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（俞云松）
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内科学新进展 第十章 风湿免疫性疾病
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第一节 风湿免疫性疾病诊疗标准及治疗原则
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摘 要 本章介绍了临床上较为常见的风湿免疫性疾病包括类风湿关节炎、系统性红斑狼疮、皮肌炎／多发性肌炎、干燥综合征、混合性结缔组织病、系统性硬化、系统性血管炎、成人斯蒂尔病、强直性脊柱炎的诊断标准及治疗原则。
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Abstract This section describes the diagnostic criteria and treatments of common rheumatic autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, dermatomyositis / polymyositis, Sjogren’s syndrome, mixed connective tissue disease, systemic sclerosis, the system vasculitis, adult onset Still’s disease, ankylosing spondylitis.
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风湿免疫性疾病的研究范畴，当今已远远不仅指风湿热、风湿关节炎以及类风湿性关节炎，而是泛指累及骨、关节及其周围软组织，如肌腱、滑囊、筋膜、肌肉等的一组疾病。病因多样，如感染性、免疫性、代谢性、内分泌性、退化性、地理环境性、遗传性等。随着分子生物学、细胞生物学、免疫学、遗传学和临床医学的迅猛发展，风湿免疫性疾病的研究范畴不断扩充，美国风湿病学学会从疾病的病因学、组织学、病理学、生物化学、遗传学、免疫学以及临床学等不同角度进行归纳分类，分为十类，共包括了100多种疾病。而临床上比较多见的仍是第一大类即弥漫性结缔组织病如系统性红斑狼疮（SLE)、类风湿关节炎（RA)、多发性肌炎／皮肌炎（PM/DM)、干燥综合征（SS)、混合性结缔组织病（MCTD)、系统性硬化症、系统性血管炎等。由于近年来风湿免疫性疾病诊断及治疗水平不断提高，新病种不断发现，现将以上这些临床上较为常见的风湿免疫性疾病的诊断标准、治疗原则及疗效标准介绍如下。
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一、类风湿关节炎（rheumatioid arthritis, RA)
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（一）分类标准
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（1）晨僵：关节内或关节周围晨僵，每日持续至少1h，持续至少6周。
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（2）3个或3个以上关节炎：14个关节区中至少有3个同时出现肿胀，持续至少6周。
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