类风湿病因是什么,有什么治疗方法？

类风湿性关节炎(rheumatoidarthritis，RA)是一种自身免疫性疾病，以对称性、侵蚀性的关节滑膜炎和可能闷迟多系统受累为特征。目前就是使用免疫抑制剂，还有可以是用生物制剂码弯治疗控制，可以用来氟米特联合蚂模李甲氨蝶呤片的，一般需要连续用药四五年的时间的，控制稳定之后逐渐的减量。

jia医学上是什么简称

“JIA”经常作为“Juvenile Idiopathic Arthritis”的缩写来使用，中文表示：“少年特发性关首迟节炎”

JIA在医学上的发展

1、In a prior retrospective study, her group demonstrated a poor correlation between clinical and ultrasound findings in ankle disease with juvenile idiopathic arthritis, she said.

她说，在先前的回顾性研究中，她的小组证明超声与临床检查在青少年特发性关节炎踝关节病变中相关性较差。

2、Study Progress of Etiology and Pathogenesis of Juvenile Idiopathic Arthritis(JIA).

幼年特发性关节炎的病因及发病机制研究进展。

3、Current Diagnosis and Treatment of Juvenile Idiopathic Arthritis(JIA).

幼年特发性关节炎的诊断与治疗现状。

4、Research of antikeratin antibody, antiperinuclear factor and anti-cyclic citrullinated peptide antibody in diagnoses of juvenile idiopathic arthritis.

抗角蛋白抗体、抗核周因子和抗环瓜氨酸肽抗在幼年特发性关节炎各型诊断中的应用。

5、Clinical application of SPIR / 3D / FFE with contrast enhanced in knee of juvenile idiopathic arthritis.

增强SPIR/3D/FFE在幼年性特发性关节炎膝关节病变的应用价值。

青少年特发性关节炎可能会有长时间的关节部位疼痛感，关节部位出现肿胀僵硬，关节变形，关节内软骨损伤等症状。

青少年特发性关节炎是儿童常见的结缔组织疾病。其特点是慢性关首纤节炎，可伴有全身多系统损害。国际风湿病学联合会儿科常务委员会专家组确定，儿童不明原因关节肿胀持续6周以上，为幼年特发性关节炎，以取代幼年类风湿关节炎和幼年慢性关节炎。在临床上，出现青少年特发性关节炎，多数是指类风湿关节炎。

青少年特发性关节炎的主要症状和注意事项

主要的症状是，病人会有长时间的关节部位疼痛感，在着凉后、活动后疼痛感明显加重，关节部位出现肿胀，有僵硬的表现。严重的会影响关节骨骼正常发育，出现关节变形，有关节内软骨损伤。所以需要及时地明确诊断，可以进行核磁共振检查，结合查体，能够作出正确诊断，然后采取正确治疗。可以减少关节部位负重活动，给予保暖处置。

青少年特发性关节炎需要注意的事项：首先，少吃牛奶和羊奶，少吃含有酪氨酸、苯丙氨酸和色氨酸的食物，如花生、巧克力、小米、奶酪和牛奶糖。少吃肥肉、者芹仿高动物脂肪和高胆固醇食物。其次，保持良好的精神状态对疾病的康复起着非常重要的作用。

每天保持好心情，避免情绪激动。最后，适当的运动：急性期患者应休息，以减少受影响关节的负重和活动；症状缓解、疼痛缓解后，可以适当锻炼，逐步加强关节功能锻炼；处于稳定期或缓解期的患者应进行适当的运动，如低强度有氧运动、关节运动、太极、剑舞、快走和撤退。

The dishes in Shanghai are as good as that in Beijing哪里错误

把are变成is，the已经指明是单数了，这个的dishes是一个个体，所以换成is。

补充内容：正丛配

主谓一致有哪些例外情况？

17.1. 以-s结尾的名词作主语的主谓一致

(1) 以-s结尾的疾病名称和游戏名称

Diabetes（糖尿病），arthritis（关节炎）等，这类名词通常作单数用，谓语用单数。

Arthritis area disease causing pain in the joints of the body.

