类风湿性关节炎
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　　Rheumatoid Arthritis 365医学网 转载请注明　　类风湿性关节炎 365医学网 转载请注明　　A Patient’s Guide to Rheumatoid Arthritis 365医学网 转载请注明　　类风湿性关节炎患者指南 365医学网 转载请注明　　Introduction 365医学网 转载请注明　　简介&365医学网 转载请注明　　Rheumatoidarthritis&(RA) is a chronic, or long-term, inflammatory form of arthritis. RA is considered anautoimmune disease,&in which your immune system attacks the tissues of your own body. In RA, the immune system mostly attacks tissues in the joints, but it can also affect other organs of your body. In some people, RA seems to run its course more or less by itself. In others, RA gets progressively worse and leads to the destruction of joints. RA can greatly affect your ability to move and do normal tasks. RA can appear at any age, but most patients are between the ages of 30 and 50. About two million Americans have RA, and most of them are women. 365医学网 转载请注明　　类风湿性关节炎（RA）是一种慢性的长期的关节炎症。RA是一种自身免疫疾病，免疫系统会攻击自身组织。在RA中，免疫系统会攻击关节上的组织，但也会影响其他的器官。对于一些人，RA似乎有自限的发展过程，对于另一些人，RA会逐渐的变严重，而且导致关节的破坏。RA对你的行动能力和生活能力会有很大的影响。它会发生在任何年龄，但最多的患者是在30到50岁之间。大约有两百万的美国人患有RA，其中女士居多。 365医学网 转载请注明　　This guide will help you understand 365医学网 转载请注明　　how RA develops 365医学网 转载请注明　　how doctors diagnose the condition 365医学网 转载请注明　　what can be done for RA 365医学网 转载请注明本指南有助于您理解： 365医学网 转载请注明　　类风湿性关节炎是怎样发展的？ 365医学网 转载请注明　　医生怎样诊断这种情况？ 365医学网 转载请注明　　我们能为类风湿性关节炎做什么？ 365医学网 转载请注明Anatomy 365医学网 转载请注明解剖 365医学网 转载请注明　　Where does RA develop? 365医学网 转载请注明　　类风湿性关节炎好发于哪些部位？ 365医学网 转载请注明　　In RA, two things are happening in the joints. First, the immune system causes inflammation in the synovial membrane, called&synovitis. The&synovial membraneis the thin tissue that lines the inside of all joints. At first this causes extra fluid, swelling, and oozing clots in the joint. The pain and swelling of synovitis can be reversed. 365医学网 转载请注明　　在RA里，关节上会发生两件事情。第一，免疫系统会造成滑膜的炎症，也就是滑膜炎。滑膜是衬在所有关节表面的一层薄组织。首先，滑膜炎会产生多余的液体,使其肿胀，还会在关节渗出血块。滑膜炎的疼痛和肿胀是可以逆转的。 365医学网 转载请注明　　Second, the synovitis itself causes other problems in the joint. The blood cells and the swollen membranes release chemicals into the&synovial fluid&(the lubricating fluid of the joint) that can break down or damage the tissues of the joint. This breakdown can cause permanent damage to the cartilage, bone, ligaments, and tendons inside and around the joint. The structural damage usually happens in the first to third year of the disease. The synovitis can come and go, but the structural damage progresses. As a result, the joint becomes painful and very difficult to move. 365医学网 转载请注明　　第二，滑膜炎自身会造成关节的其他问题。血细胞和肿胀的液体（关节的润滑液体）会崩解或损害关节的组织。这种损害会对关节周围和外面的软骨、骨、韧带和肌腱造成永久的破坏。结构的破坏一般在疾病发生的第一年到第三年之间。滑膜炎反复发作，但结构上的破坏是逐步进展的。结果关节变得很痛，而且难以活动。 