病例分析一一类风湿关节炎概述类风湿关节炎（RA）是一种以慢性破坏性关节病变为特性的全身性本身免疫 病。本病以双手、腕、膝、踝和足关节的对称性多关节炎为主。可伴有发热、贫 血、皮下结节及淋巴结肿大等关节外体现，血清中可出现多个本身抗体。临床体现（一）关节体现1.疼痛及压痛：关节疼痛的最常见部位是双手近端指间关节、掌指关节、腕关节，特点为持续性和对称性关节疼痛和压痛。Rheumatoid arthritis usually affects joints symmetrically (on both sides equatlyh may 耳 initially begin in a Couple of joints only, and most frequently attacks the wrists^ hands* elbows, shoulders, knees and anklesRheumatoid arthritis usually affects joints symmetrically (on both sides equatly)t may initially begin in a couple of joints only, and most frequently attacks the wri5tst hands, elbows, shoulders, knees and ankles2.肿胀：以双手近端指间关节、掌指关节及腕关节最常受累Rheumatoid Arttirtti^Rheumatoid Arthritis闻 ll 松 2 関工 VfeijMD 1.-1L. All「叩亦 ie&ervea.reded canbage axl narrowed joint space[nnamed membrane' and swollen pnt3. 晨僵：是指关节部位的发紧和僵硬感。清晨起来时明显，活动关节后改善＜4. 关节畸形：晚期患者可出现关节破坏和畸形。关节畸形最常见于双手近端 指间关节、掌指关节及腕关节。般为直径数毫米至数厘米Rheinnatoid arthritis (late stage)Boutonniere deformity of thumb(JLnar deviation of metacarpophalangeal jointsRheumatoid arthnti ((ate stage)Swan neck deformity of fingersSwan^neck deformity of fingersBoutonniere deformity of thumbUinar deviation of metacarpophalangeal joints5.骨质疏松（二）关节外病变1.类风湿结节：多发于易受摩擦的骨突起部位, 的硬性结节，不易活动，无疼痛及触痛。2. 血管炎：临床上出现指（趾）坏疽、梗塞、皮肤溃疡、紫癜、角膜炎、视 网膜血管炎或肝脾肿大。3. 心脏：可出现心包炎、心内膜炎和心肌炎。4. 胸膜和肺：常见肺间质纤维化和胸膜炎。5. 肾损害：本病可出现膜性及系膜增生性肾小球肾炎、间质性肾炎、淀粉样 变性等。6. 神经系统损害。7. 淋巴结病：可伴有淋巴结肿大。8. 其它关节...
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