脊柱关节炎早期诊断新进展.ppt

脊柱关节炎早期诊断新进展 CT, MR在早期诊断中的应用 12岁B27+男孩的早期右骶髂关节炎 AS发病机制的新观点 与AS发病相关的基因产物之间的相互关系 AS肌腱端炎的病理学 B27分子的3种不同结构及其诱发AS的可能过程 欢迎索阅并积极参与讨论、竟猜 Figure 3: Hypothetical functional interactions between gene products associated with ankylosing spondylitis. The genes HLA-B27, ERAP1, IL23R, IL1R2, TRADD, TNFR1, CARD9, and ANTXR2 (not shown) have definite or suggested associations with AS. One mechanism linking HLA-B27 to the IL-23/IL-17 (TH17) axis involves misfolding and UPR activation triggered by MHC class I upregulation. UPR activation enhances production of IL-23 and IFN-β in response to certain PRR agonists. CARD9 mediates IL-23 induction in response to fungal cell wall components through the PRR, Dectin-1. ERAP1 influences the quality and/or quantity of peptides available for MHC class I molecules, and might impact not only cell-surface complexes, but also the folding efficiency of HLA-B27. ERAP1 (also known as ARTS1) is also an aminopeptidase regulator of TNF (TNFR1) receptor shedding, and also influences IL-6 and IL-1R2 (IL1R2) receptors. Polymorphisms in TNFR1 and TRADD, a mediator of TNF signaling, could influence downstream effects perhaps contributing to phenotypic differences between patients with different TNF overexpression diseases such as RA and AS. Abbreviations: AS, ankylosing spondylitis; BiP, immunoglobulin-heavy-chain-binding protein; CARD9, caspase recruitment domain-containing protein 9; eR, endoplasmic reticulum; ERAP1, endoplasmic reticulum aminopeptidase 1; IFN, interferon; IL, interleukin; NK, natural killer; PRR, pattern recognition receptor; RA, rheumatoid arthritis; TH17, type 17 helper T cell; TNF, tumor necrosis factor; TNFR1, Tumor necrosis factor receptor type 1; TRADD, TNFR1-associated DEATH domain protein; UPR, unfolded protein response; XBP1, X-box-binding protein 1. * * * * * * * * * * * * * 解放军总医院风湿科 黄 烽 2011年4月9日 确诊延迟5~7年 目前关于中轴SpA的定义 X线前期或非X线期 X线期 ASAS 2010新的定义 ASAS诊断中轴SpA的新标准腰背痛3个月以上, 起病年龄45岁 影像学骶髂关节炎证据* + ≥1条SpA特征 或 HLA-B27 + ≥2条其他SpA特征