类风湿性关节炎鼓楼.pptVIP

概况 1858年由英国医生Garrod 首先提出RA这一名称。 患病率约0.3%-1.5%。发病高峰在40-60岁，女性发病率约为男性的2-3倍。 主要表现为周围对称性的多关节慢性炎症性的疾病，其病理为关节的滑膜炎。 70%患者血清中出现阳性类风湿因子。 Monocygotic twins 30-50% Fraternal twins 2-5% General population 1% RA的遗传度在60％左右，70年代起因为发现RA与HLA Ⅱ类抗原的相关性，人们就知道该病与遗传因素有关。 HLA－DR4 者患RA的相对危险性是正常人群的3－4倍。纯合子HLA-DR4的RA患者，其疾病特别严重。 HLA构成的遗传风险仅占总风险的30－40％，说明还有其他基因与发病相关。 研究策略： 全基因组扫描 whole genome scan 候选基因研究 candidate gene research 候选基因 肿瘤坏死因子（TNF）α IL－1 IL－10 环境因素不明，可能与下述因素有关 一、感染：尚未找到确证 1.病毒: EB病毒、逆转录病毒等 2.细菌: 分枝杆菌、奇异变型杆菌等 3.其它：支原体等 二、性激素 Predominate in women Pregnancy usually is associated with remission of the disease in the last trimester. More than 75 percent of pregnant patients with RA improve, starting in the first or second trimester. 90 percent of these experience a flare of disease associated with a rise in RF titers in the weeks or months after delivery. 环境因素 Potential Autoantigens in Rheumatoid Arthritis HLA-DR (QKRAA) ? Heat shock proteins Immunoglobulins (IgG) ??????????????????????????Cartilage antigens ????????????????????????? ?Type II collagen ???????????????????????????????? ???gp39 ???????????????????????????????? ??Cartilage link protein Proteoglycans Morning stiffness is related to the accumulation of edema fluid within inflamed tissues during sleep. The morning stiffness dissipates as edema and products of inflammation are absorbed by lymphatics and venules and returned to the circulation by motion accompanying the use of muscles and joints. 关节畸形大多数是肌群间力量失去平衡的结果，常见： 腕关节强直 掌指关节的半脱位、手指向尺侧偏斜 “天鹅颈”样 钮孔花样 5、神经系统： 关节滑膜增生压迫产生神经病变 腕管综合征， 多发性单神经炎 6 、肾 A 40-year-old female complains of seven weeks of pain and swelling in both wrists and knees. The patient complained of fatigue and lethargy several weeks before noticing the joint pain. The patient notes that after a period of rest, resistance to movemen