类风湿关节炎诊断及治疗指南(2010年)。

ACR/EULAR2009年的类风湿关节炎诊断标准这个是临床诊断为骨性关节炎的病人，按Kellgren-Lawrence分期。

目前了解到Kellgren和Lawrence的放射学诊断标准，将骨性关节炎分为五级：0级：正常；Ⅰ级：关节间隙可疑变窄，可能有骨赘；Ⅱ级：有明显骨赘，关节间隙可疑变窄；Ⅲ级：中等量骨赘，关节间隙变窄较明显，有硬化性改变；Ⅳ级：大量骨赘，关节间隙明显变窄，严重硬化性病变及明显畸形。

膝关节炎的影像学评估与功能、疼痛及肌力评估的关系Para Español haga clic aquí.FAST FACTS∙OA is the most common form of joint disease in humans and is a leading cause of disability among the elderly.∙It typically occurs in the hand joints, spine, hips and knees.∙It is caused by cartilage breakdown and subsequent bony changes of the joints.∙Although the joint changes are irreversible, only a small number of patients will progress to the point that requires joint replacement surgery.∙OA symptoms can vary greatly among patients. Y our rheumatologist can make the diagnosis and prescribe appropriate treatment recommendations for you.In osteoarthritis, the cartilage between the bones in the joint breaks down, and bony enlargement occurs.WHA T IS OSTEOARTHRITIS?Osteoarthritis (OA) is a slowly progressive joint disease typically seen in middle-age to elderly people. It occurs when the joint cartilage breaks down, causing the underlying bone to fail. OA symptoms include joint pain, stiffness, knobby swelling, cracking noises with joint movements and decreased function. It typically affects the joints of the hands and spine and weight-bearing joints such as the hips and knees.WHO GETS OSTEOARTHRITIS?OA typically occurs in patients age 40 and above. However, some risk factors might cause it to occur sooner (see below). It affects people of all races and gender.WHA T ARE THE RISK FACTORS FOR OSTEOARTHRITIS?∙Older age∙Family members with OA∙Obesity∙Joint trauma or repetitive use of jointsHOW IS OSTEOARTHRITIS DIAGNOSED?OA usually is diagnosed by having typical symptoms and physical examination as described above. In some cases, imaging studies may be useful to tell the extent of disease or to help rule out other joint problems.The circles on this figure indicate joints that are commonly affected by osteoarthritis.HOW IS OSTEOARTHRITIS TREATED?The goal of treatment is to reduce pain and improve function of the affected joints. This can be achieved with a combination of physical measures, drug therapy and, sometimes, surgery.Physical measures– Exercise, support devices and thermal therapy are useful in OA. Some forms of unproven alternative treatment such as spa, massage, acupuncture and chiropractic manipulation can help relieve pain for a short duration, but usually are costly and require repeated treatments.Drug Therapy– Available forms of drug therapy include topical and oral agents. Topical drugs, which include capsaicin cream, lidocaine, and diclofenac gel, can be applied directly on the skin overlying the affected joints. Oral pain relievers such as acetaminophen, and nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used as first-line treatment. For more serious pain, stronger medications, such as narcotics, may be required. Joint injections with corticosteroids or a form of lubricant called hyaluronic acid (HA) derivatives have proven effective for some patients.Surgery– Arthroscopy and/or joint replacement is considered when the joint is seriously damaged, or the patient is in intractable pain and experiencing significant loss of function.Supplements– Many over-the-counter nutritional supplements have been used for treatment of OA, but most lack good research data to support their effectiveness and safety. Among the most widely used areglucosamine/chondroitin sulfate, calcium and vitamin D, and omega-3 fatty acids. To ensure safety and avoid drug interaction, consult your doctor or pharmacist before using any of these agents, especially in combination with prescribed drugs.LIVING WITH OSTEOARTHRITISThere is no cure for OA, but you can manage how it impacts your lifestyle. For instance, giving proper positioning and support to the neck and back during sitting or sleeping; adjusting furniture, such as raising a chair or toilet seat; and avoiding trauma and repetitive motions of the joint, especially frequent bending, are great starts.Adding regular exercise to your daily activities will improve muscle strength. Exercises that increase strength of the quadriceps muscles (the front thigh muscles) also can help decrease knee pain and reduce subsequent disability associated with osteoarthritis. Working with a physical or occupational therapist can help you learn the best exercises and choose appropriate assistive devices for your joints.Weight loss in obese people can reduce pain and progression of OA. Achieving and keeping an ideal weight will make a difference in your overall comfort levels.POINTS TO REMEMBER∙OA is the most common form of arthritis and can occur together with other types of arthritis.∙Evaluation by your doctor will help confirm the diagnosis and develop an appropriate treatment plan for your condition.∙The goal of treatment in OA is to reduce pain and improve function.∙At present, there is no available therapy that can reverse the damage of OA in the joint, but many studies are underway.TO FIND A RHEUMA TOLOGISTFor more information about rheumatologists, click here.Learn more about rheumatologists and rheumatology health professionals.FOR MORE INFORMATIONThe American College of Rheumatology has compiled this list to give you a starting point for your own additional research. The ACR does not endorse or maintain these Web sites, and is not responsible for any information or claims provided on them. It is always best to talk with your rheumatologist for more information and before making any decisions about your care.Arthritis FoundationUpdated August 2009Written by Thitinan Srikulmontree, MD, and reviewed by the American College of Rheumatology Patient Education Task Force.This patient fact sheet is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnoses and treatment of a medical or health condition.© 2010 American College of Rheumatology5次坐-立试验在膝骨关节炎患者功能评估中的价值。