365医学网 转载请注明　　RA usually affects many corresponding joints on both sides of body. (For example, both knees, both ankles, both wrists, and the same joints in both hands may be affected.) Research indicates that almost all the joints that will be affected show symptoms of RA in the first year of the disease. This means that each joint may continue to get worse, but you probably won’t have many more joints that will develop the symptoms of RA. 365医学网 转载请注明　　RA通常会影响身体两侧相应的关节。（比如，膝关节，踝关节，腕关节，两只手上相应的关节也会受到影响。）研究表明，几乎所有的患者会在发病第一年显现这些症状。这就意味着每一个关节都会逐渐受累，但您可能没有很多关节出现类风湿性关节炎的症状。 365医学网 转载请注明　　Most RA patients have inflammation in the tendons around the joint. (Tendons &connect muscle to bone.)&Nodules,&or bumps, may form on the tendons, or thetendon sheath&(the membrane that surrounds the tendon) may become inflamed.Inflammation&can also occur in other parts of the body, like the lungs. In general, inflammation refers to symptoms of swelling, redness, heat, and pain. 365医学网 转载请注明　　大多RA患者关节周围的肌腱上会发生炎症（肌腱将肌肉连接到骨骼上）。在肌腱上会出现结节或肿块，腱鞘 （肌腱周围的膜）可能会发炎。炎症也会出现在身体其他部位，比如肺。一般，炎症意味着肿，红，热，痛。 365医学网 转载请注明　　Most people think of RA as a disease of the joints, but it is actually a&systemicdiseaseCit affects the whole body. That means that RA can show up in other organs, too, such as the heart, blood vessels, lungs, and eyes. Sometimes RA occurs in joints and other organs, and sometimes it occurs only in other organs. RA works somewhat differently outside the joints, but the underlying problems are still damage to the tissue and loss of function. 365医学网 转载请注明　　许多人认为RA是一种关节疾病，但实际上它是一种全身性系统疾病，它会影响我们整个身体。那就意味着RA会发生在其他器官，比如心脏，血管，肺和眼睛。有时候RA会发生在关节和其他器官上，但一些时候它仅仅会发生在其他器官。RA会在关节外发病与关节病变有些不同，但根本的问题还是会破坏组织并且导致失去功能。&365医学网 转载请注明Causes 365医学网 转载请注明病因 365医学网 转载请注明　　Why do I have this problem? 365医学网 转载请注明　　我为什么会得这种毛病？ 365医学网 转载请注明　　No one knows exactly what causes RA. There are probably different causes in different people. Many doctors and researchers think that a virus or bacteria might cause RA. So far studies haven’t proved this. However, researchers do know that bacteria can cause swelling in the synovial membrane. 365医学网 转载请注明　　没有人知道究竟是什么导致了RA。不同的人可能有不同的原因。许多医生和研究者认为病毒和细菌可能引起RA的原因。到目前为止，研究并没有证明这个观点。然而，研究者们知道细菌会导致滑膜的肿胀。 365医学网 转载请注明　　HeredityCyour genesCplays a part in RA. The disease tends to run in families. If a close relative has RA, you are 16 times more likely to develop the disease yourself. 365医学网 转载请注明　　遗传，你的基因，与RA有一定关系。这个疾病易于在家族中蔓延。如果你的亲属有RA，那你患病的风险比常人高16倍。 365医学网 转载请注明Symptoms 365医学网 转载请注明症状 365医学网 转载请注明　　What does RA feel like? 365医学网 转载请注明　　得了类风湿性关节炎会有哪些症状？ 365医学网 转载请注明　　The primary symptom of RA is pain in corresponding joints (both elbows, both knees, and so on). In rare cases the pain is only in one joint. Most often the pain develops over several weeks. But the pain can come on suddenly. As the pain spreads to other joints, it becomes more symmetrical, meaning that it shows up in the same places on both sides of your body. The pain is directly related to the amount of swelling in the synovial membranes. When the swelling is at its worst, your joints themselves will feel warm and swollen. The pain can come and go with the swelling. 