系统性红斑狼疮为什么会累及全身多个器官？
Why does systemic lupus erythematosus affect so many organs?
狼疮的核心问题是免疫系统对自身细胞核成分（如双链DNA）失去耐受，产生大量自身抗体。这些抗体与抗原形成免疫复合物，随血流沉积在皮肤、关节、肾小球、血管、血液系统和中枢神经系统，激活补体引起炎症，因此临床表现千差万别：颊部蝶形红斑、关节痛、蛋白尿、血细胞减少、癫痫等。它多见于育龄女性，紫外线、感染和某些药物可诱发活动；羟氯喹是长期治疗的基础，重症需免疫抑制剂或生物制剂。
The core problem in lupus is loss of tolerance to the body's own nuclear components, such as double-stranded DNA, generating large amounts of autoantibodies. These form immune complexes that circulate and deposit in skin, joints, glomeruli, blood vessels, blood cells and the central nervous system, activating complement and causing inflammation - hence the wildly varied presentations, from a butterfly rash and joint pain to proteinuria, low blood counts or seizures. It mostly affects women of reproductive age, with flares provoked by ultraviolet light, infection or certain drugs; hydroxychloroquine is the backbone of long-term therapy, with immunosuppressants or biologics for severe disease.
难度 专业 · 适合 高中(15-18)
CC BY 4.0 · 已核验 · Verified 2026-11-02
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《哈里森内科学》
Harrison's Principles of Internal Medicine
独立核验依据 · Independent verification: 核验依据 1 ISBN 9787518949960（豆瓣书目条目: 哈里森内科学）
#系统性红斑狼疮 #自身抗体 #免疫复合物 #羟氯喹
什么是纤维肌痛，为什么各项检查都“正常”？
What is fibromyalgia, and why do tests come back normal?
纤维肌痛是以全身弥漫性疼痛、疲劳、睡眠不解乏和注意力下降（“脑雾”）为特征的疾病，其机制被认为是中枢敏化：脊髓和大脑对疼痛信号的放大与抑制调节失衡，而不是关节或肌肉本身有破坏性炎症。因此血液炎症指标和影像通常正常，诊断主要依据症状模式并排除其他疾病。这不意味着疼痛是“想出来的”，规律的循序渐进运动、认知行为疗法、改善睡眠以及度洛西汀或普瑞巴林等药物有明确证据支持。
Fibromyalgia is characterized by widespread body pain, fatigue, unrefreshing sleep and difficulty concentrating - “brain fog” - and its mechanism is thought to be central sensitization: the spinal cord and brain amplify pain signals while inhibitory control falters, rather than destructive inflammation in joints or muscles. That is why inflammatory blood markers and imaging are usually normal and diagnosis rests on the symptom pattern after excluding other conditions. It does not mean the pain is imagined: graded regular exercise, cognitive behavioural therapy, better sleep and drugs such as duloxetine or pregabalin all have solid supporting evidence.
难度 专业 · 适合 高中(15-18)
CC BY 4.0 · 已核验 · Verified 2026-08-23 · 2 条独立证据
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Harrison's Principles of Internal Medicine 第20版,McGraw-Hill,2018
J. Loscalzo et al., Harrison's Principles of Internal Medicine, 20th ed., McGraw-Hill, 2018
独立核验依据 · Independent verification: 核验依据 2 OPENLIBRARY ISBN 标识 9781259644047（按标识回读: Harrison's prin
#纤维肌痛 #中枢敏化 #慢性疼痛 #运动与认知治疗
类风湿关节炎与骨关节炎在晨僵特点上的主要区别是什么?
What is the key difference in morning stiffness between rheumatoid arthritis and osteoarthritis?
类风湿关节炎的晨僵常超过1小时,呈对称性累及近端指间关节、掌指关节及腕关节,活动后可部分缓解。骨关节炎的僵硬一般仅持续数分钟至30分钟,以负重关节为主且多为不对称受累。晨僵持续时间因此被视为鉴别两者及评估疾病活动度的重要临床线索。
Morning stiffness in rheumatoid arthritis typically lasts more than one hour, affects the proximal interphalangeal, metacarpophalangeal, and wrist joints symmetrically, and improves partially with movement. In osteoarthritis stiffness usually resolves within minutes to 30 minutes and involves weight-bearing joints asymmetrically. Duration of morning stiffness therefore serves as a key clue for differentiation and disease activity assessment.
难度 进阶 · 适合 大众
CC BY 4.0 · 来源待核验 · Source pending review
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出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
中华医学会风湿病学分会《类风湿关节炎诊疗指南》;ACR/EULAR 2010年分类标准
2010 ACR/EULAR classification criteria for rheumatoid arthritis; Firestein: Kelley's Textbook of Rheumatology, 11th ed.
#风湿免疫病 #类风湿关节炎
45岁女性对称性双手近端指间关节、腕关节肿痛6周,晨僵约1小时,类风湿因子阳性,抗CCP抗体强阳性。符合分类标准后的初始治疗方案是什么?
A 45-year-old woman has 6 weeks of symmetric swelling and pain in the proximal interphalangeal joints and wrists with about 1 hour of morning stiffness; rheumatoid factor is positive and anti-CCP antibodies are strongly positive. After meeting classification criteria, what is the initial treatment plan?
