类风湿关节炎RheumatoidArthritis(RA)课件

类风湿关节炎RheumatoidArthritis(RA)ByRaoulDufy(1877-1953)类风湿关节炎RheumatoidArthritis(ROutlineDefinitionandhistoryPrevalanceEtiology,pathogenesisandpathologyClinicalfeaturesLaboratoryfindingsImagingDiagnosisanddifferentialdiagnosisManagementOutlineDefinitionandhistoryRA定义Anautoimmunedisorderofunknownetiologycharacterizedbysymmetric,erosivesynovitisand,insomecases,extraarticularinvolvement.Mostpatientsexperienceachronic

fluctuatingcourseofdiseasethat,despitetherapy,mayresultinprogressivejointdestruction,deformity,disability,andevenprematuredeath-----2003,AmericancollegeofRheumatologyRA定义AnautoimmunedisorderofMedicineasanartTheholyfamilywithSt.Anne(C1633—C1635)byPeterPaulRubens历史MedicineasanartTheholyfamHistory:

Pierre-Auguste

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(1841-1919)OntheTerrace(1878)ByPierre-Auguste

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Pierre-AugusteRenoi历史：

ErikWaalerErikWaalerTheoccurrenceofafactorinhumanserumactivatingthespecificagglutinationofsheepcorpuscles.ActaPatholMicroboilScand1940;1:172-88.历史：

ErikWaalerErikWaalerTheGeneticFactorsinRADRB1GeneticFactorsinRADRB1Virus-infectionHypothesisVirus-infectionHypothesisSexHormoneonRASexHormoneonRARheumatoidPannus（血管翳）RheumatoidPannus（血管翳）Pannus（血管翳）Pannus（血管翳）RheumatoidArthritis:Hand,FusiformSwelling（梭形）RheumatoidArthritis:Hand,FuUlnar（尺侧）DeviationandMuscleAtrophyUlnar（尺侧）DeviationandMuscleSwanNeckDeformityandBoutonnièreDeformity钮扣花SwanNeckDeformityandBoutonTelescopingSignTelescopingSignArthritisMutilans残毁ArthritisMutilans残毁ArthritisMutilansArthritisMutilansHypermobilityHypermobilityArthritisMutilansArthritisMutilansSubcutaneousNodule,Olecranon鹰嘴SubcutaneousNodule,OlecranonRheumatoidNodulesRheumatoidNodulesRheumatoidNodulesintheLungRheumatoidNodulesintheLungRheumatoidNodule:PathologyRheumatoidNodule:PathologyScleromalaciaPerforans

（穿孔性巩膜软化）ScleromalaciaPerforans

（穿孔性巩膜VasculitisandGangrene（坏疽）VasculitisandGangrene（坏疽）ExtensorTendonRuptureExtensorTendonRupturePoplitealCyst

（腘窝囊肿）PoplitealCyst

（腘窝囊肿）ProgressiveRightPIP3Erosionsina60-yearOldLadySufferingFromRA3/19893/198911/19903/199211/19931/19956/1996ProgressiveRightPIP3ErosionRightWristintheSamePatient3/198911/19903/199211/19931/19956/19963/198911/19903/199211/19931/19956/1996RightWristintheSamePatienRheumatoidArthritis:KneesRheumatoidArthritis:KneesHip,LateErosionsHip,LateErosionsProtrusioAcetabuli髋臼突出ProtrusioAcetabuli髋臼突出患病率患病率病因遗传因素感染因素内分泌因素病因遗传因素发病机理发病机理病理Synovitis(滑膜炎）VasculitisRheumatoidnodules病理Synovitis(滑膜炎）临床表现关节表现晨僵Morningstiffness关节痛Arthralgia

