临床病例评析——老年女性 多关节肿痛  

A case of old female with swollen and pain of multiple joints

作　　者：刘媛[1] 董馨[1] 王丽[2] 张云岗[3] 郑毅[1] 

机构地区：[1]首都医科大学附属北京朝阳医院风湿免疫科,100082 [2]首都医科大学附属北京朝阳医院放射科,100082 [3]首都医科大学附属北京朝阳医院病理科,100082

出　　处：《中华风湿病学杂志》2017年第5期333-337,I0001,共6页Chinese Journal of Rheumatology

摘　　要：目的分析焦磷酸钙沉积病的临床及影像学特点，提高对该病的认识。方法报道1例老年女性焦磷酸钙沉积病患者的临床特点及诊治经过，并进行分析讨论。结果老年女性，8年前以右膝关节肿痛起病，关节表面稍红，局部皮温高，无明显诱因，先后累及左膝、右踝、双腕、双手掌指关节及右肘关节，每次发作多表现为寡关节肿痛，1周左右自行缓解，近20d右腕、双膝关节红、肿、热、痛，X线示腕关节三角纤维软骨盘平行于软骨面的细条状钙化影，膝关节半月板及耻骨联合索条状钙化灶，关节液折光滤片镜检示双折光短棒状结晶，诊断焦磷酸钙沉积病，予关节腔冲洗及关节腔内注射复方倍他米松，口服非甾体抗炎药治疗，症状缓解。结论认识焦磷酸钙沉积病的疾病特征有助于临床正确诊断及治疗。Objective By analyzing the clinical and radiographic manifestations of calcium pyrophosphate deposition disease （CPDD） to improve the recognization of the disease. Methods Clinical features, diagnosis and treatment of an old female patient with CPDD was reported with literature review. Results An old female patient presented with swollen and pain on the right knee without obvious causes eight years ago, which was characterized by slightly reddness of joint surface, warm of local skin. Then she gradually developed swollen and pain in left knee, right ankle, both wrists, bilateral meta-carpophalangeal （MCPJ） and right elbow joints with few joint symptoms and the joints swollen and pain could relieved spontaneouslyitself in about one week. X-ray showed the thin strip of cartilage calcifications in wrist triangular fibrocartilage disc, meniscus of knee and the pubic symphysis were parallel to the surface of cartilage. Examination of microscopy with refractive filter demonstrated that short rod crystals refraction in joint fluid. CPDD was diagnosed and treated with flushing of joint cavity and injections of betamethasone as well as nonsteroidal anti-inflammatory drug orally. Symptoms relieved after therapy. Conclusion Understanding the disease characteristics of CPDD is beneficial to for accurate diagnosis and treatment.

关 键 词：关节炎 诊断 软骨钙质沉着症 

分 类 号：R684[医药卫生—骨科学]