（解析：以-s结尾的疾病名称做单数主语用，故are改为is, 全句改为：Arthritis isa disease causing pain in the joints of the body.）

(2) 以-ics结尾的学科名称

Physics, mathematics, mechanics, politics, statistics（统计学）, economics（经举指济学）, athletics（体育）等通常作单数用，谓语用单数。

Physics arean important subject in middle schools.

（解析：以-ics结尾的学科名称做单数主语用，故are改为is, 全句改为：Physics isan important subject in middle schools.）

(3) 以-s结尾的地理名称

The United states, the United Nations等作为国名表示单一的政治实体，通常作单数用，谓语用单数。

The United States area great country.

（解析：The United state作为国名表示单一的政治实体，做单数主语用，故are改为is, 全句改为：The United Statesisa great country.）

但若不是国名，而是群岛、山脉、海峡、瀑布等地理名称，通常作复数用，谓语用复数。

The Himalayas hasa variety of plants and animals.

（解析：The Himalayas不是单一的政治实体，做复数主语用，故has改为have, 全句改为：The Himalayas havea variety of plants and animals.）

The Niagara Falls isthe most famous waterfall in the world.

（解析：郑仔同理is改为are, 全句改为：The Niagara Falls arethe most famous waterfall in the world.）

(4) 其他以-s结尾的名词

炎亚纶的简介，英文的！最好也能有他的经历（英文）

Whose real name: Wu Geng Lin

拿嫌芦Stage name: Yan Ya Lun Nickname:

Abu English Name: Arron, Aaron (the official Aaron, Aaron was signed Arron)

