让我们来谈谈类风湿关节炎

Whether you’ve just been diagnosed or worry you could have rheumatoid arthritis, you’re probably nervous, confused, and maybe even a little scared. That’s normal, and everyone featured on HealthCentral with a chronic illness felt just like you do now. But we—and they—are here for you. On this page alone, you’ll discover the realities and challenges of the condition, but also the best treatments, helpful lifestyle changes, where to find your rheumatoid arthritis (RA) community, and all the crucial information to help you not merely manage—but thrive. We’re sure you’ve got a lot of questions...and we’re here to answer them.

什么是类风湿关节炎，反正？

The term "arthritis" feels familiar because: Who hasn't seen the stock image of高龄人抓膝？但事实上，这个词常常被误。首先，“关节炎”是广义术语;有不只是一个品种。类风湿关节炎（RA）是第二个最常见的类型，影响美国大约130万人，其中70％是女性，根据关节炎基金会。其次，RA并不只影响退休集，也没有命中率仅为膝盖和手。RA是一种自身免疫性疾病，导致全身炎症反应，这主要是渗入关节，但也有超越他们的影响。虽然它可以在任何时间发生，RA通常开发年龄40和60如此说来，RA还可以经由被称为幼年特发性关节炎条件影响儿童之间。

要真正了解RA，它有助于有一个形象在你的关节是如何工作的想法。所以，拍下这一刻：接头包含几个结构，使您可以轻松地移动。

• When healthy, the ends of the bones in a joint are protected from rubbing together by an elastic slippery material calledcartilage(yep, the same stuff your ear is made of).
• The entire joint is surrounded by a capsule, known as thesynovial sac。
• 组织的薄层称为synovial membrane线的囊。
• 膜分泌润滑synovial fluid, which reduces friction, protecting the cartilage and joints during movement.

但这里的时候RA撞击会发生什么：免疫系统本质上擦枪走火，并设置在滑膜的景点，攻击，如果是外来入侵者。

在早期阶段，滑膜发炎和增厚，引起疼痛并限制关节运动。有些人报告感觉温暖，甚至烧毁受累关节周围感以及刚性，使运动缓慢。随着时间的推移，未经处理的炎症可破坏的软骨和骨头。骨骼之间的空间可以变得更小，从而导致关节变得不稳定，错位，更痛苦，有时甚至不动。

Eventually, inflammatory tissue begins to build up, sometimes causing nodules to form around the area, most commonly along the back of the forearms, elbows, joints, and pressure points such as sacrum, occiput, and heel. These nodules will fluctuate with disease activity. However, if you imagine someone with arthritis in their hands, the very firm nodules at the furthest finger joints are actually those seen in Osteoarthritis and not rheumatoid arthritis. And while RA is known for causing joint pain and inflammation, it can spark other symptoms throughout your body, including dry eyes, chest pain, and osteoporosis.

Worth noting: Before you feel any joint pain, it’s common to experience general, nonspecific RA symptoms; unfortunately, they’re the kind that seem to go with一切–fever, fatigue, loss of appetite—so linking them with RA doesn’t often happen. And that tightness you feel in your joints may only be an issue in the morning (making it seem like not such a big deal). With rest, any synovial fluid you have is soaked up by the cartilage, much like a sponge absorbs water. As you move, the cartilage is "squeezed," and the fluid bathes the joint. First thing in the a.m., there’s just not going to be a lot of extra fluid to keep things loose. But the more you move, the more fluid is released.

What Causes Rheumatoid Arthritis in the First Place?

Scientists believe that the overactive immune response that precipitates RA is triggered by a complex interaction between genetic and environmental factors. Ital on the复杂一部分，因为即使是在医学上顶尖高手都想通了类风湿性关节炎的确切原因。当他们继续在神秘的蚕食，一些具体的相关性已经确定或正在研究：

• 遗传学：Certain genes increase the开发风湿性关节炎的风险。例如，遗传标记HLA-DR4已经在欧洲血统与RA的人60％〜70％％的人。但是，什么是“遗传标记”？它在你的DNA任何变化，可能表明制定特定条件的风险增加。然而，仅仅拥有该基因并不意味着你必须RA或者你会发展它。因为有很多其他因素影响类风湿性关节炎因为单独的基因不能确认诊断或未来预测它，开发​​文档不诊断RA时进行基因检测。

• 作为一个女人：Since women get the disease three times more often than men, some experts believe hormonal factors may play a role in causing rheumatoid arthritis. It has been shown that estrogen can rev up the B cells (those are the white blood cells that attack the synovial membrane) and thus exacerbate autoimmune diseases like RA.