365医学网 转载请注明　　RA早期的症状是相对应的关节疼痛。（两边的肘关节，膝关节，等等。）疼痛很少发生在单侧关节上。通常疼痛会持续几周。但疼痛会没有征兆的突然出现。当疼痛扩散到其他关节，它会变得更对称，这意味着它会出现在你身体两侧相同的位置。疼痛与滑膜肿胀的程度有直接关系。当肿胀很严重时，你的关节会感觉到发热和浮肿。疼痛伴随着肿胀出现和消褪。 365医学网 转载请注明　　RA patients also describe severe morning stiffness that can last up to two hours. The stiffness can be so bad that it makes it hard for you to get dressed, make breakfast, or even get out of bed. This stiffness also corresponds to the synovitis. When the synovitis goes away for a time, so does the stiffness. 365医学网 转载请注明　　RA患者也描述了严重的晨僵持续两小时。晨僵很糟糕，它会导致你很难穿衣服，做早餐，甚至于无法起床。这种僵硬也跟滑膜炎有关。如果滑膜炎消失了，僵硬也会消失。 365医学网 转载请注明　　About half of RA patients have&rheumatoid nodules. The nodules are hard knots, from the size of a pea to the size of a golf ball, that grow under the skin in three distinct layers. They are usually found on the outside of the&elbow, the&Achilles tendon&on your heel, the underside of your fingers, the lower abdomen, and certain toe joints. They look like the kind of bump that grows around a splinter. They don’t usually hurt. Over time they tend to shrink or disappear. 365医学网 转载请注明　　大约有一半的RA患者有类风湿结节。结节是硬块，尺寸小至豌豆大至高尔夫球，它们在皮下生长，有明显的三层。通常会在肘部外发现，足后跟的肌腱，手指的下面，腹部底部，甚至脚尖关节。他们看起来像一个碎片上长了个肿块。它们通常不会疼。随着时间的过去，它们会缩小或者消失。 365医学网 转载请注明　　Because RA is a systemic disease, most patients feel tired and weak during flare-ups. In patients who test positive for&rheumatoid factor&(RF) in their blood, other organ systems can also become inflamed when the joints do. About 50 percent of RA patients have systemic inflammation during joint outbreaks of RA. 365医学网 转载请注明　　因为RA是一种系统性疾病，许多患者会在发病时感觉疲惫和虚弱。那些血液中检测出活跃的类风湿因子(RF)的患者，关节出现炎症时，其他器官组织也会发炎。当RA发生时大约50％的病人会有全身性的炎症症状。 365医学网 转载请注明　　Conjunctivitis, or inflammation of the eye, is common. It may be related to a disease of the eye called&Sjogren’s syndrome, which often occurs along with RA. The main symptom is eye dryness, but patients often can’t even feel it. 365医学网 转载请注明　　结膜炎，是一种眼睛的炎症，很常见。有些结膜炎可能与一种叫干燥综合症的眼部疾病有关，它经常伴随着RA出现。最主要的症状是眼睛干涩，但通常患者感觉不到。& 365医学网 转载请注明　　RA can affect the lungs. Occasionally it can cause an inflammation of the membrane that surrounds the lungs (called the&pleura), which causes pain in the side and sometimes coughing and problems breathing deeply. 365医学网 转载请注明　　RA会影响肺。偶尔它会使包裹肺的膜(称为胸膜)发生炎症，从而引起胸壁疼痛，有时候会产生咳嗽和影响深呼吸。 365医学网 转载请注明　　RA commonly affects the nervous system, but it can be hard to tell from other symptoms of RA. Damage to the joints in the&cervical spine&(the neck) can eventually lead to weakness and instability between the&cervical vertebrae. This damage can cause problems with the spinal cord as it travels through the neck. 365医学网 转载请注明　　RA常常会影响神经系统，但这很与RA的其它症状相区分。颈椎(脖子)的关节损伤最终会导致颈椎的薄弱和不稳。这种破坏会使穿过颈椎的脊髓出现问题。 