自体免疫疾病.ppt

自体免疫疾病
器官特异性
非器官特异性
自体免疫疾病
肌肉
肾脏
皮肤
关节
Pathological Factors in Rheumatic Disorders
Rheumatic dise
类风湿性关节炎(RA)
Rheumatoid arthritis
类风湿性关节炎(RA)
类风湿性关节炎(RA)
类风湿关节炎的早期关节破坏
类风湿性关节炎的临床病程
变异性极大
只有小于1/5 的病人在发病10-12年内没有出现关节破坏或变形
在发病头六年内关节破坏进展最快 (1st>2nd>3rd..)
在发病头两年内对于关节功能的影响最显着
Markers of severe disease activity in RA
1. General polyarthritis involving both small and large joints
2. Extra-articular disease, especially nodules and vasculitis
3. Persistently elevated ESR or CRP with active synovitis
4. RF-positive with high titier
5. Radiologically erosions within two years of disease onset
6. HLA-DR4 positive
Major extra-articular features of RA
Common
Anemia
Lymphadenopathy
Rheumatoid nodules
Muscle wasting
Episcleritis and keratoconjuntivitis
Peripheral sensory polyneuropathy
Uncommon
Pleural effusion
Pulmonary fibrosis
Pericardial effusion
Systemic vasculitis
Splenomegaly
Rheumatoid Factors
An autoantibody reactive with denatured human or rabbit IgG
Generation of RFs in the following conditions:
Autoimmune disorders: RA, SLE, Sjogren＇s syndrome, vasculitis
Chronic inflammation
Chronic infection
Malignancy
aging
Some Disease Commonly Associated with Rheumatoid Factor
Rheumatic Diseases
Filariasis
Rheumatoid arthritis
Chronic Bacterial infections
Systemic lupus erythematosus
Tuberculosis
Scleroderma
Leprosy
Mixed connective tissue disease
Yaws
Sjogren＇s syndrome
Syphilis
Viral Infections
Brucellosis
Acquired immunodeficiency syndromes
Subacute bacterial endocarditis
Mononucleosis
salmonellosis
Hepatitis
Neoplasms
Influenza
Tumors after radiation therapy or chemotherapy
After vaccination (may yield falsely elevated
Other Hyperglobulinemic States
titers of antivival antibodies)
Hypergammaglobulinemic purpura
Parasitic Infections
Cryoglobulinemia
Trypanosomiasis
Chronic liver disease
Kala-azar
Sarcoid
Malaria
Other chronic pulmonary diseases
Schis