课件：类风湿关节炎诊断治疗.ppt

THANK YOU SUCCESS * * 可编辑 * 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: scleromalacia perforans, herniation This eye demonstrates marked scleral thinning and adjacent scleral and conjunctival injection. The darker pigmented uveal tissue has herniated through the softened sclera, and perforation is imminent. Note the nonconcentric pupil. 从公元前6500-450年居住在田纳西州河沿岸的美国本土居民的骨骼中发现了与类风湿关节炎相类似的畸形迹象； 罗马君王康斯坦丁九世（公元980-1055年）好像得的就是类风湿关节炎； 墨西哥公元1400-1550年的21具骨骼中类似于风湿性关节炎的至畸现象； 一位冰岛的医生在1782年描述了类风湿性关节炎：常见于女性，患者多为四十岁左右 * * 29 Tight control强调： 早期强化治疗（联合DMARDs或联合生物制剂） 密切随访，充分判断病情 更精确的疾病评价体系：应用 个体化治疗，随时调整治疗方案 需要建立一个统一的评价体系，对患者进行个体化评估：DAS评分体系比ACR体系更能反映患者当时的情况。也许主要标准可以是关节肿胀数，因为这是RA的一个主要特征。另一个需要探讨的是临床缓解的持续时间、放射学检查是否加入到临床缓解的标准中。 是否会出现过度治疗的问题：早期多种药物联合治疗，会不会增加药物毒性、患者能否耐受等等，也许一个解决办法是达到临床缓解后及时减量。 * Tight control强调： 早期强化治疗（联合DMARDs或联合生物制剂） 密切随访，充分判断病情 更精确的疾病评价体系：应用 个体化治疗，