课件：进修讲课风湿病学概论.ppt

* 欢迎有志青年从事风湿病学专业 后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析 Figure 68.7 Boutonni#232;re and swan-neck deformities. The boutonni#232;re deformity - PIP flexion and DIP hyperextension - results from relaxation of the central slip, with buttonholing of the PIP joint between the lateral bands. The swan-neck deformity - MCP flexion, PIP hyperextension and DIP flexion - may be mobile, snapping or fixed. Its pathogenesis may be related primarily to PIP or MCP involvement. Combinations of MCP and PIP involvement are less frequent. (Adapted with permission from Hastings DE and Welsh RP. Surgical reconstruction of the rheumatoid hand. Toronto: Orthopaedic Medical Management Corporation; 1979.) * * * * Psoriatic Arthritis Moderate narrowing and sclerosis of the L sacroiliac joint. The right is relatively normal. Asymmetric sacroiliitis is more common in Reiters and psoriatic arthritis, whereas, bilateral involvement is usually found in ankylosing spondylitis and inflammatory bowel associated arthritis. Progressive changes in the DIP joints of a patient with psoriatic arthritis. A)mild soft tissue swelling and early erosion, B)greater loss of bone substance and early proliferation, and C)bone loss and tapering proximally leading to a pencil-in-cup deformity. Swelling and deformity of the DIP joints along with psoriatic nail changes * 不能教条 * * 实验室检查 * 炎性实验室指标 主要针对疾病活动性 ESR: CRP:2周内80%, 大于4周25% OTHER:1.白细胞及中性粒 细胞. 2.糖蛋白及粘蛋白等. * ANAs ANA是指抗细胞内DNA,RNA,AHA,no-AHA,phospholipid……蛋白质分子及其复合物成分的抗体.Miescher于1957年发现。 1957年Ceppelini发现DNA :ssDNA,dsDNA. AHA:H1,H2A,H2B,H3,H4. ENA:Sm,Nrnp,rRNP,SSA/SSB,ScL-70,Jo-1,PM-1,PCNA,RA33,centromere….. * * 类风湿因子（Rheumatoid Factor） 抗变性IgG FC 段的抗体，普通测的是IgM RF 抗环胍氨酸(CCP)抗体 * 抗核抗体（ANA） ANA：指抗细胞核成分（DNA，RNA，蛋白质和酶）的抗体。ANA存在一个谱 ANA新概念：抗核酸（Nucleic acid）和核蛋白（Nucleoprotein）抗体的总称 某些核抗原成分在核仁和胞浆内比核质内更丰富 有助于疾病的诊断，如抗Sm是SLE标记抗体；抗ScL-70 是SD的标记抗体，抗Jo-1是PM/DM的标记抗体 观察疾病活动度和治疗反应 研究发病机理 * * 荧光显微镜下ANA的染色型别 均质型：与抗组蛋白和抗DNA有关 斑点型：与抗ENA有关 周边型：与抗dsDNA有关 核仁型：4-6