常见关节炎的鉴别诊断与治疗.pptxVIP

常见关节炎的鉴别诊断与治疗;关节炎定义;哪些疾病可以出现关节的症状？;;第5页/共159页;第6页/共159页;第7页/共159页;关节肿痛持续的时间与 “游走性关节炎”的关系;关节肿痛持续的时间与 “游走性关节炎”的关系;关节受累多少对关节炎的诊断意义;类风湿关节炎（Rheumatoid arthritis,RA ）;Synovitis of the hands as seen at surgery;RA与风湿性关节炎的区别;临床表现;关节表现（一）;类风关早期的关节受累情况;关节表现（二）;近端指间关节肿胀;骨质侵蚀;右手“纽扣花”畸形;右手尺侧偏斜畸形;踝关节肿胀变形;关节表现（三）;关节外表现;右手中指末端坏疽;实验室检查;类风湿关节炎早期诊断的手段;第28页/共159页;第29页/共159页;类风湿关节炎诊断标准（ACR1987）;The 2010 American College of Rheumatology/EuropeanLeague Against Rheumatism classifi cation criteria for RA;Score Target population (Who should be tested?): Patients who 1) have at least 1 joint with defi nite clinical synovitis (swelling)* 2) with the synovitis not better explained by another disease? Classifi cation criteria for RA (score-based algorithm: add score of categories A-D; a score of ≥6/10 is needed for classifi cation of a patient as having defi nite RA)? ;A. Joint involvement§ 1 large joint? 0 2?10 large joints 1 1?3 small joints (with or without involvement of large joints)** 2 4?10 small joints (with or without involvement of large joints) 3 10 joints (at least 1 small joint)?? 5 B. Serology (at least 1 test result is needed for classifi cation)?? Negative RF and negative ACPA 0 Low-positive RF or low-positive ACPA 2 High-positive RF or high-positive ACPA 3 C. Acute-phase reactants (at least 1 test result is needed for classifi cation)§§ Normal CRP and normal ESR 0 0 Abnormal CRP or normal ESR 1 1 D. Duration of symptoms?? 6 weeks 0 ≥6 weeks 1 ;治疗措施; 非倾向性COX抑制剂;“选择性COX-2抑制剂”高效安全，是临床较佳选择;甲氨喋呤(基础药物);抗疟药;雷公藤制剂;环孢霉素A;柳氮磺胺吡啶;英文名：Leflunomide 通用名：来氟米特 商品名:爱若华,妥抒 化学结构：?，?，?，?三氟?5?甲基?异噁唑?N?酰基?对甲苯胺 分子式为C12H9F3N2O2，分子量：270.2 来氟米特达到甲氨蝶呤的疗效，但二者联合用药，可以达到更佳的疗效。;第43页/共159页;激素与抗炎镇痛治疗;类风湿关节炎治疗目标的更新;强调早期使用DMARDs ;47;48;49;50;51;52;骨关节炎（Osteoarthritis,OA);骨关节炎病因;骨关节炎发病率;骨关节炎的临床表现;骨关节炎影响的关节分布;骨关节炎的病理改变;Normal articular cartilage;Cartilage defects (b);Fibrillated cartilage (b);Roughened and pitted articular cartilage (a);类风湿关节炎与骨关节炎的区别;类风湿关节炎影响的关节分布;Primary osteoarthritis;Valgus deformity knee;;OA的其