风湿性疾病－总论.pptVIP

常累及骨关节的风湿免疫病 赵 毅 四川大学华西医院风湿免疫科 INDEX Introduction-key concept Introduction-clinical features Introduction-clinical features Introduction-clinical features Introduction-clinical features 风湿病的病变部位 局部的（如滑囊炎） 全身的 （几乎所有的CTD） 风湿病分类 功能性（纤维肌痛综合征 器质性的（类风湿关节炎 Introduction-clinical features History and Physical examination 是否是关节痛 性别 年龄 起病形式 受累关节数目 受累关节部位 演变 影响因素、预后） 伴随表现 晨僵 家族史 非关节原因 辅助检查 Lumbar Flexion Schober Tragus to Wall Distance Laboratory Findings tests Laboratory Findings tests 重视介入诊断 关节腔穿刺（滑液检查） 关节镜（滑膜活检） 肾活检 病理检查：唇腺 、肌肉 、 滑膜 、血管、 皮肤、皮下结节等 ANA：均质型 ANA：斑点型 RA的特异性抗体 影像诊断 X-Ray：反映关节损伤程度、病变进展速度及对治疗的反应，应列为常规检查项目，并应定期复查。 CT ECT MRI 超声 ACR Criteria for Rheumatoid arthritis Four or more of the following criteria must be present: Morning stiffness 1 hour Arthritis of 3 joint areas Arthritis of hand joints MCPs, PIPs, wrists Symmetric swelling arthritis Serum rheumatoid factor Rheumatoid nodules Radiographic changes First four criteria must be present for 6 weeks or more ACR Criteria for Assessing Functional Status in Rheumatoid Arthritis Classification Specifications Class I Complete ability to perform usual daily activities eg, self- care,vocational/avocational Class II Ability to perform usual self-care and vocational activities; limited avocational activities Class III Ability to perform usual self-care activities; limited vocational/avocational activities Class IV Limited ability to perform usual self-care/ vocational/avocational activities Modified New York Criteria for AS Clinical criteria Low back pain and stiffness for 3 month, which improves with exercise, but is not relieved by rest Limited lumbar spine motion: in sagittal and frontal planes Limitations of chest expansion age/sex standardized Radiographic criteria: Requires EITHER Bilateral sacroiliitis ? Grade 2 or Unilateral sacroiliitis ? Gr 3 Definite AS ?1 clinical plus 1 radiographic criteria Probable AS 3 clinical criteria and no radiologic criteria