365医学网 转载请注明　　Some symptoms depend on the affected joints: 365医学网 转载请注明　　一些与关节受累相关的症状： 365医学网 转载请注明　　Cervical spine (the neck): Symptoms include neck stiffness, weakness, and loss of motion. Other symptoms often can’t be felt or seen in exams. Ligaments are often inflamed, and there may be problems with the spinal cord or nervous system.&Neck pain&alone tends to get better, even when the joints are damaged. Damage to the nervous system does not usually improve. 365医学网 转载请注明　　颈椎（脖子）：症状包括颈部僵硬，无力，活动范围减小。其他症状往往不会被感觉到，或在检验中发现。韧带经常会发炎，神经系统和脊髓也可能出现问题。单纯的颈痛有可能会好转，就算关节受到破坏。神经系统的损伤通常不会改善。 365医学网 转载请注明　　Shoulders: The main symptom is loss of motion. Your body’s unconscious reaction to&shoulder&pain is simply not to use your shoulders. Since daily life doesn’t require much shoulder use,&frozen shoulder&syndrome&can set in quickly. 　365医学网 转载请注明　　肩：最主要的症状是活动能力下降。身体对肩膀的疼痛做出的无意识的反应就是不使用肩膀。日常生活中如果不用肩膀，那么很快会发生冰冻肩综合征。&365医学网 转载请注明　　Hands and wrists: Almost everyone with RA has affected wrists. Joints in the middle of your&hand&and fingers are usually affected. The knuckles at the ends of your fingers usually are not. RA can cause joint deformities that freeze&your fingers in unusual positions. Rheumatoid nodules and tendon inflammation can make it hard to bend the fingers. Nodules can cause a locking and catching&action as your fingers bend. 365医学网 转载请注明　　手和手腕：几乎每一个RA患者手腕都会有影响。手中间的关节和指关节经常受累。远端指关节通常不受累及。RA会导致关节畸形，使手指冻结在不寻常的位置。类风湿结节和肌腱炎症使手指难于弯曲。当您在弯曲手指时，结节会产生交锁束缚作用。&365医学网 转载请注明　　Knees: It is easy to feel the swelling in the knees. A fluid-filled lump called aBaker’s cyst&often appears behind the&knee. It can burst and leak fluid into the calf. 365医学网 转载请注明　　膝：膝关节的肿胀很容易发觉。经常在膝关节后方出现一个充满液体的肿块，称为贝克囊肿。有时，它会破裂，液体会流到小腿肚。 365医学网 转载请注明　　Feet and ankles: RA commonly affects the joints in the middle of the toes and the ankle joints. The deformities and pain in the toes can cause problems with walking. The sole of the&foot&can feel tingly or numb. 365医学网 转载请注明　　足和踝：RA通常会影响足趾中间的关节和踝关节。足趾的疼痛和畸形会影响行走。足底会感觉刺痛和麻木。 365医学网 转载请注明　　The progression of RA is hard to predict. The swelling of RA flares up and dies down, and milder forms of the disease often don’t require much treatment. Mild RA may even go undiagnosed. 365医学网 转载请注明　　RA病情的进展是难以预测的。RA的肿胀会突然发作并逐渐消失，病情轻的时候通常不需要太多治疗。轻症的RA甚至在还没作出诊断的时候就已经好了。 365医学网 转载请注明Diagnosis 365医学网 转载请注明诊断 365医学网 转载请注明　　How do doctors identify RA? 365医学网 转载请注明　　医生如何确诊类风湿性关节炎？ 365医学网 转载请注明　　No single test can confirm a diagnosis of RA. Many findings over a period of time lead to the diagnosis. In fact, your doctor can’t even positively diagnose RA until you’ve had symptoms for at least several weeks. Early on, many characteristics of RA haven’t developed yet, such as the pattern of joints that are affected, X-ray findings, and blood test changes. And RA in its early stages can look a lot like other forms of arthritis, such as&lupus,&psoriatic arthritis, and diseases of the spine. Your doctor will need to consider each of these diagnoses and perhaps do tests to rule them out. 365医学网 转载请注明　　没有哪一个单独的检测可以确诊RA。