复旦大学：《内科学 Internal Medicine MBBS》课程教学资源（课件讲稿）重症监护医学_Rheumatoid Arthritis

RHEUMATOID ARTHRITIS Lindi Jiang, Xiaomin Dai Zhongshan Hospital Fudan University ianglindi@medmail.com.cn dai xiaomin @zs-hospitalsh cn

Lindi Jiang，Xiaomin Dai Zhongshan Hospital Fudan University jianglindi@medmail.com.cn dai.xiaomin@zs-hospital.sh.cn RHEUMATOID ARTHRITIS

Introduction aa chronic multisystem disease of unknown cause persistent inflammatory synovitis, usually involving peripheral Joints in a symmetric distribution 8% Ra patients with positive rheumatoid factor Pathologic change: chronic synovitis with pannus formation cartilage damage and bone erosion are the hallmarks of the disease

Introduction  a chronic multisystem disease of unknown cause.  persistent inflammatory synovitis, usually involving peripheral joints in a symmetric distribution.  68% RA patients with positive Rheumatoid factor  Pathologic change: chronic synovitis with pannus formation  cartilage damage and bone erosion are the hallmarks of the disease

Epidemiology and Genetics The prevalence of ra in China is approximately 0.3%o of the population a women are affected approximately three times more often than men 80% of all patients develop the disease between the ages of 35 and 50

Epidemiology and Genetics  The prevalence of RA in China is approximately 0.3% of the population  women are affected approximately three times more often than men  80% of all patients develop the disease between the ages of 35 and 50

Epidemiology and Genetics a Family studies indicate a genetic predisposition a The class Ii major histocompatibility complex allele HLA-DR4 (DRB1* 0401) and related alleles are known to be major genetic risk factors for ra

Epidemiology and Genetics  Family studies indicate a genetic predisposition.  The class II major histocompatibility complex allele HLA-DR4 (DRß1*0401) and related alleles are known to be major genetic risk factors for RA

Environmental factors also play a role in the etiology of the disease, such as stress, humidity, cold infectious agent and cigarette smoking It has been suggested that developed ra might be a response to an incentive in a genetically susceptible host

 Environmental factors also play a role in the etiology of the disease，such as stress, humidity, cold, infectious agent and cigarette smoking  It has been suggested that developed RA might be a response to an incentive in a genetically susceptible host

Pathology and Pathogenesis PMN PGE LT HSP EBV CIL ILI TNFa APC T cell B cell Ab(RFAPF) O IC 类风湿关节炎 HILADRBI TCRVB- 0401、*04043,14,17 TNFa T cell O

Pathology and Pathogenesis TNF IL1 Ab(RF.APF) IC M PMN IL1 TNF PGE LT 类 风 湿 关 节 炎 APC HSP EBV CII HLADRB1 *0401、*0404 TCRV- 3,14,17 T cell T cell B cell TNF IL1 Ab(RF.APF) IC M PMN IL1 TNF PGE LT 类 风 湿 关 节 炎 APC HSP EBV CII HLADRB1 *0401、*0404 TCRV- 3,14,17 APC T cell HSP EBV CII HLADRB1 *0401、*0404 TCRV- 3,14,17 T cell T cell B cell

Pathology and Pathogenesis a Pathologic Finding: chronic synovitis In acute phase: effusion and cell infiltration In chronic phase: the number of synoviocyte, new capillary mononuclear cells remarkably increases the pannus(血管翳) protrudes into the joint cavity as villous Pannus erodes cartilage, bone 类风湿性关节炎滑膜病理 Normal Diarthrodial Joint gaments and tendons Periosteum bone plate. Articular cartilage Synovial fluid Muscle novum Ligament

Pathology and Pathogenesis  Pathologic Finding： chronic synovitis In acute phase: effusion and cell infiltration In chronic phase: the number of synoviocyte, new capillary mononuclear cells remarkably increases  the pannus(血管翳) protrudes into the joint cavity as villous  Pannus erodes cartilage, bone, ligaments and tendons

Normal synovium RA: inflammatory synovium br .hyperplasia and hypertrophy of thei synovial lining cells neovascularization infiltration with mononuclear cells

•hyperplasia and hypertrophy of the synovial lining cells •neovascularization •infiltration with mononuclear cells Normal synovium RA：inflammatory synovium

Clinical Manifestations a The usually age at onset is 35-50 years a The ratio of female to male is 3: 1 The onset of ra is usually insidious a Systemic symptoms of fatigue, fever, weight loss anorexia, generalized weakness may be seen

Clinical Manifestations  The usually age at onset is 35-50 years  The ratio of female to male is 3:1  The onset of RA is usually insidious  Systemic symptoms of fatigue, fever, weight loss anorexia, generalized weakness may be seen

articular manifestations (1) morning stiffness(晨僵) O stiffness persisting for over 60 minutes is prominent in the morning or during rest and subsides after daytime activity a The persisting length of morning stiffness is associated with the degree of articular inflammation

articular manifestations （1）morning stiffness（晨僵）  stiffness persisting for over 60 minutes is prominent in the morning or during rest and subsides after daytime activity  The persisting length of morning stiffness is associated with the degree of articular inflammation