1 Definitions 风湿病( rheumatism, rheumatic diseases)是一组侵 犯关节、骨骼、肌肉、血管及有关软组织或结缔组织为主 的疾病,其中多数为自身兔疫性疾病。发病多较隐敵而缓 慢,病程较长,且大多具有遗传倾向。包括 1.弥漫性结缔组织病:类风湿关节炎 heumatoid arthritis,RA 系统红斑狼疮( systemic lupus erythematosus,SLE)、硬皮病、多 肌炎、重叠综合征、血管炎 ·2.脊柱关节病:强制性脊柱炎、Rete综合征、银屑病关节炎、未 分化脊柱关节病等
1. Definitions • 风湿病(rheumatism, rheumatic diseases)是一组侵 犯关节、骨骼、肌肉、血管及有关软组织或结缔组织为主 的疾病,其中多数为自身免疫性疾病。发病多较隐蔽而缓 慢,病程较长,且大多具有遗传倾向。包括: • 1. 弥漫性结缔组织病: 类风湿关节炎(rheumatoid arthritis, RA)、 系统红斑狼疮(systemic lupus erythematosus, SLE )、硬皮病、多 肌炎、重叠综合征、血管炎 • 2. 脊柱关节病: 强制性脊柱炎、Reiter综合征、银屑病关节炎、未 分化脊柱关节病等
3.退行性变:骨关节炎( osteoarthritis, OS) 4.与代谢和肉分泌相关的风湿病:痛风、假性痛风、马方综合 征、免疫缺陷病 5和感染相关的风湿病:反应性关节炎、风湿热( rheumatic fever. RF)等 ·6.肫瘤相关性风湿病:原发性(滑膜瘤、滑膜肉瘤等;继发性(多 发性骨髓瘤、转移瘤等) 7神经血管疾病神经性关节病、压迫性神经病变周围神经受压、 神经根受压等、雷诺病等 8 骨病变:骨质疏松、骨软化、肥大性骨关节病、弥漫性 原发性骨肥厚、骨炎等 9非关节性风湿病:关节周围病变、椎间盘病变、特发性腰痛 其他痛综合征如精神性风湿病等 10.其他有关节症状的疾病 性风湿热、间歇性关节积液、 药物相关的风综合征、慢性活动 炎等
• 3. 退行性变: 骨关节炎(osteoarthritis, OS ) • 4. 与代谢和内分泌相关的风湿病: 痛风、假性痛风、马方综合 征、免疫缺陷病等 • 5. 和感染相关的风湿病: 反应性关节炎、风湿热(rheumatic fever, RF)等 • 6. 肿瘤相关性风湿病: 原发性(滑膜瘤、滑膜肉瘤等);继发性(多 发性骨髓瘤、转移瘤等) • 7. 神经血管疾病: 神经性关节病、压迫性神经病变(周围神经受压、 神经根受压等)、雷诺病等 • 8. 骨与软骨病变: 骨质疏松、骨软化、肥大性骨关节病、弥漫性 原发性骨肥厚、骨炎等 • 9. 非关节性风湿病: 关节周围病变、椎间盘病变、特发性腰痛、 其他痛综合征(如精神性风湿病)等 • 10. 其他有关节症状的疾病: 周期性风湿热、间歇性关节积液、 药物相关的风湿综合征、慢性活动性肝炎等
2. Drugs treating rheumatism 1. Non-steroidal anti-inflammatory drugs(NSAIDs, 非体抗炎药) antipyretic, analgesic and anti-inflammatory drugs 解热镇痛抗炎约) 2. Glucocorticosteroids(糖皮质激素) steroidal anti inflammatory drugs(甾体抗炎药) 3. Disease-modifying anti-rheumatic drugs ( DMARDS,改善病情的抗风湿药) mainly immunosuppressants 4. Other adjuvant drugs Analgesic drugs(镇痛药) Bone metabolism-regulating drugs(骨代谢调节药) Antibacterial drugs(抗菌药) Gout suppressants(痛风治疗药)
• 2. Drugs treating rheumatism • 1. Non-steroidal anti-inflammatory drugs (NSAIDs, 非甾体抗炎药) antipyretic, analgesic and anti-inflammatory drugs (解热镇痛抗炎药) • 2. Glucocorticosteroids (糖皮质激素) steroidal antiinflammatory drugs (甾体抗炎药) • 3. Disease-modifying anti-rheumatic drugs (DMARDs, 改善病情的抗风湿药)mainly immunosuppressants • 4. Other adjuvant drugs • Analgesic drugs(镇痛药) • Bone metabolism-regulating drugs(骨代谢调节药) • Antibacterial drugs(抗菌药) • Gout suppressants (痛风治疗药)
DMARDS 1. Glucocorticoids(糖皮质激素类): prednisolone泼尼松龙), methylprednisolone(甲泼尼松龙) ·2. Calcineurin inhibitors钙调磷酸酶抑制剂: cyclosporine(csA环孢素), tacrolimus(FK506,他克莫司) 3. Antiproliferative and antimetabolic drugs(抗增殖抗代谢类): rapamycin(雷帕霉素, sirolimus西罗莫司, mycophenolate mofetil(wMF霉酚酸酯 azathioprine(Aza,硫唑嘌呤), cyclophosphamide(cTX,环磷酰胺 methotrexate(氨甲喋验MTX, chloroquine(氯喹 hydroxychloroquine氯喹) sulfasalazine(柳氖磺吡啶, leflunomide(来氯米特 4. Antibodies and other biological agents抗体及其他生物制剂: Active TCM components中有效成分尚进国所药物分类 tripterygium glycosides公藤总
DMARDs • 1. Glucocorticoids (糖皮质激素类): • prednisolone (泼尼松龙) , methylprednisolone (甲泼尼松龙) • 2. Calcineurin inhibitors (钙调磷酸酶抑制剂) : • cyclosporine (CsA, 环孢素), tacrolimus (FK506, 他克莫司) • 3. Antiproliferative and antimetabolic drugs (抗增殖/抗代谢类): • rapamycin (雷帕霉素, sirolimus 西罗莫司), mycophenolate mofetil (MMF, 霉酚酸酯), azathioprine (Aza, 硫唑嘌呤) , cyclophosphamide (CTX, 环磷酰胺) • methotrexate (氨甲喋呤, MTX), chloroquine (氯喹), hydroxychloroquine(羟氯喹) sulfasalazine (柳氮磺吡啶), leflunomide (来氟米特) • 4. Antibodies and other biological agents (抗体及其他生物制剂): • Active TCM components (中药有效成分, 尚未进入国际药物分类): • tripterygium glycosides (雷公藤总苷)