Birthday: November 20, 1985

Age: 24

Constellation: Scorpio

消带Zodiac: Tiger Blood Type: O-type Height: 177cm Weight: 55kg Place of Birth: Taipei, Taiwan Family members: father of a family with a mother and her sister (Min Wu Pei, born September 22, 1987) (there are red VIP pet dog named "sister"者敏), and therefore there are a lot of people mistakenly think that Wu Min-pei is adopted. Education: Yu Nong Elementary School - Hiromichi States - Chenyuan High School - Chinese Culture University, Department of Journali** University of Technology Applied to switch Jingwen Department of English Languages: English, Japanese, Taiwanese, Mandarin Hobbies: play basketball, singing and dancing to make friends Love Funny Personality: If less volatile, but most of the time they get along with attentive occasionally say cold jokes Love Measurements: 362,836 Expertise: singing and dancing basketball Piano Flute Violin Guitar Fans Nickname: Red Army, Lun powder, pudding (pudding is the most recognized fans nickname Aaron also said that his fans for the pudding), Yan Lun Yu Lin Jun The future you want to co-singer: Eason Chan, Jay Chou, Lee Hom Favorite group: Mayday SHIN Favorite Actor: Andy Lau, Nicholas Tse Favorite actress: Angelina Jolie Favorite female singer: Fish Leong Jolin Tsai Lin Fan (Aaron Jolin Tsai has said that he admired the dedication) Favorite male singer: JJ Lin Jimmy Lin Tse Favorite basketball player: Kobe Bryant than amb Cox (Kobe Bryant) The most annoying animals: frogs, bullfrogs Most want to go places: Venice Favorite type of music: soul, rock, pop, R B, hard, jazz Favorite things: a mind thing (received charitable donations keep fans than it had received a gift of more happy) Favorite color: yellow and white black blue-green Best at cooking: sweet and sour fish, pineapple Ssambap Egg Fried Rice Favorite food: big scallops, large prawns, Shan Su Most go to commercial street: there are Lutheran Circle East Most want to have the opportunity to try Occupation: journalist Recently learned nothing new: arranger The most annoying female types: contrived a sweat bad habit of wiping bubble thick socks fitted Yan Been collected from **all to big things: stamps, sheet music, cinema tickets, jerseys, players poster Appreciate the type of girls: personality is more important, build appropriate, wearing a natural, non-concentrated loading Yan wiping lovely and lively Expected would give birth to many children: 2 or more Found to be how to deal with his girlfriend Ballin: breaking up! No mention of his own pain, because it was willing to When will feel lonely: There is no time to love and work The most embarrassing thing: In the film "Charlie's MIT", because of the issue pants, exposing the gray underwear. Is also the film crew and Buddies, little devil they see! Holes in concert when the (very large a hole), wearing pants that piece came to power at all times the pace of ultra-**all. (Fortunately, not being seen) Let your most memorable impression of things: first love's heart-breaking film "Charlie's MIT" Had a few love: Haha, quite many times ... ... Dream: to go is now being reached in the future is my dream! Family members would like to say: Each of you are intimate is also very nice ~ You must take good care of each person every day, perfectly healthy body ~ definitely! Really! No matter where hearts are with you tied up! Pets: called the "sister." (Red VIP) Many fans have wanted to be her sister, because the sub-lun kiss her Well Abu and red VIP sister's story: At present, only seven or eight months a big sister just arrived home when Aaron, because it is so petite, and let Aaron felt very scared. He said: "The first time I saw his younger sister, she was **all enough to be put into OREO biscuit boxes La, plus, when she first came to my house, less able to adapt to the new environment, the infirm and sick, so I am very worried." And it will be coquetry also attentive sister, will not only lying Aaron at the gate to go home, or even to climb the stairs to the sub-lun room, licking the face of Aaron and told him to get up. However, there are mischievous side of her sister, like Aaron with her play "clean sheet" game, the younger sister deliberately hid the ball around Aaron, let the ball find out Aaron, and then continue to lose the ball game. However, in a bad mood, and my sister would pull their own little corner of a towel, but also of the socks to hide sub-lun; time to let her sister a good mood rapid recovery method is sub-lun feed her to eat, and then and then playing with her favorite lose the ball game, she would happy to stay put in the arms of Aaron. Phone Model: SHARP SH1810C (black) Camera Model: Canon digital ixus 100 is Contact: Send stuff to where you want to send (preferably not to send gifts) Brokerage firm Address: 110, Xinyi District, Taipei City 311, Jiaxing Street, 3rd Floor, No. Yan Ya-lun (close) Record Company Address: 104 Jianguo North Road, Taipei 135, No. 15, Sec F, Aaron (close) The most moving thing: in the film program, the day is my birthday La, did not expect that everyone will recall, recording finished, fans bought many things at the door to me, that moment really do not know what to say. The two solo song: "willing to not love you", "Tiamo" (Aaron Yan, Liu Li Yang chorus) Circle of Friends: Wu Ying Jie (Buddies), Fahrenheit members, Show Luo (pig), SHE members, Danson Tang, little devils, Christine Fan, tank, Yoga Lin, Huang slightly weakened, Pauline Lan, Ariel Lin, Zheng Yuan Chang, JJ Lin, Cai Zhi Yun (Han - ), CHEN Xiu (Amendment), Cai Yizhen (5 bears), Ling-Yun, Patty Hou, Wu, Genie Zhuo, happy family, and so on Pudding their hope: Aaron should be strong, because the pudding are still behind you, no matter what, never give up, we pretty you ~ ~ ~ ~ We like to hear you sing, like to see you dancing, your singing, beautiful nature, you dance, more is to see our ~~~~~~ So, you want strong, we will accompany you through their ups and downs of the difficulties!

肠漏，你必须知道的热知识2：肠漏与自免疫攻击和过敏

肠不仅是人体最大的消化器官，还是人体最大的免疫器官和内分泌器官，以及最主要的神经器官之一。其中肠道微生物是人类消化吸收过程中不可或缺的组分，同时也是人体免疫、内分泌和神经功能的必需元件。肠漏不仅破坏肠脑的消化吸收功能，同时损坏了判码肠脑的免疫、内分泌和神经功能，并可通过免疫、内分泌和神经等途径把损伤扩散到身体其他器官。上期 食与心 主要介绍了肠漏对消化系统和消化器官的影响，本期重点介绍免疫系统和免疫功能。

