银屑病关节炎合并类风湿关节炎的临床特征及文献回顾  

Coexisting psoriatic arthritis and rheumatoid arthritis:A case series and literature review

作　　者：陈源 张晓慧[1] 宋志博[1] 张卓莉[1] CHEN Yuan;ZHANG Xiao-hui;SONG Zhi-bo;ZHANG Zhuo-li(Department of Rheumatology&Clinical Immunology,Peking University First Hospital,Beijing 100034,China)

机构地区：[1]北京大学第一医院风湿免疫科,北京100034

出　　处：《中华临床免疫和变态反应杂志》2023年第5期407-414,共8页Chinese Journal of Allergy & Clinical Immunology

基　　金：北京大学第一医院青年临床研究专项基金(2019CR28)。

摘　　要：目的 尽管普遍认知银屑病关节炎(PsA)可以与类风湿关节炎(RA)合并存在,但相关病例报道很少,本文对PsA合并RA患者的临床特点进行总结。方法 纳入北京大学第一医院PsA队列(PKUFHP)中合并RA的患者,同时文献检索既往相关报道的病例,对患者的临床资料进行分析。结果 PKUFHP队列453例PsA患者中明确诊断为PsA合并RA患者5例,初诊时均处于中-高疾病活动度,超声下均有明确的滑膜炎及附着点炎表现,经单纯传统合成改善病情抗风湿药治疗,仅2例患者达到最低疾病活动度/缓解,1例加用靶向药物治疗后达标,1例先后尝试多种生物制剂和托法替布治疗病情仍未得到充分控制。既往文献中PsA合并RA病例报道仅5例,其中4例临床资料相对完整。所有9例患者均有外周关节受累,2例有中轴受累;7例有甲病,6例有附着点炎,1例有指炎;所有患者类风湿因子和(或)抗瓜氨酸化肽/蛋白抗体阳性,6例以银屑病皮损为首发表现。结论 RA与PsA可以合并存在,这类患者的病变可能较单纯PsA或RA更复杂更重、治疗效果似乎更差,除临床表现和自身抗体外,肌骨超声检查对于发现两种关节炎的典型特征有帮助,临床上需要关注。Objective It has been acknowledged that psoriatic arthritis(PsA)and rheumatoid arthritis(RA)can coexist,nevertheless there have been very few case reports so far.We aimed to summarize the clinical characteristics of patients with coexisting PsA and RA.Methods The clinical data of cases with coexisting PsA and RA from the PsA cohort of our center(PKUFHP cohort)and previous literature were retrospectively analyzed.Results Among 453 patients in the PKUFHP cohort,5 patients were diagnosed as PsA coexisting with RA.All of them were in moderate or high disease activity at their first visits,with synovitis and enthesitis confirmed by ultrasonography.With conventional synthetic DMARDs therapy,2 patients achieved minimum disease activity/remission,while 1 patient reached the target after receiving JAK inhibitor.In previous literature,there were only 5 cases of PsA combined with RA,with detailed data in 4 cases.By analyzing the clinical features of these 9 patients,we found peripheral joint involvement in 9 patients,axial involvement in 2,nail lesions in 7,enthesitis in 6,and dactylitis in 1 patient.Positive rheumatoid factor and/or anti-cyclic citrullinated peptide antibody were present in all patients.There were 6 patients with psoriasis as first manifestation.Conclusions Coexistence of PsA and RA is probably more complicated,severe,and difficult to treat than PsA or RA alone.Musculoskeletal ultrasound is useful for identifying the representative features in addition to clinical manifestations and autoantibodies.More attention is needed for the group of patients.

关 键 词：银屑病关节炎 类风湿关节炎 自身抗体 超声 

分 类 号：R593.22[医药卫生—内科学] R758.63[医药卫生—临床医学]