• Viruses and infections:虽然我们知道，RA是由于免疫系统攻击人体的健康组织，医疗陪审团还在外面对cause for that response。Some researchers believe that healthy cells may get mixed up in the action when the body senses danger from a virus or infection; when the immune system kicks into gear and attacks the germs (aka an immune response), the body’s own tissue may get assaulted, too. That's when autoimmune diseases like RA pop up, and healthy joints fall under siege.

Do I Have the Symptoms of Rheumatoid Arthritis?

There’s a reason you’re often shown an illustration of a disembodied hand when discussing RA with your doctor! Rheumatoid arthritis most often hits the small joints of the hands and wrists first, where you may feel warmth, swelling, or tenderness. The joint pain of RA has been described in all sorts of ways—deep, dull, aching, throbbing, warm, hot, tender. However, most agree that the pain is typically worse in the early mornings. It can take at least 30 to 45 minutes for joints to loosen and feel better, and it generally worsens again after periods of inactivity.

这就是说，类风湿性关节炎的症状也可以延伸到你的胳膊肘，肩，膝，髋，踝，脚和颈部。RA症状也往往对称发生;也就是说，在身体两侧的关节通常受累在同一时间。在某些情况下，其他器官系统，包括眼睛，心脏和肺，可能会发炎过，导致视力模糊，液体积聚周围的心脏或肺部，胸痛和呼吸短促一起。（现在，虽然，需要很长的，深吸一口气：RA是一种严重的疾病，但是并发症可以控制，甚至防止更多，下面。）

很多人都体会到年（这是不可预测的那样）在天漫长的发作症状，这可能缓解句号隔开，当你的RA症状消退。事实上，随着女性RA谁是怀孕通常体验过怀孕的所有RA相关的症状完全沉寂，因为激素和免疫系统调节身体状态。这些症状通常会返回全部力量产后，因为身体恢复正常的荷尔蒙平衡和免疫系统功能。

Early symptoms of RA may include:

• Fatigue and weakness
• Low-grade fever
• General feeling of poor health
• Loss of appetite and weight loss
• 接缝严密，通常在身体两侧，这可能是温暖的触感

With long-term, untreated rheumatoid arthritis, these additional symptoms may occur:

• Stiffness (especially after waking up)
• 硬而无痛的皮肤肿块，被称为类风湿结节，在手，肘，膝，或脚趾可以在大小范围从豌豆到橘子
• Bent and misshapen joints
• Dry mouth
• Red, itchy eyes
• 胸痛和呼吸困难（在先进的情况下，炎症会影响心脏和肺）

When to Call Your Doctor or Rheumatologist

预约了医生，如果您遇到晨僵与任何RA的其他早期症状，包括发烧和体重减轻。如果你没有被诊断，初级保健医生才能把你风湿病运行类风湿性关节炎必要的测试。如果您有风湿性关节炎，并遇到一个重大的眩光或出现新的症状，请联系您的风湿病或初级保健医生寻求帮助。

怎么做医生诊断类风湿关节炎？

RA is diagnosed based on your medical history, a physical examination, and laboratory and imaging tests (e.g., X-rays).

Laboratory tests that may be used to help diagnose rheumatoid arthritis include:

