arthritis 风湿性关节炎课件

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1、RHEUMATOIDARTHRITISSaurabhGargRheumatoidArthritisChronicmultisystemicinflammatorydiseaseofunknownetiologyAffectstheSynovialMembranesofmultiplejointsFemale:Maleratio3:1Mostfrequentduring4thand5thdecadePATHOGENESISNormalSynovialJointArticularcartilageSyn

2、oviumMembraneLamellarboneSubchondralboneTypeAcell:mphagelike,protectiveroleTypeBcell:fibroblastlike,producematrixandsynovialfluidVesselSynovialMembrane:only1-2cellsthickThickenedSynoviumLymphocyticInfiltrateNeovascularizationEARLYCHANGESINRAMajortypeof

3、cellsinsynoviumareT-cellsandmacrophageswhereasinsynovialfluidneutrophilsareneutrophilsDestructionofJointCartilageandBoneProliferatingsynoviallining=>PannusProliferatingsynovialliningcomesincontactwiththecartilagematrixandbonethereisdegradationofthecart

4、ilageanderosionofthebonesurface(bymatrixmetalloproteinasesandotherproteasesproducedbysynovialcells)ChondrocytesthemselvesIL-1andTNF-alphaalsostimulateproductionofmetalloproteinasebyChondrocytesofthearticularcartilage.Inresponsetothesecytokines,chondroc

5、ytesdecreasetypeIIcollagenandproteoglycansynthesisandincreasesynthesisofmetalloproteinasesthatcontributetothedegradationofcollagenandproteoglycans.NeutrophilsinSynovialFluidThemaininflammatorycellsofthesynovialfluidareneutrophils.Cytokinessuchastransfo

6、rminggrowthfactorbeta(TGF-beta)andinterleukin8(IL-8)attractneutrophils.Neutrophilsmayundergodegranulationandcausesomedamagetosurroundingtissues.OsteoclastsOsteoclastsmaybeactivatedbyinflammatorymediatorsincludingIL-1,TNFandPGE2bonecartilageRheumatoidAr

7、thritisClinicalpresentationusuallypresentsinsidiously;prodromalsyndromeofmalaise,weightlossandvagueperiarticularpainandstiffnessmaybeseenlesscommonly,theonsetisacute,triggeredbyastressfulsituationsuchasinfection,trauma,emotionalstrainorinthepostpartump

8、eriod.thejointinvolvementischaracteristicallysymmetricwithassociatedstiffness,warmthtendernessandpainRheumatoidArthritisClinicalFeaturesthestiffnessischaracteristicallyworseinthemorningandimprovesduringtheday;itsdurationisausefulindicat