和关节压痛tenderness关节肿Jointswelling关节变形Jointdeformity关节外表现APictureisWorthaThousandWords临床表现关节表现APictureisWorth关节外表现类风湿结节Rheumatoidnodule类风湿血管炎Rheumatoidvasculitis类风湿肺病变Lungdiseases干燥综合征Sjogren’ssyndrome心包炎Pericarditis肾病变KidneydiseasesAPictureisWorthaThousandWords关节外表现类风湿结节RheumatoidnoduleA实验室检查血液学异常血小板数增多炎症指标:血沉增快C反应蛋白水平升高类风湿因子Rheumatoidfactor（RF）抗CCP抗体实验室检查血液学异常RF=RA?CategoryDiseasesRheumaticdiseasesRA,SLE,scleroderma,sjogren’ssyndromeViralinfectionsAIDS,Hepatitis,influenza,aftervaccinationChronicbacterialinfectionsTuberculosis,leprosy,syphilis,subacutebacterialendocarditis,NeoplasmsAfterirradiationorchemotherapyOthersChronicliverorlungdiseaseRF=RA?CategoryDiseasesRheuma放射学检查确立诊断监测疾病发展监测药物治疗效果放射学检查确立诊断类风湿关节炎RheumatoidArthritis(RA)课件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Rheumaticfever鉴别诊断血清阴性脊柱关节病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ESR24mm/h,RF（＋）。血常规正常。72岁女性，双膝关节痛10余年，双手指关节肿痛8个月。膝痛以处理Theultimategoalsareto:PreventorcontroljointdamagePreventlossoffunctionDecreasepain.处理Theultimategoalsareto:类风湿关节炎RheumatoidArthritis(RA)课件治疗方法非药物治疗药物治疗外科治疗治疗方法非药物治疗治疗药物种类改变病情抗风湿药DiseaseModifyingAnti-rheumaticDrugs(DMARDs)糖皮质激素Glucocorticoids非甾体抗炎药NonsteroidalAnti-InflammatoryDrugs(NSAIDs)生物制剂Biologicagents抗生素Antibiotics？治疗药物种类改变病情抗风湿药DiseaseModify改变病情抗风湿药(DMARDs)甲氨蝶呤Methotrexate（MTX）来氟米特Leflunomide柳氮磺吡啶Sulfasalazine金制剂Gold,oralorintramuscular硫唑嘌呤Azathioprine青霉胺D-penicillamine环孢素Cyclosporine改变病情抗风湿药(DMARDs)甲氨蝶呤Methotrex目前观点所有RA患者均应采用DMARD治疗首选MTX.严重RA患者可采用DMARD联合治疗，但方案中应包含MTX症状缓解不等于治愈目前观点所有RA患者均应采用DMARD治疗BiologicsinthetreatmentofRABiologicsinthetreatmentof小剂量糖皮质激素每天不超过10mg的泼尼松:有效缓解症状可能减慢关节侵蚀进展应权衡得弊，综合考虑：骨质疏松osteoporosis感染Infection小剂量糖皮质激素每天不超过10mg的泼尼松:非甾体抗炎药NSAIDs不应做为RA的单一治疗具抗炎、镇痛作用不改变RA病程、减慢关节破坏发展选择应基于疗效、安全、方便性及费用布洛芬萘普生双氯芬酸非甾体抗炎药NSAIDs不应做为RA的单一治疗总结定义病理临床表现诊断治疗RaoulDufy,LeBouquetd'Arums,1939

总结定义RaoulDufy,LeBouquetd'1、有时候读书是一种巧妙地避开思考的方法。9月-239月-23Wednesday,September6,20232、阅读一切好书如同和过去最杰出的人谈话。12:03:3912:03:3912:039/6/202312:03:39PM3、越是没有本领的就越加自命不凡。9月-2312:03:3912:03Sep-2306-Sep-234、越是无能的人，越喜欢挑剔别人的错儿。12:03:3912:03:3912:03Wednesday,September6,20235、知人者智，自知者明。胜人者有力，自胜者强。9月-239月-2312:03:3912:03:39September6,20236、意志坚强的人能把世界放在手中像泥块一样任意揉捏。06九月202312:03:39下午12:03:399月-237、最具挑战性的挑战莫过于提升自我。。九月2312:03下午9月-2312:03September6,20238、业余生活要有意义，不要越轨。2023/9/612:03:3912:03:3906September20239、一个人即使已登上顶峰，也仍要自强不息。12:03:39下午12:03下午12:03:399月-2310、你要做多大的事情，就该承受多大的压力。9/6/202312:03:39PM12:03:3906-9月-2311、自己要先看得起自己，别人才会看得起你。9/6/202312:03PM9/6/202312:03PM9月-239月-2312、这一秒不放弃，下一秒就会有希望。06-Sep-2306September20239月-2313、无论才能知识多么卓著，如果缺乏热情，则无异纸上画饼充饥，无补于事。Wednesday,September6,202306-Sep-239月-2314、我只是自己不放过自己而已，现在我不会再逼自己眷恋了。9月-2312:03:3906September202312:03谢谢大家1、有时候读书是一种巧妙地避开思考的方法。8月-238月-2551、有时候读书是一种巧妙地避开思考的方法。9月-239月-23Wednesday,September6,20232、阅读一切好书如同和过去最杰出的人谈话。12:03:3912:03:3912:039/6/202312:03:39PM3、越是没有本领的就越加自命不凡。9月-2312:03:3912:03Sep-2306-Sep-234、越是无能的人，越喜欢挑剔别人的错儿。12:03:3912:03:3912:03Wednesday,September6,20235、知人者智，自知者明