类风湿性关节炎的诊断标准风湿性关节炎（Rheumatoid Arthritis，RA）是一种慢性炎性关节病，全身性诊断标准（2010年版）可用于诊断RA。

诊断标准包括：1. 精确定义的弥漫性关节炎活动（至少4周）- 对应弥漫性关节炎列表（synovial joint lists）4项或更多关节的活动性的发炎。

2. 同一时间至少有1个细胞培养定量检测（Radiographic Quantitative Assay，RQA）阳性反应- 血清共行联合抗体（CommonAssociated Immunoglobulin，CAI-IgG或IgA）蛋白水平较正常检测值增高，或，用现代囊膜色素（Modern Mucopigment）测试显示抗体滴度大于常值。

3. 同时有至少2处活动性骨质结核损伤- 可用X光检查、磁共振成像（MRI）或其他影像学检查，根据发病规律判断多处骨质结核损伤。

4. 其他相关的免疫性和血清学检查的阳性反应- 这些检查包括：血清C-反应蛋白（CRP）水平高于正常范围；粪便抗IgA抗体检测（Fecal Antibody Test for IgA）阳性；180度双侧抗体评估测定（Double Blind Assessment，DBA）阳性；RQA测定的抗体IgG水平高于常规检查值；血清促炎因子（Serum Inflammatory Factors，SIF）测定高于正常范围；RA抗原（Rheumatoid Antigen）水平增高；抗核抗体（Anti-nuclear Antibody, ANA）阳性；抗类风湿抗体（Anti-Rheumatic Antibody，ARA）阳性。

以上8个检查项目，至少满足4条标准，同时兼具以上4个特征可以诊断RA。

另外，还需要更详细的检查，如血常规检查，白细胞介素-6（Interleukin—6，IL—6），粪便抗体测定，以及对病因的进一步研究，如肿瘤基因突变检查等。

骨关节炎诊断及治疗指南中华医学会风湿病学分会1概述骨关节炎（Osteoarthritis，OA）是一种最常见的关节疾病。

是以关节软骨的变性、破坏及骨质增生为特征的慢性关节病。

本病的发生与衰老、肥胖、炎症、创伤、关节过度使用、代谢障碍及遗传等因素有关。

骨关节炎在中年以后多发，女性多于男性。

本病在40岁人群的患病率为10%-17%，60岁以上为50%，而在75岁以上人群则高达80%。

该病有一定的致残率。

本病按病因分为原发性骨关节炎和继发性骨关节炎。

前者是指原因不明的骨关节炎，与遗传和体质因素有一定关系，多见于中老年人；后者是指继发于关节外伤、先天性或遗传性疾病、内分泌及代谢病、炎性关节病、地方性关节病、其他骨关节病等。

有时很难鉴别原发性骨关节炎和继发性骨关节炎。

问诊和体格检查可以帮助判断病因。

影像学检查有助于继发性骨关节炎的诊断。

本病按是否伴有临床症状分为症状性骨关节炎和放射学骨关节炎。

前者伴有明显的骨关节炎临床症状，而后者无临床症状只有X线骨关节炎表现。

2临床表现2.1常见症状和体征本病好发于膝、髋、手（远端指间关节、第一腕掌关节）、足（第一跖趾关节、足跟）、脊柱（颈椎及腰椎）等负重或活动较多的关节。

2.1.1关节疼痛及压痛：本病最常见的表现是关节局部的疼痛和压痛。

负重关节及双手最易受累。

一般早期为轻度或中度间断性隐痛，休息时好转，活动后加重，随病情进展可出现持续性疼痛，或导致活动受限。

关节局部可有压痛，在伴有关节肿胀时尤为明显。

疼痛在阴冷、潮湿和雨天会加重。

2.1.2关节肿大：早期为关节周围的局限性肿胀，随病情进展可有关节弥漫性肿胀、滑囊增厚或伴关节积液。

后期可在关节部位触及骨赘。

2.1.3晨僵：患者可出现晨起或关节静止一段时间后僵硬感，称为晨僵，活动后可缓解。

本病的晨僵时间一般数分钟至十几分钟，很少超过半小时。

2.1.4关节摩擦音（感）：多见于膝关节。

由于软骨破坏、关节表面粗糙，出现关节活动时骨摩擦音（感）。

2010类风湿性关节炎诊断标准一、诊断标准概述类风湿性关节炎（RA）是一种慢性自身免疫性疾病，其主要特点是炎症性多系统损害，导致关节疼痛、肿胀和僵硬，并最终导致关节畸形。

