A clinical discipline that mainly studies joints, bones and their surrounding tissues (such as muscles, bursae, tendons, fascia, ligaments) Key symptoms: pain, swelling (redness), tenderness, and dysfunction

Type 1 diffuse connective tissue disease

Category II seronegative spondyloarthropathy

Category III degenerative changes

Category 4 Rheumatic diseases associated with infection

Category 5 Metabolism and Endocrinology

Category 6 Neoplasia

Category 7 Neurovascular Disease

Category 8 Bone and cartilage lesions

Category 9 Non-articular rheumatism

Category 10: Other diseases with joint symptoms

1983 ARA Standard

Note: Rheumatic diseases are not the same as rheumatic fever Joint diseases are not simply classified by rheumatism and rheumatoid

clinical manifestations

The kidneys have rich blood flow and the glomerulus serves as a blood filter

Immune complex deposition and vasculitis important prone areas

Most CTDs can involve the kidneys

Non-specific target organs most commonly affected by CTD

Easily confused with other diseases and ignored

Peripheral neuropathy

epileptiform seizures

Psychiatric symptoms

cerebral vascular embolism

The complement system is composed of a group of interacting proteins that are involved in immune and inflammatory responses and have the function of strengthening and amplifying antibody responses.

Reduced complement is seen in many immune diseases, mostly due to excessive consumption of complement. Such as SLE, acute glomerulonephritis, SLE complicated by nephropathy, cryoglobulinemia and certain hemolytic diseases and serum sickness.

Autoantibodies (antibodies produced against one's own tissues, organs, cells and cellular components) refer to immunoglobulins against intracellular, cell surface and extracellular antigens of one's own cells. They are found in a variety of rheumatic diseases, especially in diffuse connective tissue diseases. is more common in .

Autoantibody detection methods

In autoimmune diseases, the cell nucleus often becomes the target of autoimmune reactions. The nuclear envelope, chromatin in the nucleus, non-histone proteins, and various riboproteins composed of ribonucleic acid (RNA) and related proteins may be Autoantibody attack. (anti-DNA, anti-histone, anti-non-histone, anti-nucleolar antibodies, antibodies to other cellular components)

ANA can be positive in many rheumatic diseases, such as SLE, SSc, SS, RA, etc. Healthy elderly people, infectious diseases, chronic liver diseases, primary pulmonary fibrosis, tumors and those taking certain drugs (isoniazid, phenytoin, hydralazine, procainamide) may also be positive.

Lack of specificity and not related to disease activity

High specificity for diagnosing SLE The rise and fall of antibody titers is related to the activity of SLE disease Radioimmunoassay (Farr method), indirect immunofluorescence method

ANCA, named for its anti-neutrophil cytoplasmic component, is an autoantibody present in the blood. In 1985, Van der Woude et al. used IIF to find that ANCA was highly specific for Wegener's granulomatosis (WG), and the antibody titer was related to disease activity. Classic IIF detection of ANCA, positive fluorescent staining models can be divided into two types: Cytoplasmic (CANCA-PR3 serine protease 3) GPA Perinuclear type (PANCA-MPO myeloperoxidase) MPA, EGPA

Antibodies to saline extractable nuclear antigens Generally made from the spleen and thymus of animals Western blot detection The main ingredients include u1-RNP, Sm, SSA, SSB, Scl-70, Jo-1, r-RNP seven antigens

The main ingredients include seven antigens: u1-RNP, Sm, SSA, SSB, Scl-70, Jo-1 and r-RNP. Sm — SLE labeled antibody SSB — PSS-specific antibodies Jo-1 — PM/DM serum labeled antibodies

APL antibodies are a group of autoantibodies that can react with a variety of antigenic substances containing phospholipid structures, mainly including anticardiolipin antibodies (ACL antibodies), lupus anticoagulant (LAC), and anti-β-GP1 antibodies.

The target antigen is the Fc fragment of the denatured IgG molecule High titers correlate with disease activity and severity, and often have severe extra-articular manifestations In addition to CTD, it can be seen in infections, lymphomas and normal people

ELISA method detection Highly specific for rheumatoid arthritis Helps diagnose early RA related to the severity of the disease

Anti-double-stranded DNA is highly specific for the diagnosis of SLE and is associated with disease activity. DNA-anti-DNA immune complexes play an important role in lupus nephritis Anti-Sm: It is an SLE marker antibody that helps prospective and retrospective diagnosis. It often coexists with nRNP antibodies.

Anti-nRNP exists in a variety of connective tissue diseases, and high titers are beneficial to the diagnosis of MCTD. Anti-rRNP antibodies are related to SLE, especially those with psychoneurological symptoms have a higher positive rate.

Anti-SSA and anti-SSB are associated with Sjogren's syndrome and can cause neonatal lupus and congenital heart block. Anti-ScL-70: a marker antibody for systemic sclerosis.

Anti-Jo-1 is a marker antibody for polymyositis/dermatomyositis. Anti-Jo-1-positive myositis patients with arthritis, "technician's hand", Raynaud's disease, interstitial pulmonary degeneration, etc. are called anti-synthetase antibody syndrome. . Antihistone antibodies are associated with a variety of connective tissue diseases and can aid in the diagnosis of drug-induced lupus. Anti-nucleolar antibody, anti-SCL-70, is often associated with systemic sclerosis.

Highly associated with seronegative spondyloarthropathy

Ankylosing spondylitis 95% Reiter syndrome 80% Enteropathic arthritis 50% Psoriatic arthritis 70%

X-Ray: reflects the degree of joint damage, the speed of disease progression and response to treatment. It should be listed as a routine examination item and should be reviewed regularly. CT ECT MRI Ultrasound

Eradicate the original cause of the disease Control inflammatory response Prevent tissue damage Promote tissue and functional recovery

Early diagnosis (critical) Emphasis on treatment strategies (patient education, multidisciplinary cooperation, functional exercise) Tolerance (５D), compliance principle of individualization

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Glucocorticoids

Disease-modifying antirheumatic drugs (DMARDs) or slow-acting antirheumatic drugs (SAARDs)

botanical medicine

Biologic Agents

adjuvant therapy