第八篇 结缔组织病和风湿病(国外英文资料).doc

第八篇 结缔组织病和风湿病 Eighth connective tissue disease and rheumatism Chapter 2 rheumatoid arthritis [learning bullet] Understand the etiology and pathogenesis of rheumatoid arthritis. The pathological changes of the rheumatic joints. Master clinical manifestations, diagnosis, differential diagnosis and treatment of rheumatoid arthritis. [key, difficult analysis] One, the etiology: the etiology is not clear, may be with infection factor, heredity has certain relation. Pathogenesis: unknown antigens enter the body after the activation of T and B cells and the complement system appears, secrete a large number of cytokines, such as the lL1-2 and TNF alpha, 1-6, lL - 8, etc.) and immunoglobulin (such as rheumatoid factor antibody) joint inflammation and damage. CD4 + T lymphocytes play an important role in the onset of RA. The abnormal apoptosis of the synovial cells allowed the immune response of RA to continue. Three, pathology, The pathological changes of rheumatoid arthritis are synovitis. Acute phase: show the exudative and cell invasive, synovial lower small blood vessels, swelling of the endothelial cells, intercellular space increases, interstitial edema and neutrophil infiltration. 2. Chronic phase: synovial hypertrophy, bulging forming a CVS, tu into joint cavity or intrusion into the cartilage, subchondral bone, lymphocyte infiltration under the synovial membrane, most of CD4 + T lymphocytes. Angiitis is another pathologic change of RA, which can occur in any tissue outside the joint. The arteries and veins of the small and small arteries and veins, the lymphocyte infiltrates, the cellulose is composed, the inner lining is hyperplasia, which leads to the stenosis or blockage of the vessel cavity. Rheumatoid nodules are a manifestation of vasculitis, commonly seen in the area of the extension of the joint. The center of the nodules is a fibrous necrotic tissue. The epithelial cells of the surrounding epithelium are infiltrated and arranged in a ring, and are formed