临床病例讨论 第457例——多关节肿痛、腰背痛、全身多发包块  

The 457th case： polyarthralgia, back pain and subcutaneous masses

作　　者：李萌[1] 吴迪[1] 郑文洁[1] 李梦涛[1] 曾小峰[1] Li Meng Wu Di Zheng Wenjie Li Mengtao Zeng Xiaofeng.(Department of Rheumatology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences ,Beijing 100730, China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院风湿免疫科,100730

出　　处：《中华内科杂志》2017年第6期477-480,共4页Chinese Journal of Internal Medicine

摘　　要：患者男性，54岁。因多关节肿痛、腰背痛、全身多发包块就诊于北京协和医院风湿免疫科。以对称性多关节肿痛起病，诊断类风湿关节炎，治疗不规律，后出现腰背痛及全身多发包块。ESR、超敏C反应蛋白升高明显，类风湿因子和抗环瓜氨酸多肽抗体阳性，无任何感染及肿瘤证据。胸部CT示肺间质病变，胸锁关节及胸骨破坏。脊髓MRI示椎体改变伴周边软组织影，皮下软组织见不规则异常信号。椎管内占位组织活检病理见类风湿结节。最终诊断类风湿关节炎，多发滑囊囊肿。经甲泼尼龙（40 mg/d）和环磷酰胺（0.4 g/周）治疗后，症状明显缓解，复查ESR 6 mm/1 h，超敏C反应蛋白1.22 mg/L，甲泼尼龙规律减量，6个月随诊时病情稳定，未复发。A 54-year-old man was admitted to the Department of Rheumatology in Peking Union Medical College Hospital due to polyarthritis, back pain and multiple subcutaneous masses. He had symmetrical polyarthritis at onset, which was diagnosed as rheumatoid arthritis. His follow-up and treatment were irregular. Back pain and multiple subcutaneous masses developed 2 year ago. Erythrocyte sedimentation rate and C-reactive protein were elevated. Rheumatoid factor and Anti-cyclic citrullinated peptide antibody were positive. No evidence of infection or malignancy was detected. Chest CT suggested pulmonary fibrosis and osteolytic lesions of sternum. Spinal MRI showed paravertebral soft tissue. Biopsy of the soft tissue suggested the pathological finding of a rheumatoid nodule. The patient was diagnosed as rheumatoid arthritis complicated with multiple rheumatoid bursal cysts.Combination therapy of methylprednisolone（40mg/d） and cyclophosphamide（0.4 g/w） lead to a rapid improvement of clinical symptoms and laboratory parameters.The patient was still in remission at 6-month follow-up.

关 键 词：关节炎 类风湿 多发滑囊囊肿 

分 类 号：R686.7[医药卫生—骨科学]