肠是人体最大的免疫器官，内表面积约200平方米，形成一层隔离外界与体内的屏障。肠道粘膜免疫是固有免疫系统的主要构成之一，肠道淋巴组织（GALT）含有的免疫细胞占整个机体免疫细胞的70%到80%。健康的肠道微生物为个体固有免疫和获得性免疫发育成熟所必需。而菌群异常和肠漏则会引起肠道免疫异常，短期肠漏可诱发局部炎症，而长期肠漏则可导致慢性炎症或持续低水平炎症[1-4]。

炎症（Inflammation）这个词听起来可能有点陌生，但是上火和发炎（Inflammation）这两个词算是老生常谈了。经常有人说“最近老上火”“牙龈发炎了”，“眼睛有点发炎”……等判冲族等。发炎是免疫系统对外界感染的正常必要反应，日常生活也不得不像对待感冒一样对待发炎。但是 慢性炎症（Chronic Inflammation） 虽然听上去不算严重，但影响却不容小觑[1]。

肠漏不仅导致肠道内慢性炎症/持续性低水平炎症，还可引起肠外其他器官慢性炎症和全身系统性炎症[5]。慢性炎症几乎是目前已知所有疾病的特点，参与疾病起始及发展的各个阶段，如IBD、癌症、心血管疾病和自身免疫性疾病[1]。

尽管如此，慢性炎症这个词听上去不容易引起重视，像温水煮青蛙般缓慢能熬，因而总被轻视。不过一旦产生自免疫攻击就让人不得不警惕了（类似于食物不耐受与食物过敏）。实际上，肠漏对免疫系统的影响不仅在于引发缓慢不适的慢性炎症，更在于触发身体多个器官和部位的 自免疫攻击[5] 。上期 食与心 介绍过自免疫攻击发生在胰腺时的后果（一型糖尿病），本期介绍发生在其他部位的情况。

肠漏与乳糜泻掘弊

乳糜泻(Celiac Disease， CD)是一种 麸质（谷蛋白） 不耐受引发的小肠自免疫疾病，患者摄入含有谷蛋白的食物后出现腹泻腹痛、乏力水肿等各种症状，因而日常不得不严格限制饮食，同时补充营养。乳糜泻目前影响着世界上1-1.5%人群，且发病率还在不断增加。早期研究人们强调遗传基因和感染在CD发病中的作用，但最新研究发现，肠漏和肠道微生物异常在其中发挥着更为关键的作用[6]。

肠道渗透性增加时，食物中的谷蛋白多肽可穿过肠上皮细胞进入体内，被 组织谷氨酰胺转移酶（tTg） 脱去酰胺基，接着被抗原提呈细胞表面的HLA-DQ2/8识别，进而引发Th1，Th2，Th17等细胞的免疫反应，产生大量促炎症细胞因子和抗CD抗体；谷蛋白多肽还可通过NF-κB通路激活固有免疫反应；这些反应引起免疫细胞对肠上皮细胞的免疫攻击，导致肠绒毛萎缩。而某些益生菌可改变谷蛋白多肽，修复肠漏，对患者有一定好处[6, 7]。

肠漏与甲状腺自免疫疾病

甲状腺自免疫疾病是最常见的器官自免疫疾病，目前影响着全世界8%以上的人口，包括 桥本氏甲状腺炎 （Hashimoto’s thyroiditis， HT ）和格雷夫斯病（Graves’ disease）等，其中HT也是目前最常见的自免疫疾病。桥本氏甲状腺炎的主要特征是甲状腺单核细胞浸润及出现抗甲状腺球蛋白和抗甲状腺过氧化物酶抗体，引起体内甲状腺激素含量降低而促甲状腺激素含量升高，导致甲状腺机能减退。而格雷夫斯病则是出现抗促甲状腺激素受体抗体，引起甲状腺激素合成分泌增加，从而导致甲状腺功能亢进。

