内科学教学课件：Rheumatic Diseases.pptVIP

Rheumatic Diseases 沈阳医学院沈洲医院肾内科 王曦 rheumatic diseases  Rheumatic diseases is a group of musculoskeletal diseases including:diffuse connective tissue disease(CTD)and disease of muscle ,tendon,ligament and other connective tissue around joints. 目前认为风湿是指关节、关节周围软组织、肌肉、骨出现的慢性疼痛。 pathogeny infection immunity metabolic endocrine retrigression gergraphy heredity tumour Whole body system limitation organic functionality 风湿性疾病的范畴和分类 1. Diffuse connective tissue diseaes 类风湿关节炎、红斑狼疮、硬皮病、多肌炎、重叠综合症、血管炎病等 2. Spondyloarthropathies 强直性脊柱炎、反应性关节炎、炎症肠病性关节炎、银屑病关节炎、未分化脊柱关节病等 3. Degeneration 骨关节炎（原发性，继发性） 4. metabolic and endocrine 痛风、假性痛风、马方综合征、免疫缺陷病等 5. Infective-factor related disease 反应性关节炎、风湿热等 6. tumour A原发性（滑膜瘤、滑膜肉瘤）；B继发性（多发性骨髓瘤、转移瘤等） 7.神经血管疾病 神经性关节病、压迫性神经病变（周围神经受压、神经根受压等）、雷诺病等 8.骨与软骨病变 骨质疏松、骨软化、肥大性骨关节病、弥漫性原发性骨肥厚、骨炎等 9.非关节性风湿病 关节周围病变、椎间盘病变、特发性腰痛、其他痛综合症（如精神性风湿病）等 10.其他有关节症状的疾病 周期性风湿病、间歇性关节积液、药物相关的风湿综合症、慢性活动性肝炎等 pathology Inflammatory reaction Non-inflammatory reaction The characterized of rheumatic diseases 1. 属自身免疫病，其发生与感染、 遗传因素，性激素等因素有关。 　　　　 2. 基本病理改变为结缔组织及血管的慢性炎症。 3. 患者可有多系统、多脏器受累。 4. 发病情况差异大。为异质性疾病. 5 血清学检查：多种自身抗体. 6. 对糖皮质激素及免疫抑制剂类药物治疗有一定 反应.。 7. 早期诊断、合理治疗、病情及预后均可明显改 善。 Rheumatic Diseases =5D Discomfort=痛苦 Disability=残废 Drug toxity=药物中毒 Dollar lost=经济损失 Death=死亡 History and examination of patient History taking age. sex. occupation.chief complain. symtom.family history.past history. treatment. ● Symtom ache. morning stiffness. tired. system symtom. 1. Is the pain in one or more joints? 2. When does the pain occur? 3. How long does the pain last? 4. When did you first notice the pain? 5. What were you doing when you first noticed the pain? 6. Does activity make the pain better or worse? 7. Have you had any illnesses or accidents that may account for the pain? 8. Is there a family history of any arthritis or other rheumat