课件：类风湿关节炎诊断治疗16-11.ppt

糖皮质激素治疗RA的荟萃分析 COBRA结果 新的治疗靶点： TNFa抑制剂：etanercept, adalimumab, remicade, abatacept, certolizumab pegol, golimumab IL-1抑制剂：anakinra B细胞清除：rituximab IL-6抑制剂：tocilizumab BDRs biological disease modifiers 靶向治疗是希望 但真正的发病机制尚未探明 FDA批准应用于治疗RA的生物制剂 1998 etanercept 1999 infliximab 2001 anakinra 2002 adalimumab 2013 Tocilizumab?。。。。。。 总 结 RA三味 高端大气上档次 低调奢华有内涵 诊断 ACR/EULAR标准 北大或定义指标 评价 DAS28/44 三无三少指标 治疗 生物制剂为基础 口服药物为基础 THANK YOU SUCCESS * * 可编辑 * Rheumatoid arthritis: hand, swan-neck and boutonni鑢e deformity Swan-neck deformities are seen in the second, third, and fourth digits of a patient with chronic rheumatoid arthritis. A boutonni鑢e deformity of the fifth digit is present. * 5-R-21 Rheumatoid arthritis: pulmonary nodules (roentgenogram) Large nodules are seen in the pulmonary parenchyma bilaterally. These nodules are discrete and similar in appearance to opacities caused by metastatic disease. They are histologically identical to subcutaneous rheumatoid nodules. * 5-R-22 Rheumatoid arthritis: pulmonary nodules, cavitary (roentgenogram) Pulmonary nodules with cavitated central portions give the appearance of cystic lesions. Fibrotic changes are present at both bases. The radiographic differential diagnosis includes infectious and malignant lesions. * Rheumatoid arthritis: scleromalacia perforans This eye demonstrates several rheumatoid scleral nodules, scleral thinning, and adjacent conjunctival injection. The uveal tissue is about to herniate through the softened sclera in the midsuperior portion of the eye, which could result in a perforation of the globe. 5-C-17 Rheumatoid arthritis: scleromalacia perforans, herniation This eye demonstrates marked scleral thinning and adjacent scleral and conjunctival injection. The darker pigmented uveal tissue has herniated through the softened sclera, and perforation is imminent. Note the nonconcentric pupil. 从公元前6500-450年居住在田纳西州河沿岸的美国本土居民的骨骼中发现了与类风湿关节炎相类似的畸形迹象； 罗马君王康斯坦丁九世（公元980-1055年）