类风湿早期诊断

Early Diagnosis of Rheumatoid Disease

背景类风湿性关节炎(RA)是一种以滑膜炎性病变为主要特征的病因不明的自身免疫性疾病,以晨僵、关节肿胀、畸形为主要症状,RA可对患者关节产生不可逆的病理损害并使其丧失劳动能力,加重社会负担,若能进行RA早期诊断,及时对RA患者进行抗风湿干预,则可有效改善预后,避免RA致残,减轻患者痛苦。因此,RA早期诊断具有重要临床价值。方法 通过中国知网、PubMed平台,以“类风湿性关节炎”“影像学诊断”“实验室检测”等为关键词,对2012年1月至2022年5月发表的相关文献进行检索,了解RA诊断现状。结论 目前临床多依靠影像学手段和实验室标志性抗原检测进行诊断,但早期RA关节病变不明显,影像学检测难以及时发现,故早期RA诊断多依赖实验室特异性因子检测,如类风湿因子(RF)抗体、抗环瓜氨酸肽抗体(抗CCP抗体)、抗角蛋白抗体(AKA)等,相关研究表明,单一实验室指标检测较影像学手段更高效,但灵敏度和特异度亦存在缺陷,而多因子联合诊断可有效弥补单一因子的缺陷,已成为RA早期诊断的发展方向。

Background Rheumatoid arthritis(RA)is an autoimmune disease of unknown etiology characterized by synovitis,with morning stiffness,joint swelling and deformity as the main symptoms,RA can cause irreversible pathological damage to the joints of patients and make them lose the ability to work,increasing the social burden.If early diagnosis of RA and timely anti-rheumatism intervention can be carried out for PATIENTS with RA,the prognosis can be effectively improved,the disability of RA can be avoided,and the pain of patients can be alleviated.Therefore,early diagnosis of RA has important clinical value.Methods Through CNKI,PubMed and other platforms,relevant literatures published from January 2012 to May 2022 were searched with keywords such as“rheumatoid arthritis”,“imaging diagnosis”and“laboratory test”to understand the diagnosis status of RA.Conclusion At present,a lot of clinical diagnosis rely on imaging means and laboratory landmark antigen testing,but early RA articular damage is not apparent,imaging detection is difficult to find in time,so the early RA diagnosis much depend on the laboratory test,such as rheumatoid factor(RF)antibodies,anti-cyclic citrullinated peptide antibody(anti-CCP antibody),anti-keratin antibody(AKA),etc.Related studies have shown that single laboratory index detection is more efficient than imaging methods,but there are also faultiness in sensitivity and specificity.Multi-factor combined diagnosis can effectively compensate for the faultiness of single factor,and has become the development direction of early diagnosis of RA.