摘要
目的探讨缓解性血清阴性对称性滑膜炎伴凹陷性水肿（RS3PE）综合征的临床特点及转归。方法回顾性分析经住院确诊的14例RS3PE综合征患者临床资料、实验室检查、治疗和预后，相关数据采用频数或x±s表示，复习国外文献并进行比较。结果14例患者男性9例，女性5例，发病年龄52～78岁，平均（68±9）岁。均表现为突发的对称性手或足背凹陷性水肿及多关节炎，其中手关节炎14例，腕关节炎13例，膝关节炎10例，踝关节炎9例，肩关节炎8例；实验室改变：红细胞沉降率平均（68±26）mm／1h，C反应蛋白平均（49±41）mg/L，轻度低白蛋白血症、轻度正细胞正色素性贫血常见，1例抗核抗体1：20阳性，类风湿因子及其他自身抗体均阴性，8例受累关节行磁共振成像（MRI）检查，可见滑膜炎改变，其中2例并发骨侵蚀；5例合并肿瘤，其中3例以RS3PE综合征首发；小剂量激素和缓解病变抗风湿药（DMARDs）治疗后临床症状均好转，但合并肿瘤者易复发。结论RS3PE综合征老年男性较女性多见，临床上多以突发手足背凹陷性水肿伴多关节炎为突出表现，MRI可见侵蚀性改变，提示RS3PE并非绝对不出现骨破坏，小剂量激素和DMARDs治疗有效。该病与肿瘤关系密切，应密切筛查和随访。
Objective To analyze the clinical features and outcome of remitting seronegative symme- trical synovitis with pitting edema （RS3PE） syndrome, and enhance the understanding of it. Methods Four- teen cases of RS3PE syndrome treated in the Department of Rheumatology and Immunology were analyzed retrospec-tively, including the clinical characteristics, laboratory data. Data were presented as x±s. Results Fourteen patients（nine man, five women） with RS3PE were enrolled. Their age was （68＋9） （range： 52-78） years. The main clinical features were acute onset symmetrical edema in both hands and feet and polyarthritis. Polyarthritis were involved in hand joints in 14 patients,wrists in 13 patients, knees in 10 patients, ankles in 9 patients, and shoulders in 8. In laboratory examinations, the average value of erythrocyte sedimentation rate was （68±26） mm/1 h and C-reactive protein was （49±41） mg/L. Mild anemia of normocytic-normochromic type and mild low level of serum albumin were frequent findings. Antinuclear antibody was present only in one patient at low titer （1：20）. Rheumatoid factor and other auto antibodies were all negative in patients. Before corticostexoid treatment, the MRI test was performed in 8 patients and revealed prominent synovitis and articular effusion. Two cases had bone erosions on MRI; five patients were fuond to have malignant tumors, three of them initially presented with RS3PE. Polyarthritis and edema were relieved after treated with low dose eorticosteroids and DMARDs drugs. But those patients with cancer were easily to reeurr： Conclusion RS3PE syndrome is relatively uncommon. It occurs predominantly in elderly men and is characterized by rapid-onset symmetrical polyarthritis, presence of pitting edema of both hands and feet. Erosive changes can be seen on MRI. Patients usually have dramatic response to low dose corticosteroids and DMARDs drugs. Patients should be closely followed as RS3PE is closely related to cancer.
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2012年第7期468-472,共5页
Chinese Journal of Rheumatology
