandchallenges4WhatisrheumatologyTheterm''rheumatology''originatesfromtheGreekword''rheuma'',meaning"thatwhichflowsasariverorstream“.

Rheumaticdisorderswereattributedtohumorsthatflow(rheuma)throughthebodytosettleinjointsandcausearthritis.Thespecialtyofrheumatologycaresforpatientswithalltypesofarthritisandsystemicautoimmunediseases.WhatisrheumatologyRheumaticdiseasesareadiversegroupofsyndromesthatmostfrequentlyincludepainandinflammationinthejointsandconnectivetissues.

Theyareoftenreferredtoas“collagen-vasculardiseases”becausethetissuesmostfrequentlyaffectedbytheimmuneandinflammatoryprocessesarethoserichincollagenandconnectivetissuesaswellasbloodvessels.Manyrheumaticdiseasesareconsideredautoimmunediseases.WhatarerheumaticdiseasesSystemicconnectivetissuediseasesRA,JIA,lupus,scleroderma,PM/DM,vasculitis,SS,MCTD,etc.ArthritisSpondyloarthropathiesAS,reactivearthritis,psoriaticarthropathy,enteropathicarthropathyOsteoarthritisCrystal-associatedarthropathiesgout,psudogout,etc......SystemiclupuserythematosusOralulcerAlopeciaHairlossDiscoidrashMalarrashRheumatoidarthritisUlnardeviationdeformityFusiformswellingAnkylosingspondylitisSclerodermasclerodactylyRaynaud’sphenomenonDermatomyositisHeliotroperash,eyelidGottron’ssignGoutTophiDiagnosearheumaticdiseaseSystemicconnectivetissuediseasesRheumaticdiseasesJointdiseasesMultipleorganinvolvementJointpain,swelling,Stiffness,anddifficultyinmovementSymptomsDiagnosearheumaticdiseaseLabs:Routines:CBC,Urine,ESR,CRP,Ig,Complement,etcAutoantibodies:ANA,ENA,aCL,LA,anti-dsDNA,ANCA,RF,anti-CCP,etcDiagnosearheumaticdiseaseANAs(antinuclearantibodies)areautoantibodiesthatbindtocontentsofthecellnucleus.ENAs(Extractablenuclearantigens)areagroupofautoantigensthatwereoriginallyidentifiedasantibodytargetsinpeoplewithautoimmunedisorders.TheyaretermedENAbecausetheycanbeextractedfromthecellnucleuswithsaline.TheENAsconsistofribonucleoproteinsandnon-histoneproteins,namedbyeitherthenameofthedonorwhoprovidedtheprototypeserum(Sm,Ro,La,Jo),orthenameofthediseasesettinginwhichtheantibodieswerefound(SS-A,SS-B,Scl-70).DiagnosearheumaticdiseaseDiagnosearheumaticdiseaseaCLanticardiolipinantibodiesLALupusanticoagulantsDiagnosticforAntiphospholipidsyndromeANCAAntineutrophilCytoplasmicAutoantibody(vasculitis)RF,anti-CCPdiagnosticforRADiagnosearheumaticdiseaseJointfluidanalysisisanalyzedintheevaluationofjointinflammation,swelling,pain,andfluidaccumulation.Theresultsmayrevealinfectiousdiseases,bleedingdisorders,inflammatorydiseases,ordegenerativediseases.CrystalsinjointfluidcanhelptodiagnoseGout(monosodiumurate(MSU)orpseudogout(calciumpyrophosphatedihydrate(CPPD)).

MedicationforrheumaticdiseasesNon-SteroidalAnti-InflammatoryDrugs(NSAIDs)NonselectiveCyclooxygenase(COX)-2SelectiveSteroidsImmunosuppressant&DMARDsMethotrexateAzathioprine,leflunomide,Mycophenylatemofetil,Cyclophosphamide,Cyclosporin,FK506AntimalarialdrugshydrochloroquineBiologicsBiologicsTumorNecrosisFactor(TNF)-ainhibitorsMonoclonalantibodiesagainstTNF-α(infliximabadalimumabcertolizumabpegoletc)Solublereceptor-Igfusion(Etanercept)MonoclonalantibodyagainstIL-6RInterleukin(IL)-1receptorantagonistanti-Bcell(CD20;Blys)therapyInhibitorsofcostimulation(CTLA4-Ig;i.e.Abatacept)