關(guān)節(jié)病型銀屑病28例臨床資料分析
發(fā)布時(shí)間：2018-08-25 17:34
【摘要】：目的:銀屑病性關(guān)節(jié)炎（psoriatic arthritis, PsA），又名關(guān)節(jié)病型銀屑病，是一種與銀屑病皮損與關(guān)節(jié)炎癥狀同時(shí)存在的疾病，關(guān)節(jié)和周圍軟組織紅腫、疼痛、壓痛、關(guān)節(jié)僵直和運(yùn)動(dòng)障礙，有的可出現(xiàn)骶髂關(guān)節(jié)炎和/或脊柱炎，病程慢性，易反復(fù)，疾病晚期可有關(guān)節(jié)強(qiáng)直、畸形，甚至殘疾，嚴(yán)重影響患者生活質(zhì)量[1].因此，在該疾病正確的診斷、合理的治療及科學(xué)的療效評價(jià)，對于皮膚科醫(yī)生和免疫風(fēng)濕科醫(yī)生都是極大的挑戰(zhàn)。由于該病的臨床特點(diǎn)病人可就診于皮膚或免疫風(fēng)濕科，因此接受這個(gè)挑戰(zhàn)成為兩科醫(yī)生必須面對的問題。為了使這個(gè)跨學(xué)科的疾病在診斷、治療及療效評價(jià)能得到系統(tǒng)、完整的有指導(dǎo)作用的參考信息，我們將回顧近五年來的實(shí)際臨床工作，以期得到完整的臨床資料提出有意義的參考信息。本研究通過對河北醫(yī)科大學(xué)第二醫(yī)院免疫風(fēng)濕科和皮膚性病科2006年01月至2011年06月的住院的關(guān)節(jié)型銀屑病患者的診斷、治療及療效評價(jià)做回顧性分析，以初步了解目前我們對于PsA的診斷、治療及療效評價(jià)的現(xiàn)狀，以期今后能為兩科的醫(yī)生提供對于該病在以上幾方面有指導(dǎo)作用的信息。 方法:本研究通過對河北醫(yī)科大學(xué)第二醫(yī)院免疫風(fēng)濕科和皮膚性病科2006年01月至2011年06月的住院的關(guān)節(jié)型銀屑病28例患者的診斷、治療、療效評價(jià)做回顧性研究。 結(jié)果: 1．本組病例中平均發(fā)病年齡為37.2歲，男女比例為1.55：1，28例患者中皮損先發(fā)生者20例（71.43%），關(guān)節(jié)炎先發(fā)生者4例（14.28%）；皮損與關(guān)節(jié)炎同時(shí)發(fā)生者4例（14.28%）。 2．按照1973年Moll-Wright[2]的分型標(biāo)準(zhǔn)分型，非對稱性少數(shù)關(guān)節(jié)炎型13例（占46.42%），，對稱性多關(guān)節(jié)炎型3例（占10.71%）；殘毀型關(guān)節(jié)炎型4例（占14.28%）；遠(yuǎn)端指間關(guān)節(jié)炎型5例（占17.85%）；脊椎關(guān)節(jié)病型3例（占10.71%）。臨床分型中以非對稱性少關(guān)節(jié)炎型為主，而本文中13例（46.42%）為多關(guān)節(jié)炎型（至少為5個(gè)關(guān)節(jié)受累）。各型銀屑病皮損均可發(fā)生關(guān)節(jié)病變。以遠(yuǎn)端指間關(guān)節(jié)最常見（53.57%），其次為膝關(guān)節(jié)（39.28%）及踝關(guān)節(jié)（39.28%）。 3.28例PsA患者中有18例進(jìn)行了病變關(guān)節(jié)X線檢查，其中16例有陽性改變，病變關(guān)節(jié)多見的X線表現(xiàn)為：關(guān)節(jié)周圍軟組織腫脹，關(guān)節(jié)面模糊，關(guān)節(jié)間隙變窄，骨質(zhì)疏松，可見囊狀低密度影，蟲蝕狀骨質(zhì)缺損，其中4例有手關(guān)節(jié)融合畸形，發(fā)生于遠(yuǎn)端指間關(guān)節(jié)；1例提示足趾間關(guān)節(jié)融合；1例為腰椎關(guān)節(jié)間隙變窄，椎體成竹節(jié)樣改變。 4．28例PsA患者治療方法多種，生物制劑治療者8例，其用藥后關(guān)節(jié)平均開始顯效時(shí)間為3天，皮損平均開始顯效時(shí)間為8天；甲氨喋呤與非甾體抗炎藥、來氟米特、柳氮磺胺吡啶合用者7例，用藥后關(guān)節(jié)平均開始顯效時(shí)間為7天，皮損平均顯效時(shí)間為10天；環(huán)孢素A聯(lián)合非甾體抗炎藥扶他林治療3例，皮損及關(guān)節(jié)顯效時(shí)間均為2.5天。 結(jié)論: 1.對于這個(gè)跨學(xué)科的疾病在其診斷、治療及療效評價(jià)過程中亟待得到系統(tǒng)、完整的有指導(dǎo)作用的信息，尤其是在療效評價(jià)方面。 2. PsA臨床治療以傳統(tǒng)的非甾體抗炎藥（Non-steroidal anti-inflammatorydrugs, NSAIDs）、改變病情抗風(fēng)濕藥（Disease modifying antirheumatic drugs,DMARDS）等為主，多為幾種藥物聯(lián)合應(yīng)用，輕微緩和的寡關(guān)節(jié)炎患者可用NSAIDs控制，對于活動(dòng)性或關(guān)節(jié)、皮損癥狀較重的患者可用NSAIDs聯(lián)合DMARDS聯(lián)合治療。 3.甲氨蝶呤是最常用于治療PsA的藥物，對銀屑病皮損及關(guān)節(jié)炎癥狀均有較好效果。小劑量MTX與其他DMARDS合用可增加療效，并且其毒副作用增加不顯著。 4.生物制劑起效快，作用強(qiáng)，可延緩PsA患者關(guān)節(jié)放射學(xué)進(jìn)展，具有靶向特異性、安全、耐受性好等特點(diǎn)，使用方便，但長期使用費(fèi)用較高。根據(jù)患者病情可在病情較重時(shí)使用生物制劑緩解控制病情，待病情控制后漸減量輔以傳統(tǒng)用藥，以達(dá)到病情長期緩解，維持病情穩(wěn)定。
