小结
定义
病史和体格检查
关键诊断因素
- 持续＞6 周的活动性对称性关节炎
- 年龄在 50-55 岁之间
- 女性
- 关节痛
- 关节肿胀
其他诊断因素
- 晨僵
- 天鹅颈样畸形
- 钮扣状畸形
- 尺侧偏斜
- 类风湿结节
- 血管炎性损伤
- 胸膜炎性胸痛
- 巩膜炎和/或葡萄膜炎
危险因素
- 遗传易感性
- 吸烟
诊断性检查
首要检查
- 类风湿因子 (RF)
- 抗环瓜氨酸肽（抗 CCP）抗体
- 影像学检查
- 超声检查
需考虑的检查
- 疾病活动度评分
治疗流程
最初发病时疾病活动度呈轻度：非妊娠或计划妊娠
最初发病时有中度至重度疾病活动度：非妊娠或计划妊娠
妊娠或计划妊娠
经 3 个月治疗后病情未达到低疾病活动度者：未妊娠或无计划妊娠
撰稿人
作者
Yusuf Yazici, MD
Clinical Associate Professor of Medicine
New York University School of Medicine
New York
NY
利益声明
YY receives research support from BMS and Genentech; he has consulted for Amgen, BMS, and Sanofi.
同行评议者
Chris Deighton, BMedSc, MD, FRCP
Consultant Rheumatologist
Department of Rheumatology
Royal Derby Hospital
Derby
UK
利益声明
CD has received honoraria for talks at symposia sponsored by Wyeth and Abbott.
Raashid Luqmani, DM FRCP, FRCP(E)
Consultant Rheumatologist
Nuffield Orthopaedic Centre
Senior Lecturer in Rheumatology
Botnar Research Centre
University of Oxford
Oxford
UK
利益声明
RL declares that he has no competing interests.
Alan Bridges, MD
Professor of Medicine
Section of Rheumatology
University of Wisconsin
Madison
WI
利益声明
AB has received fees for speaking and consulting from Abbott, BMS, UCB, and Genentech.
John Kirwan, BSc, MB, BS, MD
Emeritus Professor of Rheumatic Diseases
School of Clinical Sciences
University of Bristol
Bristol
UK
利益声明
JK declares that he has no competing interests.
Paul Emery, MA, MD, FMedSci
Professor of Rheumatology
Arthritis Research UK
Director
Leeds Institute of Rheumatic and Musculoskeletal Medicine
University of Leeds
Director
Leeds Musculoskeletal Biomedical Research Unit
Leeds Teaching Hospitals NHS Trust
Leeds
UK
利益声明
Not disclosed.
Prabha Ranganathan, MD, MS
Associate Professor of Medicine
Division of Rheumatology
Washington University School of Medicine
St Louis
MO
利益声明
PR declares that she has no competing interests.
鉴别诊断
- 银屑病关节炎 (Psoriatic arthritis, PsA)
- 感染性关节炎
- 痛风
更多 鉴别诊断指南
- EULAR 对于难治性类风湿性关节炎的管理考量要点
- 美国风湿病学会类风湿关节炎治疗指南
更多 指南患者教育信息
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