强直性脊柱炎强直性脊柱炎是一种慢性、进行性和炎性疾病，病变部位主要在骶髂关节、脊柱、脊柱旁软组织及四肢关节。该病变常自骶髂关节开始，逐渐向上蔓延到脊柱及脊旁组织，最后引起骨性强直。一、概念二、流行病学1.自古有之。2.HLA-B27阳性。3.遗传和环境因素。ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel遗传因素分子模拟学说。自身隐匿抗原暴露。三、病因和发病机制四、病理1.附着点病。2.滑膜炎3.关节外病变五、临床表现(1)常有腰痛或不适。常为隐痛难以定位。其发生率在90％左右。夜间痛。休息不能缓解，活动能使症状改善。非对称性，反复发作与缓解。脊柱强直：腰椎前凸消失，驼背畸形。一、症状：五、临床表现(4)外周关节症状：眼虹膜睫状体炎，出现眼痛、畏光和流泪。心脏主动脉瓣病变肺纤维化下肢周围神经病变而出现下肢膝以下部位肌肉酸痛和麻木ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel虹膜炎ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel“4”字试验1.4字试验体征：ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel2.schober试验3.胸廓活动度检查ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel４.枕墙距检查ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel六、实验室检查化验：无特异性X－ray：骨盆正位片，腰椎正、侧位片。早期尤现骶髂关节的轻微病变。ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel骨盆正位片ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel腰正、侧位片ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel炎症反应ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel七、诊断1、腰痛、晨僵3个月以上。2、腰椎额状、矢状面活动受限。3、胸廓活动度低于同龄正常人。4、X－ray：骶髂关节炎双侧≥2级或单侧3～4级肯定诊断：X－ray＋1项临床可疑诊断：符合3项临床标准或有X－ray改变而无临床征象。ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel鉴别诊断：机械性腰痛。骨质增生。类风湿性关节炎。ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel八、治疗目的：缓解症状，延缓进展一般治疗：1、鼓励病人，增强对治疗的信心。2、合理运动3、理疗。ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel药物治疗：1、非甾体类消炎药2、肾上腺皮质激素3、慢性用药ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel功能锻炼：ClicktoeditMastertitlestyleClicktoeditMastertextstylesSecondlevelThirdlevelFourthlevelFifthlevel功能锻炼：痛风痛风痛风是嘌呤代谢紊乱或尿酸排泄障碍所致以高尿酸血症、痛风性关节炎、痛风石沉积为特征的一种疾病.一、概念二、病因和发病机制嘌呤代谢异常。高尿酸血症。腺苷酸脱氨酶次黄苷嘌呤核苷（ADA）磷酸化酶（PNP）AMPIMP次黄苷三、临床表现1.无症状期:2.急性关节炎期:午夜起病,拇趾及跖趾关节。发热，秋水仙碱特效。自限性。高尿酸血症。关节液白C尿酸盐三、临床表现3.痛风石：多关节受累，远端多见。关节肿胀、僵硬、畸形。无定形且不对称。瘘管及豆渣物质排出。破溃而少感染。三、临床表现4.肾病变：肾髓质及椎体尿酸盐沉着。间歇性蛋白尿。夜尿增多，等渗尿。肾功能衰竭。...
