课件：常见骨关节疾病诊断流程及手术窗口.ppt

免费热线：800-830-5160 会员热线：400-700-5160 免费热线：800-830-5160 会员热线：400-700-5160 痛风：最难治的可治愈性疾病 Gout: the most curable joint disease is the worst treated 免费热线：800-830-5160 会员热线：400-700-5160 秋水仙碱 NSAIDs 皮质激素 IL-1拮抗剂（二线用药） 目标治疗（T2T）：血尿酸≤6mg/dl 消除体内尿酸盐结晶 缩小甚至化解痛风石 减少甚至终止痛风发作 防止关节结构改变 尿酸重吸收 尿酸分泌 促尿酸排 泄药 次黄嘌呤 嘌呤核苷酸 嘌呤核苷酸 黄嘌呤 尿酸 黄嘌呤氧化酶 黄嘌呤氧化酶 尿酸氧化酶 近曲小管 包曼氏囊 远曲小管 集合管 亨利氏襻 尿酸排出体外 别嘌醇 非布索坦 别嘌醇 非布索坦 尿囊素 降尿酸治疗药物 全人抗IL-1β单克隆抗体 Fubuxostat（非布司他） 聚乙二醇重组尿酸酶注射液Krystexxa 2012 American College of Rheumatology guidelines for management of gout. Part 1: systematic nonpharmacologic and pharmacologic therapeutic approaches to hyperuricemia. 免费热线：800-830-5160 会员热线：400-700-5160 基础用药 抗炎止痛药 麻醉止痛药 皮质激素 DMARs 生物制剂 云克 免疫抑制剂 针对性药物 中药制剂 保护性药物 手术窗口 疾病稳定： 关节肿胀疼痛明显改善 炎性指标正常（血小板、血沉、C反应蛋白。） 影像学指标正常 无共生并生疾病 特别是主要脏器功能异常 无手术禁忌症 风湿病的特殊病变 特殊手术要求 THANK YOU SUCCESS * * 可编辑 * * There is a genetic susceptibility (HLA-B27). Much to the contrary of rheumatoid arthritis, the therapeutic optons in these patients are limited to the use of NSAIDs, Sulphasalazine (in case of peripheral arthritis) and physiotherapy. Probability 90%可确诊 加入关节外表现作为诊断参考计算probability * NSAIDs used continuously – no particular drug recommendation Physical therapy active preferred over aquatic In case of NSAID failure: strong recommendation to use TNFi No particular compounds outlined If TNFis are contraindicated, use sulfasalazine, pamidronate; recommended against any other bDMARDs (other MoA) TNFi non responders – switch to another TNFi No recommendation of systemic glucocorticoids (considered only for peripheral flare, pregnancy and IBD flares) Isolated flares of sacroiliitis, peripheral arthritis, enthesitis – use local injections of glucocorticoids Regular monitoring of disease activity incl. objective markers (