许多发现要经过一段时间才能用于诊断。事实上，您的医生甚至不能确诊RA，直到你出现症状几周之后。在早期，许多RA的特征还没有出现，比如关节受累的类型，X线片和血液检验发现改变。RA早期阶段看起来更像其他形式的关节炎，比如红斑狼疮，牛皮癣关节炎，脊柱疾患。您的医生需要考虑每一个可能的诊断，或许需要做些检验去排除它们。 365医学网 转载请注明　　Your doctor will start with a detailed health history. You will need to describe your pain and be very specific about where your pain is located and when it came on. You will also need to tell your doctor about any other medical conditions you have had and drugs you are taking. Even if these other conditions are not related to your joint pain, your doctor will need to know these things to help you find effective treatment. Your doctor will also examine your joints closely. Your doctor will be looking for&bone-on-bone crepitus, a high-pitched screech that you can feel or hear in the joint. It is the sound of bone rubbing on bone, and nothing else makes this sound. 365医学网 转载请注明　　您的医生会从病史的细节开始。您需要详细描述疼痛，非常明确地指出它发生的位置和出现的时间。您需要告知医生你之前的治疗情况，以及您正有使用的药物。就算这些情况与您的疼痛无关，您的医生需要知道这些来帮助您找到有效的治疗方案。您的医生也会认真的检查您的关节。您的医生会寻找骨擦音，那是一种您会在关节处感觉到或听到的尖锐的声音。这是骨与骨摩擦的声音，没有其他什么原因会引起这种声音。 365医学网 转载请注明　　Every patient with RA has inflammation of the synovial membranes. Your doctor can confirm this by checking the count of&white blood cells&(WBC) in your synovial fluid. This involves inserting a thin needle into your joint and drawing out a small amount of the fluid for testing. The fluid can also be tested for other things. The WBC alone doesn’t prove that you have RA. Your doctor will need to rule out other causes of synovitis. 365医学网 转载请注明　　每个RA患者都有滑膜炎症。您的医生可以通过判断滑膜液中白血球的数量来确定炎症。这个需要在你的关节处插入一个细针管，抽出一点液体用于检测。这个液体可用于其他检测。单靠白血球检验不能判定你患有RA。你的医生需要排除其他可能导致滑膜炎的原因。 365医学网 转载请注明　　Your doctor will also ask you to undergo a blood test. RF, or rheumatoid factor, is found in the blood of about 85 percent of RA patients. But this test alone can’t confirm RA either. Some patients with RA do not have RF, and people with RF can have other forms of arthritis. 365医学网 转载请注明　　你的医生也会叫你去做另一种血液检测。RF，类风湿因子，在85％的患者血液中会出现。但这个检测单独也不能证明患有RA。一些RA患者没有RF，而一些有RF的人也可能是其他形式的关节炎。 365医学网 转载请注明　　Another blood test is the&erythrocyte sedimentation rate&(ESR, or&sed rate), which measures how fast red blood cells settle in the test tube. Red blood cells that settle faster than normal indicate inflammation in the body. But the ESR varies greatly between people. It is even possible for a patient with RA to have a normal ESR. The ESR may be more useful in monitoring the progress of your disease than in diagnosing it. A higher ESR usually means that the inflammation is more severe. 365医学网 转载请注明　　另一种血液检测叫红细胞沉降率（ESR，血沉），用来检测红细胞在试管中沉降的速度。血沉快表明身体出现炎症。但ESR在不同的人中差别巨大。甚至可能RA患者会有正常的血沉。ESR在监测疾病发展中更有用，而不是诊断。ESR高通常意味着炎症很严重。 