• 抗环瓜氨酸肽（抗CCP）抗体：Antibodies are proteins made by your body to fight off foreign substances. Anti-CCP is an antibody present in most RA patients. This simple blood test looks for the presence and level of the antibody.
• Complete blood count (CBC):This common test is used to measure levels of red blood cells, white blood cells, and platelets in the blood. A low red blood cell count can be an indication of the chronic inflammation seen in.
• C-reactive protein (CRP):你抽血，然后检查的CRP蛋白，它是由肝脏产生的，可以在你的血液中对炎症的反应被发现的存在。
• 红细胞沉降率（ESR）：After a sample of your blood is added to a tube, a technician measures the rate at which the red blood cells fall to the bottom of the tube. A fast sedimentation indicates inflammation, with blood cells clumping together and falling quicker.
• 类风湿因子：Also known as the latex agglutination test, this blood test is used to detect levels of this antibody, which are elevated in most patients who have RA.
• X射线：从X射线产生的图像显示，RA的炎症已在你的关节造成的损害的量。
• MRI：磁共振成像用的磁场，射频，和计算机技术得到是如此敏感的图像质量，他们可以检测RA损害六个月以上的显示出来的X射线之前。
• 超声：Sometimes referred to as ultrasonography, this is a very sensitive test that exposes both the bone erosion that happens in RA damage as well as the presence of inflammation.
• 滑液分析：In this test, which is performed when a joint has pain, inflammation, or swelling, fluid is drawn from the joint to help determine a potential diagnosis. It could be an infection, gout, or arthritis, among other things. It’s important for docs to get this right because, obviously, gout—for example—has a completely different treatment plan than RA.

What Is the Best Treatment for RA?

The goal of treatment is super simple: to keep you moving in all the ways you need to. That means reducing—and ideally stopping—the pain and inflammation that can eventually lead to joint damage. When RA is diagnosed early (check those symptoms!) and you’re aggressive with treatment, you're more likely to avoid complications later.

Treat-to-Target (T2T) is a newish treatment strategy that sets remission or minimal disease activity as the objective. How it works: Disease activity is frequently monitored and if the target (remission!) is not met, meds and doses are adjusted right then and there, at your appointment. How exactly? Docs follow a predetermined protocol, which could include medication, therapy, dietary changes, RA-friendly exercises, surgery, or a combination of treatment options.

RA的药物：你有选项

There are more rheumatoid arthritis medications and treatment choices now available than ever before, which makes it easier to find the best treatment plan for you.

RA药物包括（上市，一般情况下，在你的RA是否是轻度，中度或重度排序）：

NSAIDS

非甾体抗炎药（NSAIDs），不动摇，不懈怠RA的进展，但是医生可能因炎症开一个大剂量治疗慢性疼痛。常用的NSAID包括那些你知道：

• Aspirin (Bufferin, Bayer)
• Celecoxib (Celebrex)
• Disalcid（双水杨酯）
• 布洛芬(艾德维尔和其他品牌)
• Naproxen (Aleve and other brands)
• RELAFEN（萘丁美酮）
• COX-2抑制剂中，具有内部出血或胃溃疡-一个被在大剂量使用了很长时间的其他NSAID的常见副作用的风险较低NSAID的一个子类。如果你做需要高剂量的其他NSAID的，它应该是一个短期修复。

DMARDs

These disease-modifying anti-rheumatic drugs (hence: DMARDs) help preserve joints by blocking inflammation. Due to the unpredictable risk of potential side effects from DMARDs—such as upset stomach, infection, hair loss, and liver damage—you must be closely monitored with regular (weekly to every few months) lab tests when taking these medications. DMARDs include:

• Trexall（甲氨蝶呤）
• Azulfidine (sulfasalazine)
• Arava (leflunomide)
• Plaquenil (hydroxychloroquine)

Biologics

也被称为生物反应调节剂，这些药物被设计成控制免疫的某些部分系统实际上，他们是一类型的抗体。但是，而不是锁定到细菌或病毒，他们的目标，然后关机，蛋白质燃料炎症。（酷吧？）今天，有许多可用的不同的生物，所以医生根据他们把靶心对细胞进行分类。

• 肿瘤坏死因子抑制剂（TNF抑制剂）——例如抗(adalimumab),恩利(道),Cimzia (certolizumab), Simponi (golimumab), and Remicade (infliximab)—put the brakes on tumor necrosis factor, a naturally occurring substance that is overproduced in people with RA; it’s the main cause for the first inflammation a person with RA gets. They’re delivered by self-injection or IV infusion, depending on the drug.
• B细胞抑制剂一样，美罗华（利妥昔单抗），是通过IV和杀B淋巴细胞可产生火花的炎症给药。
• Interleukin-1 (IL) blockers一样KINERET（阿那白滞），是每日自注射;他们的目标白介素1，在主体中的炎症性化合物。
• Interleukin-6 inhibitors, such as self-injected Kevzara (sarilumab) and IV-administered or self-injected Actemra (tocilizumab), stop interleukin-6 proteins from attaching to cells and triggering inflammation.
• T细胞抑制剂, like Orencia (abatacept), latch on to the surface of T-cells (aka inflammation-causing white blood cells). A doctor will give you this medicine via IV.