[Abstract]:Objective: Psoriatic arthritis (PsA), also known as arthropathic psoriasis, is a psoriatic skin lesion and arthritis symptoms coexist disease, joint and surrounding soft tissue swelling, pain, tenderness, joint stiffness and dyskinesia, some can appear sacroiliac arthritis and / or spondylitis, chronic course, easy to repeat, disease It is a great challenge for dermatologists and immunorheumatologists to correctly diagnose, rationally treat and scientifically evaluate the curative effect of the disease. Because of the clinical characteristics of the disease, patients can be consulted in dermatology or immunorheumatology. Acceptance of this challenge is a problem that both physicians must face. In order to provide systematic and complete guidance for the diagnosis, treatment and evaluation of the interdisciplinary disease, we will review the actual clinical work in the past five years in order to obtain complete clinical data and provide meaningful reference information. The diagnosis, treatment and efficacy evaluation of psoriasis arthritis patients in the Department of Immune Rheumatism and Dermatology and Venereal Diseases of the Second Hospital of Hebei Medical University from January 2006 to June 2011 were retrospectively analyzed in order to preliminarily understand the current status of the diagnosis, treatment and efficacy evaluation of PsA, so as to be able to serve as doctors in both departments in the future. Provide information for guiding the disease in the above aspects.
Methods: A retrospective study was conducted on the diagnosis, treatment and efficacy evaluation of 28 patients with psoriasis in the Department of Immunology, Rheumatism and Dermatology, the Second Hospital of Hebei Medical University from January 2006 to June 2011.
Result:
1. The average age of onset was 37.2 years. The ratio of male to female was 1.55:1. Among 28 cases, 20 cases (71.43%) had skin lesions first, 4 cases (14.28%) had arthritis first, and 4 cases (14.28%) had skin lesions and arthritis simultaneously.
2. According to Moll-Wright classification standard in 1973, 13 cases (46.42%) were asymmetrical minority arthritis, 3 cases (10.71%) were symmetrical polyarthritis, 4 cases (14.28%) were deformity arthritis, 5 cases (17.85%) were distal interphalangeal arthritis, and 3 cases (10.71%) were spondyloarthritis. The most common type was the distal interphalangeal joint (53.57%), followed by the knee joint (39.28%) and the ankle joint (39.28%).
Among the 28 cases of PsA, 18 cases were examined by X-ray, of which 16 cases were positive. The most common X-ray manifestations were swelling of soft tissue around the joint, blurred articular surface, narrowing of articular space, osteoporosis, cystic low-density opacity, wormlike bone defect. Among them, 4 cases had hand joint fusion deformity and occurred in distal finger. Inter-articular joint; 1 case showed toe joint fusion; 1 case showed narrowing of lumbar joint space and bamboo-like changes of vertebral body.