365医学网 转载请注明　　The&C-reactive protein test&can also monitor inflammation. It is a newer test that may be more accurate than the ESR. This test measures the amount of a certain protein that is produced by the body due to inflammation. When inflammation is very active the amount of C-reactive protein is high, and when inflammation is brought under control the level of protein decreases. 365医学网 转载请注明　　C反应蛋白检测同样可以监测炎症。这是个新的检测，正确率会比ESR高。这个检验是检测炎症使身体产生的某几种蛋白的数量。当炎症非常活跃时，C反应蛋白的数量高，当炎症被控制时，蛋白的水平降低。 365医学网 转载请注明　　At some point your doctor will probably ask you to get X-rays of your affected joints and organs. X-rays and other imaging techniques can show damage to the cartilage and bone and the swelling in the soft tissues of the joint. 365医学网 转载请注明　　有时，医生可能会叫您去照X光片来看看您的关节和器官受影响的程度。X光片和一些其他的医学技术可以看出疾病对软骨、骨的破坏和关节软组织肿胀的程度。 365医学网 转载请注明　　In some cases your doctor may want to biopsy the rheumatoid nodules. A small amount of the nodule is removed and examined in a laboratory. 365医学网 转载请注明　　在一些情况下，您的医生可能会让您做一个类风湿性皮下结节的活检。一小部分结节会被切下去实验室进行检查。 365医学网 转载请注明Treatment 365医学网 转载请注明治疗 365医学网 转载请注明　　What can be done for the condition? 365医学网 转载请注明　　得了这种病该如何治疗？ 365医学网 转载请注明　　Doctors have learned much about RA in recent years, but they still don’t know much more about how to truly cure the disease. They do have many strategies for treating the symptoms of RA. If you start treatment within a few months after your symptoms appear, the better you will probably do in the long-term. Early detection and treatment can help avoid the worst joint damage. Sudden remission does occur, but it’s unclear how often, and it appears to be more likely within the first two years of the disease. Patients who develop RA at a young age, are RF positive, have close relatives with RA, and have RA nodules tend to have a more difficult time managing the disease. 365医学网 转载请注明　　近些年来，医生对RA作了很多研究，但他们仍然不知道真正治愈的方法。他们确实有许多治疗RA症状的策略。如果您在症状出现几个月后开始治疗，您可能最好进行长期的治疗。早发现早治疗能避免关节严重破坏。突然的缓解确实会出现，但不清楚多长时间一次，而且这种情况更可能出现在疾病发生的前两年。年轻的RA患者，RF阳性，RA亲缘关系密切，有类风湿结节的，对于控制疾病更为困难。 365医学网 转载请注明　　Your doctor will prescribe one or more medications.&Nonsteroidal anti-inflammatory drugs&(NSAIDs), such as aspirin and ibuprofen, can help decrease the pain and swelling.&Corticosteroids&taken by mouth can also help with inflammation. Because steroid use can cause other problems in your body, they are usually not be used over long periods of time, if at all possible. Corticosteroid injections into the affected joints can ease the swelling and give you immediate, short-term relief. And your doctor may prescribe eye medications, even if you have no eye symptoms. Because eye inflammation is so common with RA and is hard to diagnose, the eye s can help prevent it from developing or becoming severe. 365医学网 转载请注明　　您的医生可能会给您处方一种或几种药。非甾体抗炎药（NSAIDs），比如阿司匹林和布洛芬，能帮助减轻疼痛和肿胀。长期服用皮质类固醇也能控制炎症。因为使用皮质类固醇会造成你身体的其他问题，如果可能的话，它们通常不会被长期使用。受累关节注射皮质类固醇，会缓解肿胀，而且会迅速给您带来短期的缓解。您的医生可能会开眼部药物，就算你没有眼部的症状。因为RA常伴有眼部炎症，而且很难被发现，眼部分泌物会阻止炎症发展或变严重。 