These medicines can slow the progression of RA and even bring about long periods of remission. Drawbacks? The delivery method—you must give yourself shots or visit an IV infusion center regularly—and because they tamp down your immune system, you may be more likely to catch colds and other infections.

Steroids

口服糖皮质激素，如DELTASONE（强的松），类风湿性关节炎症状提供快速救援，并在先进的情况下，可以防止RA相关的炎症损害您的眼睛和内脏。由于长时间使用时强的松有严重的副作用，它往往是保留对严重的突发或当其他治疗都无效。皮质类固醇注射到受影响的关节也可能会有帮助。

Surgery

There are some RA cases—usually advanced and/or undertreated—where surgery may be a necessary consideration. Meaning: The pain is likely debilitating, and you no longer have normal joint function. There are two surgery types:

• 滑膜切除术。任何时候，肿胀已经变得如此糟糕，你有一个很难移动和运作，这种手术可以进行。它会从受影响的关节病变滑膜，以减少肿胀和疼痛，并有助于防止进一步的关节损害。
• Arthroplasty.This surgery replaces the damaged joint with a mechanical one to restore joint function or fix a deformity. More than a million joint replacement surgeries are performed each year, mostly of the hip or knee, but the shoulders, elbows, and joints in the hands and feet may be replaced as well. Critical to discuss with your surgeon: the types of activities you want to continue after joint replacement. This will help your doc select the appropriate type of prosthesis and implantation technique, while giving you a deeper dive into the risks and limitations of surgery.

治疗可以帮助其他类型

如果你有风湿性关节炎,是的,你有一种慢性疾病。But there are a number of things you can do—in addition to typical meds—to help you feel your best. For this, consider assembling a medical team of specialists from a variety of fields, including psychiatry, nutrition, and radiology.Other health-related professionals may also be part of your team to assist you with the following:

• Movement.Your doctor may prescribe an exercise program or advise you to see a physical or occupational therapist. While exercise that is too vigorous may worsen your symptoms,programs with gentle exercises can increase the range of motion of your joints。因为水有助于支撑身体的一些练习更容易进行在游泳池或热水浴缸。跟你的医生哪些技术将是最适合你的。

• Sleep.Given how uncomfortable the condition is, more than half of people with RA have trouble晚上睡得。Plus, RA-related inflammation tends to deplete energy levels faster than for those without RA—so a solid eight hours of shut-eye is even more critical. Start tonight by using pillows as extra support where needed (for example, under a painful shoulder or between stacked knees).

• Compresses.Since heat works to reduce muscle tension and stimulate blood circulation, many people with RA say that applying something warm (a fresh-from-the-dryer hoodie will do!) makes joints feel better before exercise and other physical activity. Cold compresses, on the other hand, reduce inflammation, swelling, and soreness after an RA flare.

• Topical creams.Applying creams or lotions containing capsaicin (an extract from chili peppers!) may soothe minor joint pain. Ditto for those with camphor, menthol, or turpentine oil. Try: capsaicin-infusedCapzasin HP Crème要么J.R.沃特金斯白色膏状搽剂，同时具有樟脑，松节油。

• Splints.你的风湿病可能会开夹板对于那些对你麻烦点区域。在严重发作，他们会通过固定关节帮助缓解疼痛。

• 饮食。While most evidence about the role of diet with RA is anecdotal, there are some studies that indicate certain foods may be helpful. In particular, the Mediterranean diet (aka the anti-inflammatory diet)—which emphasizes fish, olive oil, and vegetables—has been shown to have some impact on inflammation, likely due to the omega-3 fatty acids in certain fish. Several smaller studies also tout the helpfulness of a vegan or vegetarian diet on RA. Learn all aboutRA and diethere.

What Triggers a Rheumatoid Arthritis Flare-up?

