中华风湿病学杂志
中華風濕病學雜誌
중화풍습병학잡지
CHINESE JOURNAL OF RHEUMATOLOGY
2012年
7期
468-472
,共5页
滑膜炎%关节炎%缓解性血清阴性对称性滑膜炎伴凹陷性水肿综合征
滑膜炎%關節炎%緩解性血清陰性對稱性滑膜炎伴凹陷性水腫綜閤徵
활막염%관절염%완해성혈청음성대칭성활막염반요함성수종종합정
Snovitis%Arthritis%Remitting seronegative symmetrical synovitis with pitting edema syndrome
目的 探讨缓解性血清阴性对称性滑膜炎伴凹陷性水肿(RS3PE)综合征的临床特点及转归.方法 回顾性分析经住院确诊的14例RS3PE综合征患者临床资料、实验室检查、治疗和预后,相关数据采用频数或-x±s表示,复习国外文献并进行比较.结果 14例患者男性9例,女性5例,发病年龄52～78岁,平均(68±9)岁.均表现为突发的对称性手或足背凹陷性水肿及多关节炎,其中手关节炎14例,腕关节炎13例,膝关节炎10例,踝关节炎9例,肩关节炎8例;实验室改变:红细胞沉降率平均(68±26)mm/l h,C反应蛋白平均(49±41) mg/L,轻度低白蛋白血症、轻度正细胞正色素性贫血常见,1例抗核抗体1∶20阳性,类风湿因子及其他自身抗体均阴性,8例受累关节行磁共振成像(MRI)检查,可见滑膜炎改变,其中2例并发骨侵蚀;5例合并肿瘤,其中3例以RS3PE综合征首发;小剂量激素和缓解病变抗风湿药(DMARDs)治疗后临床症状均好转,但合并肿瘤者易复发.结论 RS3PE综合征老年男性较女性多见,临床上多以突发手足背凹陷性水肿伴多关节炎为突出表现,MRI可见侵蚀性改变,提示RS3PE并非绝对不出现骨破坏,小剂量激素和DMARDs治疗有效.该病与肿瘤关系密切,应密切筛查和随访.
目的 探討緩解性血清陰性對稱性滑膜炎伴凹陷性水腫(RS3PE)綜閤徵的臨床特點及轉歸.方法 迴顧性分析經住院確診的14例RS3PE綜閤徵患者臨床資料、實驗室檢查、治療和預後,相關數據採用頻數或-x±s錶示,複習國外文獻併進行比較.結果 14例患者男性9例,女性5例,髮病年齡52～78歲,平均(68±9)歲.均錶現為突髮的對稱性手或足揹凹陷性水腫及多關節炎,其中手關節炎14例,腕關節炎13例,膝關節炎10例,踝關節炎9例,肩關節炎8例;實驗室改變:紅細胞沉降率平均(68±26)mm/l h,C反應蛋白平均(49±41) mg/L,輕度低白蛋白血癥、輕度正細胞正色素性貧血常見,1例抗覈抗體1∶20暘性,類風濕因子及其他自身抗體均陰性,8例受纍關節行磁共振成像(MRI)檢查,可見滑膜炎改變,其中2例併髮骨侵蝕;5例閤併腫瘤,其中3例以RS3PE綜閤徵首髮;小劑量激素和緩解病變抗風濕藥(DMARDs)治療後臨床癥狀均好轉,但閤併腫瘤者易複髮.結論 RS3PE綜閤徵老年男性較女性多見,臨床上多以突髮手足揹凹陷性水腫伴多關節炎為突齣錶現,MRI可見侵蝕性改變,提示RS3PE併非絕對不齣現骨破壞,小劑量激素和DMARDs治療有效.該病與腫瘤關繫密切,應密切篩查和隨訪.
목적 탐토완해성혈청음성대칭성활막염반요함성수종(RS3PE)종합정적림상특점급전귀.방법 회고성분석경주원학진적14례RS3PE종합정환자림상자료、실험실검사、치료화예후,상관수거채용빈수혹-x±s표시,복습국외문헌병진행비교.결과 14례환자남성9례,녀성5례,발병년령52～78세,평균(68±9)세.균표현위돌발적대칭성수혹족배요함성수종급다관절염,기중수관절염14례,완관절염13례,슬관절염10례,과관절염9례,견관절염8례;실험실개변:홍세포침강솔평균(68±26)mm/l h,C반응단백평균(49±41) mg/L,경도저백단백혈증、경도정세포정색소성빈혈상견,1례항핵항체1∶20양성,류풍습인자급기타자신항체균음성,8례수루관절행자공진성상(MRI)검사,가견활막염개변,기중2례병발골침식;5례합병종류,기중3례이RS3PE종합정수발;소제량격소화완해병변항풍습약(DMARDs)치료후림상증상균호전,단합병종류자역복발.결론 RS3PE종합정노년남성교녀성다견,림상상다이돌발수족배요함성수종반다관절염위돌출표현,MRI가견침식성개변,제시RS3PE병비절대불출현골파배,소제량격소화DMARDs치료유효.해병여종류관계밀절,응밀절사사화수방.
Objective To analyze the clinical features and outcome of remitting seronegative symmetrical synovitis with pitting edema (RS3PE) syndrome,and enhance the understanding of it.Methods Fourteen cases of RS3PE syndrome treated in the Department of Rheumatology and Immunology were analyzed retrospec-tively,including the clinical characteristics,laboratory data.Data were presented as -x±s.Results Fourteen patients(nine man,five women) with RS3PE were enrolled.Their age was (68±9) (range:52-78)years.The main clinical features were acute onset symmetrical edema in both hands and feet and polyarthritis.Polyarthritis were involved in hand joints in 14 patients,wrists in 13 patients,knees in 10 patients,ankles in 9 patients,and shoulders in 8.In laboratory examinations,the average value of erythrocyte sedimentation rate was (68±26) mm/l h and C-reactive protein was (49±41) mg/L.Mild anemia of normocytic-normochromic type and mild low level of serum albumin were frequent findings.Antinuclear antibody was present only in one patient at low titer (1∶20).Rheumatoid factor and other auto antibodies were all negative in patients.Before corticosteroid treatment,the MRI test was performed in 8 patients and revealed prominent synovitis and articular effusion.Two cases had bone erosions on MRI; five patients were fuond to have malignant tumors,three of them initially presented with RS3PE.Polyarthritis and edema were relieved after treated with low dose corticosteroids and DMARDs drugs.But those patients with cancer were easily to recurr.Conclusion RS3PE syndrome is relatively uncommon.It occurs predominantly in elderly men and is characterized by rapid-onset symmetrical polyarthritis,presence of pitting edema of both hands and feet.Erosive changes can be seen on MRI.Patients usually have dramatic response to low dose corticosteroids and DMARDs drugs.Patients should be closely followed as RS3PE is closely related to cancer.