365医学网 转载请注明　　Disease-modifying antirheumatic drugs&(DMARDs) are important in treating RA. No one is sure exactly how well DMARDs actually slow or prevent the structural damage from RA. However, tests have shown all DMARDs to be effective for at least one year of treatment. 365医学网 转载请注明　　缓解病情的抗风湿药（DMARDs）在RA治疗中很重要。没有人确切地知道DMARDs药物对减缓和防止RA造成结构性破坏实际上会有多好的效果。然而检验表明所有DMARDs在治疗至少一年时都是有效的。 365医学网 转载请注明　　DMARDs can be very hard on your body and can interact with other drugs, so it is not always easy to find the best medication for you. Often more than one drug is taken at the same time.& 365医学网 转载请注明　　DMARDs可能对您的身体带来影响，而且还会与其他药物互相影响，所以为您找到合适的药并不是很容易。常常会同时使用不止一种药物。 365医学网 转载请注明　　Several DMARDs are frequently prescribed: 365医学网 转载请注明　　下面是几种经常处方的缓解病情的抗风湿药： 365医学网 转载请注明　　Hydroxychloroquine&is a relatively nontoxic drug that was made to treat malaria. It can be safely used with other DMARDs. It is most useful in early, mild RA. You should get regular eye check-ups while taking this drug. 365医学网 转载请注明　　羟化氯喹是一种相对无毒的治疗疟疾的药物。它与其它DMARDs联用安全。对于早期轻症的RA患者很有效。用此药需定期做眼部检查。365医学网 转载请注明　　Sulfasalazine&is much like hydroxychloroquine. This drug requires regular blood monitoring. 365医学网 转载请注明　　柳氮磺吡啶很像羟化氯喹。用药需定期血检。 365医学网 转载请注明　　Gold salts&can cause short-term remissions. Over the long-term, however, the RA does progress. Blood and urine monitoring is required. 365医学网 转载请注明　　金盐（氯金酸钠）能短期缓解病情。然而长期使用RA还是会继续进展。用药需定期做血检和尿检。 365医学网 转载请注明　　Methotrexate&can help manage RA, but it is unclear how much it actually changes the course of the disease. Methotrexate can be very useful over the long-term, but there are problems with flare-ups when patients stop taking it. 365医学网 转载请注明　　甲氨喋呤可以控制RA，但不确定实际对疾病的进展有多少改变。甲氨蝶蛉长期使用有效，但一旦停药会复发加重。 365医学网 转载请注明　　Azathioprine&is used with moderate and severe RA. 365医学网 转载请注明　　咪唑硫嘌呤用于治疗中、重度RA患者。 365医学网 转载请注明　　Penicillamine&is only used in patients who have systemic disease that doesn’t respond well to other medications. 365医学网 转载请注明　　青霉胺仅用于有系统性疾病且用其他药效果不好的患者。 365医学网 转载请注明　　Cyclosporine&is expensive and hard on the kidneys, so it is most often used in severe RA. 365医学网 转载请注明　　环孢霉素价格昂贵且对肾脏不好，所以常用于重度RA患者。 365医学网 转载请注明　　Cyclophosphamide&is very effective but very toxic, so it is only used in specific cases. 365医学网 转载请注明　　环磷酰胺非常有效但毒性大，所以仅用于特殊病例。 365医学网 转载请注明　　Certain antibiotics are somewhat effective in mild cases. 365医学网 转载请注明　　某些抗生素会对轻型RA患者有些效果。 365医学网 转载请注明　　Combining methotrexate with another drug to get the desired results (decreased joint pain, swelling, and stiffness) is a popular and effective strategy for many patients. One group of disease modifying medications used along with methotrexate is called&anti-tumor necrosis factor&(TNF) agents. 365医学网 转载请注明　　甲氨蝶蛉与化药联合用药能达到预期效果（减轻关节疼痛，肿胀和僵硬），是现在较受欢迎的治疗方案，且对大多数患者有效。有一类和甲氨喋呤联用的缓解病情的药物称为抗肿瘤坏死因子药（TNF）。 