Analgesic drugs Opioid analgesics (centrally acting) opiates synthetic agents Antipyretic, analgesic, and anti-inflammatory drugs (peripherally acting) aspirin, indomethacin Other drugs(for special types of pain) carbamazepine, atropine, nitroglycerin, etc
Analgesic drugs • Opioid analgesics (centrally acting) • opiates • synthetic agents • Antipyretic, analgesic, and anti-inflammatory drugs (peripherally acting) • aspirin, indomethacin • Other drugs (for special types of pain) • carbamazepine, atropine, nitroglycerin, etc
Bone metabolism-regulating drugs · Hormones(激素类) ° estrogens(雌激素类): diety stilbestrol〔己烯雌酚) androgens(雄激素类): Testosterone〔睾酮) parathyroid hormone(甲状旁腺激素,PTH) and teriparatide(特 立帕肽), calcitonin(降钙素) Diphosphonates(双膦酸盐类药物) alendronate sodium(阿仑膦酸钠) Calcium and vitamin d3(钙及维生素D3) · Others Glucosamine(氨基葡萄糖), chondroitin sulfate(硫酸软骨素) fluorides(氟化物)
Bone metabolism-regulating drugs • Hormones(激素类) • estrogens(雌激素类):diethylstilbestrol(己烯雌酚) • androgens(雄激素类):Testosterone(睾酮) • parathyroid hormone(甲状旁腺激素,PTH) and teriparatide(特 立帕肽), calcitonin(降钙素) • Diphosphonates(双膦酸盐类药物 ) • alendronate sodium(阿仑膦酸钠) • Calcium and Vitamin D3(钙及维生素D3) • Others • Glucosamine(氨基葡萄糖), chondroitin sulfate(硫酸软骨素), fluorides(氟化物)
Ca. P Serum D(+), PTH(+) I Gut Ca, P Bone D(+),PTH(+) CT( Ca P Kidney D(-) DO PTHO PTH(+) CT(+) CT(+) FGF23(+ Ca Calcium and phosphate metabolism in the body and the regulation parathyroid hormone(PTH), Calcitonin (CT), 1, 25(OH)2 D3( D), fibroblast growth factor 23(FGF23)
Calcium and phosphate metabolism in the body and the regulation parathyroid hormone (PTH), Calcitonin (CT),1,25(OH)2 D3 (D), fibroblast growth factor 23 (FGF23)
Antibacterial drugs Agents against streptococcal(链球菌) infections Penicillins(青霉素类): penicillin G( benzylpenicillin,苄青霉素) Cephalosporins(头孢菌素类) Macrolides(大环内酯类): erythromycin(红霉素 · Lincomycins(林可霉素类) Quinolones喹诺酮类) · Sulfonamides(磺胺类)
Antibacterial drugs • Agents against streptococcal (链球菌)infections • Penicillins (青霉素类):penicillin G (benzylpenicillin, 苄青霉素) • Cepharosporins(头孢菌素类) • Macrolides(大环内酯类):erythromycin (红霉素) • Lincomycins(林可霉素类) • Quinolones (喹诺酮类) • Sulfonamides (磺胺类)
Gout suppressants Colchicine(水仙碱): relieving the pain and inflammation of gouty arthritis Indomethacin(吲哚美辛) and other NsAids (except aspirin, salicylates and tolmetin) inhibiting urate crystal phagocytosis(尿酸结晶体吞噬) Probenecid两磺舒 and sulfinpyrazone(磺吡酮: decreasing reabsorption of uric acid in the proximal tubule, thereby accelerating uric acid excretion (uricosuric drugs,尿酸促排 剂 Allopurinol(嘌醇 and febuxostat: Inhibiting xanthine oxidase, thereby reducing uric acid synthesis
Gout suppressants • Colchicine (秋水仙碱): • relieving the pain and inflammation of gouty arthritis • Indomethacin (吲哚美辛) and other NSAIDs (except aspirin, salicylates and tolmetin) : • inhibiting urate crystal phagocytosis (尿酸结晶体吞噬) • Probenecid (丙磺舒) and sulfinpyrazone (磺吡酮) : • decreasing reabsorption of uric acid in the proximal tubule, thereby accelerating uric acid excretion (uricosuric drugs, 尿酸促排 剂) • Allopurinol (别嘌醇) and febuxostat: • Inhibiting xanthine oxidase, thereby reducing uric acid synthesis