关节炎(英文版).ppt

“Things may come to those who wait, but only the things left by those who hustle.” – Abraham Lincoln Pathology of Arthritis Joints: Mobility - Cranial sutures ? Shoulder joint. Articular cartilage – hyaline – friction res. Synovial fluid – lubric/nutri, Type A B synoviocytes. Hyaluronidase Continuous production and absorption. Affected by Inflammation, immobility. Capsule, ligaments, menisci. Vascular, rich nerve supply – Art. Cartilage* Joints - Anatomy Arthritis - Introduction Inflammation of joints - Common Common site for autoimmune injury Heart valves Joints - damage – Exposure of hidden antigens. Infections. Degeneration – Age/Stress/life style Use it or Loose it….! Arthritis – Clinical features: Pain ? Inflammation - capsule, synovium, periosteum. Swelling: ? inflammation, effusion, proliferation. Restricted movement ? pain, fluid, synovial swelling, damage. Deformity ? mal-alignment, erosion, ankylosis Arthritis Clinical Classification: Monoarthritis: Local, asymmetric, secondary. Acute: Bacterial, Trauma, Crystal, Reactive Chronic :Tuberculosis, Lyme, Fungal, Trauma, Tumors. Polyarthritis: Chronic, symmetric, systemic. Autoimmune, degenerative, Crystal. Rarely infective. Polyarthritis Classification: Autoimmune: Rheumatic, Rheumatoid, Ankylosing spondylitis, Reiter syndrome etc. Degenerative: Osteroarthritis Crystal Deposition: Gout – Monosodium urate CPPD - Pseudo Gout Infective - Septic, TB, Lyme etc. rare. Rheumatoid Arthritis Epidemiology of RA Prevalence about 1% of US population Female : Male ratio = 2:1 Strong association with HLA DR4. Concordance in identical twins only 30% RA - Definition: Chronic Multisystem autoimmune inflammatory disorder primarily affecting joints producing a proliferative synovitis that often progresses to destruction of the articular cartilage and ankylosis. Etiology: Genetic Susceptibility: HLA DR4, or DR1 in 65% to 80% cases. Microbial inciting agent: Epstein-Barr virus, Borrelia Mycoplasma Autoimmunity: