类风湿关节炎诊断治疗—培训课件.pptVIP

新的治疗靶点： TNFa抑制剂：etanercept, adalimumab, remicade, abatacept, certolizumab pegol, golimumab IL-1抑制剂：anakinra B细胞清除：rituximab IL-6抑制剂：tocilizumab BDRs biological disease modifiers 靶向治疗是希望 但真正的发病机制尚未探明 FDA批准应用于治疗RA的生物制剂 1998 etanercept 1999 infliximab 2001 anakinra 2002 adalimumab 2013 Tocilizumab?。。。。。。 单抗命名 风湿病能治愈吗 疾病发展八步曲 ACR 遗 传 缺 陷 免 疫 异 常 炎 症 损 害 临 床 不 适 可 逆 窗 口 加 速 发 展 稳 定 平 台 疾 病 疲 乏 有了种子，还要有土壤、空气、阳光和水等 RA的异质性疾病 初始分层？ 轻： MTX，早期RA，30%单用MTX有效 重：联合生物制剂，快速进展型RA，约20-30%的患者MTX单用或MTX与其它DMARD合用时疗效不佳 一般：联合传统药物或生物制剂 每一个病人都会有属于自己的鸡尾酒方案 风湿医生必须是一个优秀的调酒师，人的身体情况、社会地位、口味、喜好各有不同，适饮不同的酒 调酒师的技艺高超，能熟谙各种酒品和配料，更高超的是他对于饮酒人的判断 鸡尾酒的配料 钙剂 维生素制剂 抗骨松药 抗感染药 抗高血压药 调血脂药 中药 其他一切药、一切和人有关的事物 非靶向药物 艾拉莫德？ 总 结 RA三味 高端大气上档次 低调奢华有内涵 诊断 ACR/EULAR标准 北大或定义指标 评价 DAS28/44 三无三少指标 治疗 生物制剂为基础 口服药物为基础 谢谢大家 * Rheumatoid arthritis: hand, swan-neck and boutonni鑢e deformity Swan-neck deformities are seen in the second, third, and fourth digits of a patient with chronic rheumatoid arthritis. A boutonni鑢e deformity of the fifth digit is present. * 5-R-21 Rheumatoid arthritis: pulmonary nodules (roentgenogram) Large nodules are seen in the pulmonary parenchyma bilaterally. These nodules are discrete and similar in appearance to opacities caused by metastatic disease. They are histologically identical to subcutaneous rheumatoid nodules. * 5-R-22 Rheumatoid arthritis: pulmonary nodules, cavitary (roentgenogram) Pulmonary nodules with cavitated central portions give the appearance of cystic lesions. Fibrotic changes are present at both bases. The radiographic differential diagnosis includes infectious and malignant lesions. * Rheumatoid arthritis: scleromalacia perforans This eye demonstrates several rheumatoid scleral nodules, scleral thinning, and adjacent conjunctival injection. The uveal tissue is about to herniate through the softened sclera in the midsuperior portion of the eye, which could result in a perforation of the globe. 5-C-17 Rheumatoid arthritis: sc