Like a tornado, the triggers of rheumatoid arthritis are unpredictable. The best way to gain more control? Pinpointthe culprits behind your flares。Everyone’s are different, but typical offenders include:

• 强调
• Infections, including flu and cold, that activate your immune system
• Physical trauma, like surgery or broken bones
• Post-pregnancy
• Poor dental health
• Certain foods, including processed snacks, red meat, and excess refined sugars
• 过大的运动量
• Dramatic, sudden changes in weather

RA是否有严重的并发症？

It can. Side effects from rheumatoid arthritis are manifestations of the condition itself and come in two varieties: those from untreated or undertreated RA, and those caused by joint damage.Common complications of RA包括：

• Heart disease。It affects more than half of all people with RA.
• Rheumatoid nodules, which occur in 30% to 40% of RA patients and are more bothersome than painful.
• 骨质疏松- 相关的骨折。这些是25％至30％，与RA的人比一般人群更常见。
• Infections (flu, staph, pneumonia). They’re twice as common in people with RA.
• 肺部疾病。它的发展在近四分之一的RA患者。
• 干眼症。This is the most common eye complaint for people with RA.

大约有10％的人被诊断为RA（勤勉处理）在一年内经历完全缓解，约40％进入缓解within two years. That’s thanks to significant advances in treatment over the past two decades.

这就是为什么它是如此重要的不要忽视的症状，或推迟获得帮助。如果疾病进展和不治疗，当可能出现的最坏的副作用：运动的严重限制范围或者，接头的恶化，逐渐破坏。炎症过程减慢如纤维组织形式或骨头融合，和关节完全停止工作。

预防

While there is no known way to keep from getting rheumatoid arthritis, there are plenty of steps you can take to prevent complications and feel better overall.

• Quit smoking.34101名妇女的瑞典研究报告说，即使光吸烟与女性RA的风险增加和退出（或不启动的话）可以降低风险。
• 保持健康的体重，缓解关节压力。如果你are overweight, you may want to consider a weight-loss plan, as excess pounds can put unnecessary stress on your joints. Consider working with a dietitian to help build a personalized diet or program that targets your specific goals (i.e. less sugar and more omega-3 fatty acids/fish) for managing your RA.
• Eat a healthy diet.While there is no prescribed diet for RA, aim to avoid foods that cause inflammation, like packaged snacks,and include foods that promote bone health and immune function.
• 启动或跟上的例行演习。Research shows that exercise can help alleviate RA symptoms and even improve day-to-day functioning. It can also make you more flexible, help you sleep better, and boost your endurance.

什么是生活像人的RA？

A day-to-day with rheumatoid arthritis often includes pain and fatigue, which can, admittedly, be overwhelming. You may also have to deal with people who don't really understand your condition and can't fully grasp what you're going through. If RA is relatively new to you, or you’re exhausted and in constant pain, we understand how impossible it can feel to gather the strength to search for good care and try new treatments. So start small: First educate yourself about RA, then work toward building confidence in who you are as a person living with RA.

情绪健康

People who have rheumatoid arthritis often feel that they must掩盖或掩饰他们的问题, which can be a real drain on your brain. The best solutions?

• 说出来。只需使用你打算通过什么与RA可以删除的孤独和帮助，负担你的人帮助你在你需要的方式和朋友家人聊天。
• 想办法来缓解压力。尝试创建一个自我护理常规和探索替代疗法沉思状。
• 考虑向心理医生。被诊断为RA往往会引发你哀悼你的健康和工作对接受您的情况悲伤的过程。你可能会感到沮丧，特别是如果你的病是超级活跃。通过优先发展你的心理健康，并与辅导员或治疗师（你的家人或文档风湿病可以指你一个）链接，你会为自己设定了RA管理的所有其他方面坚持到底。

性生活

百分之五十九那些具有RA的，每发表的一项研究中Rheumatology, felt the disease had a negative effect on their sex life. And no wonder: Depending on its severity, RA itself—along with some of the meds used to treat it—can decrease desire due to fatigue, stiffness, vaginal dryness, erectile dysfunction, and a decreased libido.

So, what’s the fix? Patience, communication, and understanding between you and your partner are obviously key. There are also certain sex positions that may feel more comfortable for you, typically based on your most ouchy joints:

• For wrist and/or elbow pain:根据需要对下你的胳膊肘的背面或侧面，以及地方枕头躺下。
• 颈部疼痛：Don’t put pillows behind your neck or bend it forward when you’re on your back having sex. And be sure to talk to your doctor about how RA may affect your neck and how to protect it.
• 对于髋关节疼痛：If it hurts to move your hips around, have sex in a spoon position, with your partner behind you.
• 对于膝关节疼痛：你要保持你的膝盖伸直，所以尝试是在你的彼此面对的传教士体位或躺在底部。

怀孕

这是够复杂了无RA-所以当然怀孕withthe condition comes with a billion extra questions.Will I have to come off my medication?（有些药品是不安全怀孕期间服用，有的则是很好。）我将通过RA上给我的孩子？(In short, not necessarily.) Learn as much as possible aboutthe issues to consider, and talk to your rheumatologist early on (ideally, before you start trying) regarding medication risks.

