痛风强直性脊柱炎VIP专享VIP免费

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。...