摘要
目的探讨系统性硬化症(SSc)合并类风湿关节炎(RA)患者的临床特征和实验室检查特点,提高临床医生对重叠综合征的认识。方法对我科近年收治的3例SSc合并RA患者的临床表现、实验室检查结果及双手X线检查结果进行分析,并结合国内外文献进行复习。结果 3例患者均为女性,以SSc起病,有典型的SSc临床表现,包括雷诺现象、面具脸、张口受限、指端皮肤硬化、双手挛缩畸形等,且均合并间质性肺病、肺动脉高压症。3例患者均无明显的关节炎表现,而类风湿因子(RF)抗体全部或部分阳性;患者1抗核周因子(APF)阳性,患者2抗环瓜氨酸肽(CCP)抗体阳性,患者3 APF、抗CCP抗体、抗角蛋白抗体(AKA)及抗RA33抗体均阳性。3例患者双手X线检查结果均提示双手部分掌指关节或腕关节有不同程度的关节间隙狭窄甚至关节间隙消失,部分骨质有囊变及破坏。3例患者均给予糖皮质激素联合环磷酰胺治疗后好转出院。结论在重叠综合征中,SSc合并RA较为少见,而以SSc起病合并RA时,患者可无典型的关节炎表现,筛查RF抗体、抗CCP抗体、AKA、APF、抗RA33抗体并进行双手X线检查有助于明确诊断,及时给予规范治疗,改善患者预后。
Objective To explore the clinical features and laboratory tests of patients with systemic sclerosis（SSc） combined with rheumatoid arthritis（RA）,to improve the understanding of overlap syndrome（OS）.Methods The clinical manifestations,laboratory results and X-ray examinations of the hands of 3 patients with SSc combined with RA were analyzed and literatures both domestic and abroad reviewed.Results All patients were female,starting with SSc,with typical SSc clinical manifestations,including Raynaud＇ s phenomenon,mask-like face,limitation of mouth opening,skin sclerosis of finger tips,both-hand contracture deformity,etc.and combined with interstitial lung disease,hypertensive pulmonary vascular disease.None of patients had obvious arthritis manifestations but all or part of rheumatoid factors（RF） were positive;patient 1 had positive anti-perinuclear factor（APF）,patient 2 had positive anti-cyclic citrullinated peptide（CCP） antibody,patient 3 had positive APF,anti-CCP antibody,anti-keratin antibody（AKA） and anti-RA33 antibody.The patients＇ hand X-ray suggested that there were different degrees of narrow or even disappeared joint space in metacarpophalangeal joints or carpal joints,part sclerotin being cystic-degenerated and destructed.Three patients were discharged after treatment of glucocorticoids and cyclophosphamide.Conclusion In OS,SSc combined with RA is rare.Patients may have no typical arthritis manifestations when SSc combined with RA.Screening RF antibody,anti-CCP antibody,AKA,APF,anti-RA33 antibody and hand X-ray help its diagnoses,to carry out standard treatment and improve patients＇ outcomes.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第14期1677-1680,共4页
Chinese General Practice
关键词
重叠综合征
硬皮病
系统性
关节炎
类风湿
诊断
治疗
Overlap syndrome
Scleroderma
systemic
Arthritis
rheumatoid
Diagnosis
Therapy
作者简介
通信作者：王永福，014010内蒙古包头市，包头医学院第一附属医院风湿免疫科；E—mml：wyf5168@hotmail．com