尽管甲状腺和肠并非邻近器官，最新研究发现微生物可通过神经内分泌途径直接影响甲状腺功能，即 肠-脑（下丘脑-垂体）-甲状腺轴 。而肠漏及其伴随的免疫、内分泌和神经异常均可传达到甲状腺[7, 8]。甲状腺自免疫患者存在菌群异常，且在桥本氏甲状腺炎和格雷夫斯病中均发现与乳糜泻患者相同的自身抗体，即 抗组织谷氨酰胺转移酶抗体(anti-tTg) 。因此， 食与心 认为在甲状腺自免疫疾病治疗中对肠漏修复具有更好的效果。

风湿类问题/骨骼关节肌肉问题困扰着多数现代人（如2/3以上人口可能在生命某一时期出现脖子疼），伏案不动久坐的现代工作方式不仅让人肥胖，还使得大量人群腰酸背疼脖子难受，加强身体锻炼是社会和科学都推荐的解决方法。但是，即便认识到久坐不动的危害，增加运动的人群中仍有相当部分不幸者运动（如走路）后反而出现了关节问题。那么问题出在哪呢，为什么现代人的关节如此脆弱？

传统观点多强调遗传背景在关节肌肉疾病中的作用，而最新研究显示早在关节肌肉症状出现数年之前，黏膜免疫失调已经发生，如肠漏导致的肠黏膜自免疫攻击。 菌-肠-关节轴功能异常 在风湿病中发挥着关键作用[9, 10]，因此 食与心 认为在骨骼关节疾的治疗中必须考虑肠道微生物的影响，下面以类风湿性关节炎为例进行简单介绍。

肠漏与类风湿性关节炎

类风湿性关节炎（Rheumatoid Arthritis ，RA）是一种以关节病变为特征的慢性全身自身免疫性疾病，目前尚无有效治疗方法。主要临床表现为小关节滑膜所致的关节肿痛，继而软骨破坏、关节间隙变窄，晚期因严重骨质破坏、吸收导致关节僵直、畸形、功能障碍。RA目前影响着世界上0.5-2%的人口，且患病人数以5-10/10万人的速度逐年递增。已有研究显示，遗传基因解释约16%的RA风险，那什么样的环境因素诱发了RA呢，答案是 黏膜免疫异常 ，比如肠漏[9, 11, 12]。

RA患者的肠道菌群明显不同于健康人群的。异常的菌群导致进入肠道的多糖A和短链脂肪酸（SCFAs）减少，而血清淀粉样蛋白A（SAA）和三磷酸腺苷（ATP）增加；前两者可促进调节性T细胞（Treg）激活，维持免疫稳态；而后两者则会激活Th1和Th17细胞，产生促炎症反应，诱导B细胞分化为分泌自身抗体的浆细胞，当这些免疫细胞迁移到关节组织时会发生级联反应，免疫结果被各种效应元件（如巨噬细胞、成纤维细胞、破骨细胞、细胞因子和蛋白酶等）放大；这些反应长期存在时会形成关节翳和关节炎[11, 13]。

特别需要强调的是，在文中反复提到的消化道一词，英文为gut，并不单指肠道，而是指从口腔到**的整个消化道。上文所说的 肠漏并不单指肠道菌群异常和渗透性增加，还包括口腔菌群异常和口腔黏膜渗透性增加 。除了肠道菌群紊乱，口腔菌群异常同样可引起骨质疏松和关节炎，所以经常口腔溃疡/口臭的个体骨关节疾病风险也会增加[10, 14]。

自免疫攻击发生时，全身的器官和组织都可能受害，神经系统也不例外。下面 食与心 以多发性硬化为例对神经系统自免疫疾病进行简单介绍。

肠漏与多发性硬化

多发性硬化(multiplesclerosis, MS), 是一种最常见中枢神经系统脱髓鞘病变，患者神经髓鞘被自身免疫系统攻击。早在2010年，Ochoa-Repáraz就通过动物实验发现，MS与肠道菌群密切相关：单一定植分节丝状菌/SFB就可诱发中枢脱髓鞘，而定植脆弱拟杆菌则有保护作用；SFB可促进小鼠的幼稚T细胞分化为Th17细胞，分泌促炎症因子IL-17A从而引发免疫异常。脆弱拟杆菌（菌的兼性荚膜多糖A）则可促进幼稚T细胞分化为Treg，分泌抗炎症因子IL-10，从而提升对髓鞘的免疫耐受[15]。