患者符合类风湿关节炎分类标准且存在预后不良因素(抗CCP强阳性),一经诊断即应启动传统合成DMARD治疗,首选甲氨蝶呤,并可短期联用小剂量糖皮质激素作为桥接以尽快控制炎症。治疗遵循达标策略,目标为缓解或低疾病活动度,每1–3个月评估病情并调整方案。使用甲氨蝶呤期间需定期监测血常规与肝功能,并补充叶酸以减少不良反应。
The patient meets rheumatoid arthritis classification criteria with a poor-prognosis marker (strongly positive anti-CCP), so a conventional synthetic DMARD should start immediately—methotrexate first choice—optionally bridged with low-dose glucocorticoids for rapid inflammation control. A treat-to-target strategy aims for remission or low disease activity, with reassessment every 1–3 months to adjust therapy. On methotrexate, blood counts and liver enzymes need regular monitoring, plus folic acid supplementation to reduce toxicity.
难度 进阶 · 适合 初中(12-15)
CC BY 4.0 · 来源待核验 · Source pending review
来源 · Source
出处备注：著录含书名，但缺版次 / 出版社 / 年份中的一部分，需编辑补全后才能做独立比对。
中华医学会风湿病学分会《2018中国类风湿关节炎诊疗指南》 ; 另见: EULAR Recommendations for the Management of Rheumatoid Arthritis, 2022 update
EULAR Recommendations for the Management of Rheumatoid Arthritis, 2022 update ; see also: 中华医学会风湿病学分会《2018中国类风湿关节炎诊疗指南》
#类风湿关节炎 #甲氨蝶呤达标治疗
在类风湿关节炎的 2010 年 ACR/EULAAR 分类标准中,类风湿因子和抗CCP抗体是如何计分的?总分达到多少才能归类为类风湿关节炎?
How are rheumatoid factor and anti-CCP antibodies scored under the 2010 ACR/EULAR classification criteria for rheumatoid arthritis, and what total score assigns the classification?
血清学部分按阴性、低滴度阳性、高滴度阳性三档计分:两项均阴性计0分,任一项低滴度阳性(不超过正常上限3倍)计2分,任一项高滴度阳性计3分,以得分较高的一项为准,血清学最多贡献3分。标准还包括关节受累范围、急性期反应物和症状持续是否达到6周,四部分合计至少6分即可分类为类风湿关节炎。抗CCP特异性高于类风湿因子,两者联用可提高早期诊断把握。
Serology is graded negative (0 points), low-positive up to three times the upper limit of normal (2 points), or high-positive beyond that threshold (3 points), taking the higher-scoring of RF or anti-CCP, with at most 3 points from this domain. Joint involvement, acute-phase reactants, and symptom duration of six weeks or longer complete the domains, and a total of at least 6 of 10 assigns the classification. Anti-CCP is more specific than RF, and testing both strengthens early diagnostic confidence.
难度 进阶 · 适合 大众
CC BY 4.0 · 来源待核验 · Source pending review
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出处备注：此条未指向带版次的可引用著作（通识性内容、机构文件或未展开的英文书名），本库不提供独立书目出处；如需精确引用，需由编辑补全具体篇目与版次。
Aletaha D 等,2010年ACR/EULAR类风湿关节炎分类标准,Ann Rheum Dis 2010;69:1580-1588
Aletaha D et al., 2010 ACR/EULAR rheumatoid arthritis classification criteria, Ann Rheum Dis 2010;69:1580-1588 (also Arthritis Rheum 2010;62:2569-2581)
#风湿免疫病 #类风湿关节炎
痛风为什么最爱在大脚趾半夜偷袭?尿酸结晶还挑地方吗?
Why does gout ambush the big toe in the middle of the night — is uric acid choosy about location?
血尿酸过饱和时析出针状单钠尿酸盐结晶,而第一跖趾关节几乎是它的完美温床:夜间体温略降、该关节承重最大软骨磨损后水分较多,局部pH与温度都利于结晶成核;加上白天行走造成的微小损伤释放促炎信号,结晶一出现,巨噬细胞便倾巢释放白介素-1β,数小时内红肿热痛达到顶峰——病人常描述连被子的重量都难以忍受。降尿酸治疗把血浓度压到结晶溶解线以下,发作才会真正减少;只消炎不降酸等于只灭火不拆柴。
Supersaturated uric acid precipitates as needle-shaped monosodium urate crystals, and the first metatarsophalangeal joint is their perfect nursery: slightly cooler at night, heavily load-bearing, with hydrated worn cartilage favoring nucleation. Microtrauma from walking primes inflammatory signals, so when crystals appear macrophages flood the site with interleukin-1 beta, escalating to red-hot agony within hours — patients say even a blanket hurts. Lowering urate below the dissolving threshold is what truly reduces attacks; anti-inflammatories alone only douse flames while the firewood remains.
难度 入门 · 适合 大众
CC BY 4.0 · 已核验 · Verified 2026-10-04
来源 · Source
Dalbeth 等,《Gout》,The Lancet 第388卷,2016
N. Dalbeth et al., Gout, The Lancet 388, 2016
独立核验依据 · Independent verification: 核验依据 1 ISBN 9780198748311 (2016)
#痛风 #尿酸结晶 #炎性小体