风湿病总论2015年.ppt

激素副作用——多毛症 皮肤菲薄脆性增加 激素副作用 - 皮肤菲薄不易愈合 U善用激素 ≠滥用激素 甲氨喋呤 柳氮磺吡啶 羟氯喹 来氟米特 硫唑嘌呤 环孢素 The top three! 植 物 药 历史上曾用过 奎宁 麻黄素 洋地黄 雷公藤 青风藤 白芍总甙 TNF?抑制剂 - 目前最有效和最有希望的 生物制剂 - 已在国内陆续上市 生 物 制 剂 细胞因子的抑制作用 炎性细胞因子 正常的相互作用 细胞因子的中和作用 阻断受体 抗炎症过程的激活 细胞因子受体 可溶性受体 单克隆抗体 单克隆抗体 受体拮抗剂 抗炎细胞因子 抑制炎性细胞因子 无信号产生 无信号产生 炎症信号 3/4为人源性， 1/4为鼠源性，抗原结合区 可结合可溶性及细胞膜上的TNF?，阻断炎症反应 单独使用或与MTX联用 infliximab (Remicade) Etanercept (Enbrel) 为一可溶性TNF?受体，可中和TNF?的体内活性 单独使用与MTX疗效相当，副作用小于MTX 目前疗效最为肯定的生物制剂 Humira (adalimumab ) 抗人肿瘤坏死因子(TNF)的人源化单克隆抗体 国外2003年上市，国内III期临床试验 治疗类风湿关节炎、强直性脊柱炎、银屑病关节炎等疗效确切。 外 科 治 疗 治 疗 展 望 基因治疗 干细胞移植治疗 血液净化疗法 风湿科 骨科 皮肤科 眼科 耳鼻喉科 口腔科 呼吸内科 循环内科 消化内科 泌尿内科 神经内科 血液科 妇产科 谢谢大家！ * Someone with osteoarthritis in the hips is likely to feel pain in the groin, inner thigh, or outer portion of the hip. Some people feel what is called “referred pain” in the knee or along the side of the thigh. Referred pain is pain in an area which is not directly affected by the condition. The pain from osteoarthritis in the hip may cause you to limp when walking. * * * Someone with osteoarthritis in the hips is likely to feel pain in the groin, inner thigh, or outer portion of the hip. Some people feel what is called “referred pain” in the knee or along the side of the thigh. Referred pain is pain in an area which is not directly affected by the condition. The pain from osteoarthritis in the hip may cause you to limp when walking. * Someone with osteoarthritis in the hips is likely to feel pain in the groin, inner thigh, or outer portion of the hip. Some people feel what is called “referred pain” in the knee or along the side of the thigh. Referred pain is pain in an area which is not directly affected by the condition. The pain from osteoarthritis in the hip may cause you to limp when walking. * Someone with osteoarthritis in the hips is likely to feel pain in the groin, inner thigh, or outer portion of the hip. Some people feel what is c