强直性脊柱炎合并类风湿关节炎2例并文献复习  

Ankylosing spondylitis with rheumatoid arthritis:an analysis of two cases and literature review

作　　者：俞烜华[1] 黄惠娟[2] 邱磷安[1] Yu Xuanhua;Huang Huijuan;Qiu Linan(Department of Rheumatology,People's Hospital Afilited tofujian University of Traditional Chinese Medicine;Department of Preventive Treatment of Disease,People's Hospital Afilited tofujian University of Traditional Chinese Medicine)

机构地区：[1]福建中医药大学附属人民医院风湿病科,福州350004 [2]福建中医药大学附属人民医院治未病科,福州350004

出　　处：《重庆医科大学学报》2020年第8期1131-1136,共6页Journal of Chongqing Medical University

摘　　要：目的:探讨强直性脊柱炎(ankylosing spondylitis,AS)合并类风湿关节炎(rheumatoid arthritis,RA)患者的发病因素、临床及辅助检查特点。方法:回顾性分析福建中医药大学附属人民医院风湿病科确诊的2例AS合并RA患者,通过复习文献,总结其临床特征及实验室检验、影像学检查特点。结果:AS合并RA发病与遗传因素、病原体感染、吸烟及免疫异常等有关,有共同细胞因子参与。中青年女性多见,大多于青年发病,以腰背痛或腰骶痛起病为主。影像学检查均有骶髂关节炎,大多有外周关节炎,部分患者有竹节样脊柱。人类白细胞抗原(human leukocyte antigen,HLA)-B27阳性率较AS低,类风湿因子(rheumatoid factors,RF)、抗环瓜氨酸肽(anti-cyclic citrullinated peptide,CCP)抗体阳性率与RA相近。病情活动度高,治疗反应不如单一疾病,应早期、积极、联合用药,严重难治性患者可使用糖皮质激素和(或)生物制剂。结论:AS合并RA发病多因素相关,中青年女性多见,首发症状复杂多样,病情活动度高,影像学骨质破坏重,应早期诊断,积极治疗。Objective:To investigate the pathogenic factors and clinical and laboratory features of patients with ankylosing spondylitis(AS) and rheumatoid arthritis(RA). Methods:A retrospective analysis was performed for the clinical data of two patients with AS and RA who were diagnosed in Department of Rheumatology,People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine,and a literature review was performed to summarize the clinical,laboratory,and imaging features of such patients. Results:The pathogenesis of AS with RA was associated with genetic factors,pathogen infection,smoking,and immune abnormalities,with the involvement of common cytokines. AS with RA was commonly seen in young and middle-aged women,with a disease onset in youth and low back pain or lumbosacral pain as initial symptoms. Radiological examination showed sacroiliitis in all patients,peripheral arthritis in most patients,and bamboo spine in some patients. The patients with AS and RA had a lower positive rate of human leukocyte antigen-B27 than those with AS alone and similar positive rates of rheumatoid factor and anti-cyclic citrullinated peptide antibody as those with RA alone. The patients with AS and RA had a high degree of disease activity and poorer treatment response than those with AS or RA alone;early,active,and combined medication could be given,and glucocorticoids and/or biological agents could be used in patients with a severe refractory disease. Conclusion:The pathogenesis of AS with RA is associated with multiple factors.AS with RA is commonly seen in young and middle-aged women and has complex initial symptoms. There is a high degree of disease activity and severe bone destruction on imaging. Early diagnosis and active treatment should be performed.

关 键 词：脊柱炎 强直性 关节炎 类风湿 病例报告 

分 类 号：R593.2[医药卫生—内科学]