类风湿关节炎的病因和诊断

汉斯 ·乌, 托马 斯·, 格德 ·斯, 丹尼 尔·, 约瑟 夫·
德国风湿免疫学中心

摘要

类风湿性关节炎是一种异质性疾病，根据遗传风险因素和自身抗体的数据，可将其细分为ACPA阳性和
ACPA阴性RA。一些患者在临床症状出现前几年就存在ACPA和RF以及 CRP水平升高，这表明与RA发展相关的
免疫反应很早就开始了。ACPA尤其适用于RA，而RF也可以在健康（老年人）个体和患有其他自身免疫性疾病或
感染的患者中发现。RA发展最重要的遗传风险因素，即共享表位等位基因，位于MHCII类区域。然而，共享的表
位等位基因只会导致ACPA阳性RA的发生。对滑膜炎的研究表明，不仅适应性而且先天免疫反应的重要性。总结血
液和滑膜组织中免疫学变化的各种结果，免疫反应从弥漫性髓样炎症扩展到淋巴髓样炎症似乎与对生物制剂的更成
功的治疗反应有关。关于滑膜炎研究的进展和对疾病病因学的理解，有效的诊断方法和治疗免疫细胞或成纤维细胞
病理亚群的新靶点已经出现。

关键词

病因学；类风湿性关节炎；滑膜炎

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