类风湿性关节炎课件_18.ppt

Rheumatoid Arthritis for Primary Care Physicians类风湿性关节炎Shenzhen China IPCEA Primary Care ProjectAugust 2013 William H. Stager, DO, MS, MPH, FAAFP, FAAMA, FAAO, FACOFP Clinical Professor, Dept. of Family Medicine, NSUCOM Clinical Associate Professor, Dept. of Family Medicine, LECOM 2013-2014 First Vice President, FOMA 2006-2010 President, Florida Academy of Osteopathy 2006-2013 President, FOMA District 9 2008-2009 President, FSACOFP Rheumatoid Arthritis: Introduction介绍 Rheumatoid arthritis (RA) is a symmetric, inflammatory, peripheral polyarthritis of unknown etiology. It typically leads to deformity through the stretching of tendons and ligaments and destruction of joints through the erosion of cartilage and bone. If it is untreated or unresponsive to therapy, inflammation and joint destruction lead to loss of physical function, inability to carry out daily tasks of living, and maintenance of employment.类风湿性关节炎（RA）是对称的，炎症，病因不明的外周多发关节炎。它通常会通过拉伸肌腱、韧带导致畸形，侵蚀软骨和骨质来破坏关节。如果是未经处理的或无效的治疗，炎症和关节的破坏会导致生理功能丧失，不能正常进行日常生活和就业。 Early recognition and treatment with disease-modifying antirheumatic drugs is important in achieving control of disease and prevention of joint injury and disability. However, in patients with early disease, the joint manifestations are often difficult to distinguish from other forms of inflammatory polyarthritis. The more distinctive signs of RA, such as joint erosions, rheumatoid nodules, and other extraarticular manifestations, are seen primarily in patients with longstanding, poorly-controlled disease but are frequently absent on initial presentation.(1,2,3)早期识别和使用抗风湿药物治疗，是控制病情和防止关节损伤和残疾的要点。然而，在疾病早期的患者，关节的表现往往难以区分于其他形式的炎症性的多发关节炎。RA的更鲜明的标志，首先要看比如关节侵蚀，类风湿结节，和其他关节外的表现。 Rheumatoid Arthritis: Diagnosis诊断 Perform a thorough medical history, with particular attention to joint pain, reported swelling, and the presence, location (peripheral joints rather than low back), and duration (at least 30 minutes) of morning stiffness. The absence of other conditio