Where Can I Find Rheumatoid Arthritis Communities?

RA affects such a small percentage of the population that, without actively searching, running into another RA-er IRL is as likely as spotting a Charleston Chew at a movie-theater concession stand. Yet, finding your people—those who know究竟你经历什么，是同样重要的是你的精神健康为找到一个治疗计划工程。形式的连接，探索资源，共享双方的痛苦和灵感，并结交新朋友，从这里开始。

顶部RA Instagrammers

• Britt Johnson,@hurtblogger

Follow because:She’s been through the mud—and pretty much stuck there—and does not sugarcoat the realities. She做es, however, find light and love in the tiniest places, constantly reminding you that if she can find the strength, so can you.

• Desiree Lee,@thebarbellbeautie

Follow because:She may be afraid of needles (hello, Humira shots), but she is not afraid of a barbell. Serving up your daily dose of workout inspiration—and actual workout routines—without ignoring the exercise issues that come with a chronic condition.

• 蕾妮·安德森，@the_rheumatoid_arthritis_mama

Follow because:She’s relatable on every level: She covers all aspects of how RA affects her life—and shares that emotional rollercoaster in her captions—including how she maintains a robust marriage in a hurting bod, keeps mommin’ through exhaustion, and fuels her health with arthritis-approved recipes.

• Eileen Davidson,@chroniceileen,chroniceileen.com

Follow because:她是一个大型主张谁背水战上使她发来提高认识什么是真的很喜欢有RA，和她做这件事没有（疼痛）的骨头。她是一个天生的讲故事的人，与上海社会科学院的一个侧面。

• 艾梅松本，@fitaimee_ra

Follow because:当你认为你不能岩石妈妈生活(或电动汽车en have it at all), splurge on In-N-Out Burger, or muster the energy to exercise, Aimee is here to prove you wrong on所有它的周期。

顶级RA相关的播客

• 慢性简报。通过灵活和热闹的作家丹尼尔马利托（谁拥有了幼年型关节炎超过25年了，因为他是11岁），该RA-相关的播客的档案是凄美的，有时LOL搞笑。
• 慢性性别。Sex educator and activist Kirsten Schultz hosts this explicit—as in, NSFW unless you’re wearing headphones!—podcast, uncovering truths about how chronic illness and disability (including RA) affect relationships, sex, and sexuality.
• Sickness + Health。Artist and health advocate Cara Gael O’Regan has lived with Ehlers-Danlos Syndrome, another joint-related condition, for more than two decades; here, she does in-depth interviews on some of the toughest topics—insurance coverage, disability, mortality—as they intersect with chronic conditions and pain.
• Arthritis and Work by the Arthritis Society。While it’s not an ongoing series, this is a gold mine of solid work-related resources specific to balancing a career when you have RA.

顶部RA Support Groups and Non-Profits

• Arthritis Foundation。该组织和其屡获殊荣的杂志，Arthritis Today，帮助您创建一个完整的生命个性化的计划。从测验（“什么是你的关节炎的饮食？”）和专家Q＆A的可自定义的程序和工具（“跟踪并做出反应，”症状跟踪应用程序），关节炎基金会鼓励你在你的RA诊断一下全盘。
• 关节炎国立研究基金会。For more than four decades, this group has provided grants and organized fundraising for arthritis research into the causes and prevention of, and new treatments for, chronic joint conditions. Whether you're heavy into science or not, this is where you'll want to look for researchers’ latest and greatest RA findings.
• Rheumatoid Arthritis Support Network。Its goal? Provide up-to-date information so that people with RA know their options for prescription drugs and alternative therapies, and fully understand their diagnosis. The site also has a treasure trove of resources, including a rheumatologist directory.
• My RA Team。这个庞大的社交网络几乎与别人谁拥有风湿性关节炎您连接。这是伟大的情感上的支持，实用的建议，并在管理条件真实世界的洞察。