RA的诊断通常基于临床、实验室和影像学检查的综合结果。

以下是2010年ACR/EULAR提出的类风湿性关节炎诊断标准。

二、疾病历史和家族史1. 至少一个关节肿胀或疼痛，持续至少6周；2. 至少一个关节活动受限或畸形；3. 炎症性滑膜炎的典型症状（如关节晨僵，活动后缓解，以及皮肤下的类风湿结节）；4. 类风湿因子（RF）阳性；5. 有RA的家族史。

注：满足以上至少四项可诊断为RA。

三、临床表现1. 关节表现：RA常影响多个关节，尤其是手足小关节，表现为肿胀、疼痛和僵硬。

随着病情发展，可出现关节活动受限、畸形和功能受损。

2. 系统表现：RA可累及身体其他器官和系统，如皮肤、眼睛、肺、心脏、血管等。

常见症状包括疲劳、体重减轻、发热、盗汗、贫血等。

四、实验室检查1. 类风湿因子（RF）：RF是一种自身抗体，在约70%的RA患者中可检测到。

但RF阳性并不一定意味着RA的诊断，因为其在其他自身免疫性疾病和感染性疾病中也可能出现。

2. 抗瓜氨酸抗体（ACAs）：包括抗CCP抗体和抗AKA抗体。

这些抗体在RA患者中具有较高的特异性，有助于早期诊断。

3. 其他实验室指标：包括血沉（ESR）、C反应蛋白（CRP）、白细胞计数等，这些指标可反映疾病活动度。

五、影像学检查1. X线检查：X线平片可显示关节炎症、增生和畸形等病变。

2. 超声检查：关节超声可用于评估滑膜炎的严重程度和治疗效果，且具有无创、便捷的优势。

3. MRI检查：MRI对软组织的显示能力优于X线和超声，可更早地发现关节病变。

六、病理学检查1. 滑膜活检：通过关节镜或切开手术获取滑膜组织样本进行病理检查，可观察到RA特征性的滑膜病理改变。

2. 皮下结节活检：类风湿结节是RA的典型表现，对其活检可显示类风湿性肉芽肿。

类风湿关节炎病证结合诊疗指南1范围本《指南》规定了类风湿关节炎的流行病学、诊断要点、辨证论治、中成药选择、外治疗法、预防调摄、治疗推荐等。

本《指南》适用于类风湿关节炎病证结合诊断和治疗。

2规范性引用文件下列文件对于本规范的应用是必不可少的。

凡是注明日期的引用文件，仅所注明日期的版本适用于本规范。

凡是不注明日期的引用文件，其最新版本（包括所有的修改版本）适用于本文件。

证据推荐级别及证据水平，参照[1]2001年牛津证据分级与推荐意见强度。

GB/T1.1-2009《标准化工作导则第1部分：标准的结构和编写》《中医药标准制定管理办法（试行）》GB/T16751.1-1997《中医临床诊疗术语-疾病部分》GB/T16751.2-1997《中医临床诊疗术语-证候部分》2015American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis3术语及定义下列术语和定义适用于本规范。

3.1病证结合Combination of Diseaseand Syndrome辨病与辨证相结合的研究模式，主要是指现代医学诊断疾病结合辨证论治模式。

3.2药品不良反应adverse drug reaction，ADR合格药品在正常用法用量下出现的与用药目的无关的有害反应。

4流行病学类风湿关节炎（Rheumatoid arthritis,RA）是一种以对称性多关节炎为主要临床表现的自身免疫性疾病，以关节滑膜慢性炎症、关节的进行性破坏为特征。

目前发病原因不明，可能与遗传、免疫、感染、环境等因素有关，该病属于中医风湿病（痹证、痹病）范畴，中医诊断为“尪痹”[2]。

RA几乎见于世界所有的地区和各种族；目前患病人数约占世界总人口的1.0%，中国的发病率大约为0.28-0.4%[3]。

RA可以发生于任何年龄，女性高发年龄为45～54岁，男性随年龄增加而发病率上升，男女罹患本病的比例约为1:3[4]。