365医学网 转载请注明　　Another term for the anti-TNF agents is TNF&inhibitors. These are a special type of antibody also referred to as&human monoclonal antibodies. They specifically target (and inhibit) tumor necrosis factor. Tumor necrosis factor (TNF) promotes the inflammatory response, which in turn causes many of the clinical problems associated with autoimmune disorders such as rheumatoid arthritis. 365医学网 转载请注明　　另一类抗肿瘤坏死因子药叫TNF抑制剂。它们是一种特殊的抗体，即所谓的人单克隆抗体。明确的作用靶点（抑制）是肿瘤坏死因子。肿瘤坏死因子(TNF)促进炎症反应，这就造成了许多临床上的自体免疫疾病，比如类风湿性关节炎。 365医学网 转载请注明　　Anyone taking tumor necrosis inhibitors must be careful to report any signs of infection to the physician right away. There have been reports of deaths possibly associated with unrecognized or untreated infections in patients taking these immune suppressing drugs. 365医学网 转载请注明　　每个使用肿瘤坏死因子抑制剂的患者都需要注意有任何感染的迹象都要立即报告给医生。之前报告过的死亡病例就可能跟使用免疫抑制剂发生感染而未及时发现和治疗有关系。 　365医学网 转载请注明　　Symptoms of infection anywhere but commonly affecting skin, lungs, or urinary tract include fever, chills, fatigue, enlarged lymph nodes, skin rash or red streaks, cough, and/or sore throat. Upset stomach, painful urination or blood in the urine or stools are additional important symptoms that could be a signal of infection and should be reported to the physician as well. 365医学网 转载请注明　　感染的症状可能发生在任何地方，但通常会影响皮肤，肺，尿道，还会引起发烧，寒栗，疲乏，淋巴结肿大，皮疹或红纹，感冒，咽痛。腹痛，尿痛或尿血、便血都是一些提示感染的重要信号，如果出现也要报告给医生。 365医学网 转载请注明　　In general, your doctor may recommend some of the following treatments that will require some effort and lifestyle changes from you: 365医学网 转载请注明　　一般，医生会建议一些你需要付出努力或改变生活习惯的治疗方法：&365医学网 转载请注明　　Patient education. RA is a frustrating and complex disease. The more you understand it, the better you can help treat your own symptoms and prevent flare-ups. 365医学网 转载请注明　　患者教育。RA是一种令人沮丧的复杂的疾病。您了解的越多，就能越好的缓解症状，避免突然发作。365医学网 转载请注明　　Range-of-motion and strengthening exercises. These will most often be designed and monitored by a physical or occupational therapist. 365医学网 转载请注明　　活动范围和力量练习。这些通常需要理疗师或职业治疗师进行计划和监护。 365医学网 转载请注明　　Equipment and gadgets, such as canes and jar openers that can help you go about your daily business without putting too much stress on affected joints. 365医学网 转载请注明　　使用装备和小工具，比如手杖和开罐器能帮助你进行日常任务，避免给受累关节太大压力。 365医学网 转载请注明　　Gentle aerobic exercise. 365医学网 转载请注明　　温和的有氧运动。 365医学网 转载请注明　　Support groups. 365医学网 转载请注明　　后援团。 365医学网 转载请注明　　At least half of RA patients don’t find much relief from treatment and eventually need surgery on the affected joints. Surgery, including total joint replacement, can be a very effective way to help you overcome the pain and loss of movement of RA. 365医学网 转载请注明　　至少有一半的患者无法通过治疗得到很好的缓解，最终需要对受累关节进行手术。手术，包括关节置换，能非常有效地帮助您消除疼痛，恢复因RA而失去活动能力。 365医学网 转载请注明　　For most patients, RA is a disease that comes and goes throughout their lives. But it doesn’t have to be crippling. With your doctor’s help, you should be able to find treatment that works for you. 365医学网 转载请注明　　对大多患者而言，RA是终身性疾病，但并不一定致残。在医生的帮助下，您会找到适合自己的治疗方案。 365医学网 转载请注明
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