银屑病关节炎-张奉春课件

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1、银屑病关节炎脊柱关节病包括的疾病强直性脊柱炎是本组疾病的原型反应性关节炎（ReA）/Reiter综合征（RS）银屑病关节炎（PsA）炎性肠病相关的关节病（IBDA）幼年发病的脊柱关节病（JSpA）分类未定的脊柱关节病（USpA）脊柱关节病之间的重叠ASReAIBDAPsAUSpA急性虹膜炎其它寡关节炎、JSpA定义：因银屑病而引发的关节炎，属血清阴性脊柱关节病的范畴。历史：1818年（法国）Alibert报道1860年Bazin命名20世纪60年代：独立疾病流行病学发病：世界范围患病率：美国0.1%在银屑病

2、中5%~7%专科医院：7%~49%我国：银屑病0.123%15%PsA发生在银屑病之前年龄：32~45岁性别：男:女为1:1.04~1:1.4NPFBenchmarkSurveyforPsoriasisandPsoriaticArthritis(N=27,000)PsoriaticArthritisStatisticsAmericansaffected:1millionadultsImpactonpatients’lives:84%reportmoderatetosignificantimpactonda

3、y-to-dayactivities75%losesleeporsleeppoorly69%reportdiseaseinterfereswitheducational,vocational,andsocialactivitiesSatisfactionwithtreatment:50%reportedseeing3physiciansfordiseaseinpast2years1in4weredissatisfiedwithtreatmentNationalPsoriasisFoundation(200

4、2).Presskitforpsoriaticarthritissurvey.January2002.Availableat:www.psoriasis.org/images/papresskit.pdf.AccessedNovember13,2002.GladmanDD.RheumDisClinNorthAm.1992;18(1):247-256.GladmanDD.UpToDate.1997;7(1):1-8.FamilialPredisposition（倾向、易患病的体质）1stdegreerela

5、tivewithpreviousdiseasehistory:40%ConcordanceratesMonozygotic单卵twins:65%–72%Dizygotictwins:15%–30%2021/6/117病因遗传：1/3有家族史银屑病第一代亲属中：银屑病16.9%，PsA3.3%寻常型银屑病：HLA-B13，-B17，-A1，-CW6PsA：HLA-B2746%~78%脊柱炎周围型HLA-B38，-B39免疫异常免疫球蛋白：IgA升高60%PsAIgG免疫复合物升高,IgA免疫复合物升高补体：C

6、H50C3可升高细胞因子：IL-6IL-8,转化因子-α（TGF-α）……Sources:MeaseP.AnnRheumDis2004;63:755-758KruegerJG.JAmAcadDermatol2002;46:1-23ImmunologicbasisofpsoriasisT-cellsarecontinuouslyactivatedinlymphnodes淋巴结byunidentifiedantigens未识别的抗原ActivatedT-cellsmigrateintoskinandindu

7、cemacrophages巨噬细胞toproduceTNF-aandotherpro-inflammatorycytokines代谢障碍酶代谢cAMP↓cGMP↑cAMP/cGMP失调……结果：表皮皮损周期缩短，表皮增生感染链球菌感染，葡萄球菌α抗毒素滴度其他：精神因素、外伤、内分泌改变……PathogenesisofPsoriaticArthritisEtiologyunknownMultifactorialSkinandjointchangesdonotoccurinparallelGladmanDD.

8、RheumDisClinNAmer1992;18:247-56.GeneticsImmuneSystemEnvironmentPsoriaticArthritis病理炎症性滑膜炎——类似类风湿关节炎骨破坏、吸收肌腱附着处骨质增生InflammatoryEnthesopathySubchondralBoneInflammationandResorption软骨下骨炎症和吸收PeriostealNewBoneForm