内科学教学课件：RHEUMATOID ARTHRITIS.pptx

RHEUMATOID ARTHRITIS (RA) What is Rheumatoid Arthritis (RA) ? Clinical Picture What happened on these joints? Pathology PathologySynovitis: Infiltrates of inflammatory cells Angiogenesis Synovial cell proliferationsFormation of PannusDestruction of cartilage and Subchondral bone ↓Narrowing of joint space and bone erosion 早中期X光表现 进展期X光表现 erosion Joints frequently involvedImportant clue for differential diagnosis for Ankylosing Spondylitis ( AS ) and Osteoarthritis Nature of RASystemic autoimmune connective tissue disease Extra-articular Manifestations Subcutaneous nodules with muscle atrophy ischemic necrosis due to vasculitis Neurovascular Disease Diffuse interstitial lung fibrosis Felty Syndrome: Splenomegaly, lymphadenopathy, anemia, Bpc ↓ WBC ↓ , RF positive Rheumatoid Factor RF are now defined as antibodies specific to antigenic determinants on the Fc fragments of human or animal immunoglobulin. Seropositivity of patients with RA or with otherdisease is usually defined by the latex fixation testor red cell agglutination tests. These assays reflect the presence of IgM Rheumatoid factors(IgM-RFs). The presence of RF is not unique to RA, and a positive RF should not be used as the sole criterion for the diagnosis of RA. Occurrence of RF in various Disease IgM-RF positive IgM-RF negativeRheumatoid Arthritis OsteoarthritisOther rheumatic Diseases Ankylosing Spondylitis Sjogren*s Syndrome Gout SLE, PSS, PM Psoriatic arthritisInfections Diseases SBE TBNon-infections Disease Normal individuals (Aged) Chronic active hepatitis Diffuse Interstitial pulmonary fibrosis Diagnosis Proposed 1987 Revised ARA criteria for RA