第八篇 结缔组织病和风湿病（Eighth connective tissue diseases and rheumatism）.doc

第八篇 结缔组织病和风湿病（Eighth connective tissue diseases and rheumatism） Eighth connective tissue diseases and rheumatism The second chapter rheumatoid arthritis [learning points] 1. to understand the etiology and pathogenesis of rheumatoid arthritis. 2. familiar with the pathological changes of rheumatoid arthritis. 3. to master the clinical manifestation, diagnosis, differential diagnosis and treatment of rheumatoid arthritis. [key and difficult analysis] First, etiology: etiology is not clear, may be associated with infection factors, genetic a certain relationship. Two, pathogenesis: unknown antigen into the body after the activation of T, B cells and the complement system, the release of cytokines (such as lL1-2, TNF-, 1-6, alpha lL-8) and immunoglobulin (such as rheumatoid factor antibodies) caused by the joint inflammation and destruction. CD4+T lymphocytes play an important role in the pathogenesis of RA. The abnormal apoptosis of synovial cells leads to the immune response of RA synovitis. Three 、 pathology The pathological change of rheumatoid arthritis is synovitis. 1. acute phase: manifested as exudative and cell infiltration, expansion of small blood vessels in the lower synovial layer, swelling of endothelial cells, enlargement of intercellular space, interstitial edema and neutrophil infiltration. 2. chronic phase: synovial hypertrophy, formation of villous projections, protruding into the joint cavity or invade cartilage, subchondral bone, synovial infiltration of lymphocytes, most of which were CD4+T lymphocytes. 3. vasculitis is another pathological change of RA, which can occur in any tissue outside the joint. Involvement of small and medium arteries and venous walls, lymphocytic infiltration, fibrosis, and intimal hyperplasia leads to narrowing or occlusion of the lumen. Rheumatoid nodules are a manifestation of vasculitis and are common in the extensor portion of the joint. The nodular center is a cellulose like necrotic tissue. Around the epithelioid