8例RS3PE临床回顾性分析  

Remitting seronegative symmetrical synovitis with pitting edema:a retrospective analysis of 8 cases

作　　者：郑文洁[1] 王昱[2] 蒋颖[1] 张烜[1] 曾小峰[1] 张奉春[1] 

机构地区：[1]北京协和医院风湿免疫科,北京100730 [2]京大学第一医院风湿免疫科,北京100034

出　　处：《基础医学与临床》2008年第8期882-885,共4页Basic and Clinical Medicine

摘　　要：目的分析缓解性血清阴性对称性滑膜炎伴凹陷性水肿（RS3PE）的临床特点与肿瘤的关系，以减少误诊和漏诊。方法收集北京协和医院2003年1月—2007年6月住院的8例RS3PE病例，分析其临床表现、实验室检查、治疗反应及转归。结果男5例，女3例；平均发病年龄60．9岁（38～79岁）。5例为原发性，3例合并肿瘤。均有对称性多关节炎以及肢端水肿。合并肿瘤者关节外表现明显。血清类风湿因子（RF）、抗角蛋白（AKA）、抗核周因子（APF）以及抗环瓜氨酸多肽（CCP）抗体均阴性，抗核抗体（ANA）低滴度阳性5例。关节X线均未见骨侵蚀。激素和／或免疫抑制剂治疗后，2例关节症状和肢端水肿持续缓解，3例症状反复，分别在RS3PE确诊后第6、7和36个月，病理确诊为非霍奇金淋巴瘤，定期接受化疗。结论RS3PE是一种异质性临床症候群，治疗期间应密切随诊，出现多系统受累表现者应高度警惕肿瘤。Objective To investigate the clinical features of Remitting Seronegative Symmetrical Synovitis with Pitting Oedema（RS3PE） ,especially it＇ s association with malignancy. Methods The clinical data of eight RS3PE patients hospitalized during Jan 2003 and June 2007 in Peking Union Medical College Hospital were reviewed. The clinical characteristics, laboratory tests, response to treatment as well as the outcome were studied. Among the 8 patients, five were male and 3 were female, the mean age of RS3 PE onset was 60. 9 （38 - 79yr）. 5 had idiopathic RS3PE without underlying disease, and 3 presented associated neoplasm. Results All patients had symmetrical polyarthritis and pitting edema on the dorsum of hands and/or feet. Extra-articular symptoms were more conspicuous in patients complicated by neoplasm. Serum RF,AKA,APF and anti-CCP antibody were all negative, antinuclear antibodies （ANA） was positive with low titer in five cases. Hand and foot radiographs did not show bone erosion in all cases. After steroid and/or immunosuppressive treatment, 2 cases exhibited persistent remission of articular symptoms and edema, whereas relapses occurred 6, 7 and 36 months respectively after the initial diagnosis in 3 cases who had been pathologically confirmed as having Non-Hodgkin-Lymphoma and thereby received periodical chemotherapy . Conclusion RS 3 PE is a group of clinical manifestations with prominent heterogeneity , thereforeintensive follow-up is necessary, and the presence of systemic symptoms/signs in RS3PE patients alert the physician for the potential concomitant malignancy.

关 键 词：RS3PE 肿瘤 

分 类 号：R593.2[医药卫生—内科学]