新近的研究发现，MS患者存在明显的菌群异常和低程度的细菌易位。虽然还不清楚肠漏和MS的前因后果，但已有证据均提示： 菌群异常是MS发生必不可少的帮凶 ；通过抗生素、益生菌和粪便菌群移植（FMT）等方式而调节菌群健康即能改善MS症状[16, 17]。

不断积累的研究显示：自免疫疾病大都与肠道微生物异常和肠漏密切相关； 环境和饮食等各种因素导致的菌群异常 而非遗传基因变异是近年来自免疫疾病飙升的罪魁祸首[8, 10]。

研究者已经开始考虑针对肠漏，重建健康菌群来治疗这些疾病[10, 17, 18]。 食与心 认为，在治疗中更注重菌群而不是遗传基因，将会给这些传统不治之症带来更多的正确认识和治疗希望。

慢性炎症变化缓慢或者某些弱感知、甚至无自觉症状很容易让人忽视，自免疫攻击反应激烈容易引起恐惧；还有一种常见免疫异常介于两者之间，同样不容忽视，那就是 过敏 。过敏是指免疫系统对无害环境成分产生过度免疫反应从而导致对自身产生损伤的状态，除了上期介绍过的食物不耐受和食物过敏，皮肤和呼吸 过敏性疾病 也极为常见，比如花粉症、荨麻疹、过敏性鼻炎和过敏性哮喘等。

除了食物过敏和过敏性哮喘等情况，大部分过敏虽然迅速但并不致命，但发作时依然让人非常难受。那么这些过敏与肠漏有关吗？答案当然是密切相关！ 皮肤和呼吸道过敏不仅跟皮肤菌群和呼吸道菌群有关，还跟肠道菌群有关[19] ，下面 食与心 以过敏性哮喘为例进行简单介绍。

肠漏与过敏性哮喘

肠免疫细胞、免疫成分及细菌代谢产物可通过淋巴循环和血液循环等途径进入呼吸道淋巴结，影响肺和整个呼吸道的免疫功能，这就是 肠-肺轴[20] 。

过敏性哮喘与儿童早期肠道菌群发育异常有关。由于出生方式改变（从产道分娩或剖腹产），喂养方式改变（母乳**喂养或奶粉奶瓶喂养），饮食改变（大量精加工食品），药物大量使用（如抗生素）和环境改变等各种因素引起的 菌群发育异常 ，可能是目前儿童过敏性哮喘不断增加的重要原因。如果婴幼儿1岁前能定植充足的有益共生菌，日后发生过敏性哮喘风险会明显降低[21]。

综上，肠道微生物是免疫系统必不可少的组分，菌群异常肠漏时，免疫细胞发育不成熟并分泌大量促炎症成分。随着这些异常免疫细胞和免疫成分迁移到其他部位，并引起当地免疫反应，身体各个器官和组织都可能受到伤害。只有拥有健康的菌群（肠道生物屏障），人的固有免疫和获得性免疫才能发育成熟，不易出现持续不适当的炎症/慢性炎症，不易发生自免疫攻击/耐受自身抗原，不对环境无害成分做出过度疫反应/不过敏。也就是说， 想要提高免疫力，最好的方法毫无疑问是保护好肠道菌群，保持良好的肠免疫能力 。

下期 食与心 将介绍肠漏对内分泌系统和心肾功能的影响，敬请关注！

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illness、sick、disease的区别

名词前冲戚可用sick，不能用ill，指某人不适通雀旅常不用sick，但美国英语中可以代散岁陵替be ill

ill 是形容词,"生病的,得病的"

illness 是名词,"病症""疾病"

I am ill \sick

I have illness It is a sick dog.disease指具体的病证.this kind of heart disease