4.28 cases of PsA were treated with various methods, 8 cases were treated with biological agents, the average effective time of joints was 3 days, the average effective time of skin lesions was 8 days; 7 cases were treated with methotrexate and non-steroidal anti-inflammatory drugs, leflunomide, sulfasalazine, the average effective time of joints was 7 days, and the average effective time of skin lesions was 7 days. Cyclosporin A combined with non-steroidal anti-inflammatory drug fosalin was used in 3 cases and the effective time of skin lesions and joints was 2.5 days.
Conclusion:
1. Systematic, complete and instructive information is urgently needed in the diagnosis, treatment and efficacy evaluation of this interdisciplinary disease, especially in the evaluation of efficacy.
2. The clinical treatment of PsA is mainly non-steroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDS) and so on. Most of them are combined with several drugs. Patients with mild oligoarthritis can be controlled by NSAIDs. For active or joint, the symptoms of skin lesions are more severe. Heavy patients can be treated with NSAIDs combined with DMARDS.
3. Methotrexate is the most commonly used drug for the treatment of PsA. It has a good effect on psoriatic skin lesions and arthritis symptoms. Low dose MTX combined with other DMARDS can increase the efficacy, and the increase of toxicity and side effects is not significant.
4. Biological agents have the advantages of rapid onset, strong effect, delaying the progress of joint radiology in patients with PsA. They have the characteristics of targeting specificity, safety, good tolerance, easy to use, but the long-term cost is high. The disease was relieved for a long time to maintain a stable condition.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R758.63
本文編號(hào)：2203605
[Abstract]:Objective: Psoriatic arthritis (PsA), also known as arthropathic psoriasis, is a psoriatic skin lesion and arthritis symptoms coexist disease, joint and surrounding soft tissue swelling, pain, tenderness, joint stiffness and dyskinesia, some can appear sacroiliac arthritis and / or spondylitis, chronic course, easy to repeat, disease It is a great challenge for dermatologists and immunorheumatologists to correctly diagnose, rationally treat and scientifically evaluate the curative effect of the disease. Because of the clinical characteristics of the disease, patients can be consulted in dermatology or immunorheumatology. Acceptance of this challenge is a problem that both physicians must face. In order to provide systematic and complete guidance for the diagnosis, treatment and evaluation of the interdisciplinary disease, we will review the actual clinical work in the past five years in order to obtain complete clinical data and provide meaningful reference information. The diagnosis, treatment and efficacy evaluation of psoriasis arthritis patients in the Department of Immune Rheumatism and Dermatology and Venereal Diseases of the Second Hospital of Hebei Medical University from January 2006 to June 2011 were retrospectively analyzed in order to preliminarily understand the current status of the diagnosis, treatment and efficacy evaluation of PsA, so as to be able to serve as doctors in both departments in the future. Provide information for guiding the disease in the above aspects.
Methods: A retrospective study was conducted on the diagnosis, treatment and efficacy evaluation of 28 patients with psoriasis in the Department of Immunology, Rheumatism and Dermatology, the Second Hospital of Hebei Medical University from January 2006 to June 2011.
Result:
1. The average age of onset was 37.2 years. The ratio of male to female was 1.55:1. Among 28 cases, 20 cases (71.43%) had skin lesions first, 4 cases (14.28%) had arthritis first, and 4 cases (14.28%) had skin lesions and arthritis simultaneously.
2. According to Moll-Wright classification standard in 1973, 13 cases (46.42%) were asymmetrical minority arthritis, 3 cases (10.71%) were symmetrical polyarthritis, 4 cases (14.28%) were deformity arthritis, 5 cases (17.85%) were distal interphalangeal arthritis, and 3 cases (10.71%) were spondyloarthritis. The most common type was the distal interphalangeal joint (53.57%), followed by the knee joint (39.28%) and the ankle joint (39.28%).
Among the 28 cases of PsA, 18 cases were examined by X-ray, of which 16 cases were positive. The most common X-ray manifestations were swelling of soft tissue around the joint, blurred articular surface, narrowing of articular space, osteoporosis, cystic low-density opacity, wormlike bone defect. Among them, 4 cases had hand joint fusion deformity and occurred in distal finger. Inter-articular joint; 1 case showed toe joint fusion; 1 case showed narrowing of lumbar joint space and bamboo-like changes of vertebral body.
4.28 cases of PsA were treated with various methods, 8 cases were treated with biological agents, the average effective time of joints was 3 days, the average effective time of skin lesions was 8 days; 7 cases were treated with methotrexate and non-steroidal anti-inflammatory drugs, leflunomide, sulfasalazine, the average effective time of joints was 7 days, and the average effective time of skin lesions was 7 days. Cyclosporin A combined with non-steroidal anti-inflammatory drug fosalin was used in 3 cases and the effective time of skin lesions and joints was 2.5 days.
Conclusion:
1. Systematic, complete and instructive information is urgently needed in the diagnosis, treatment and efficacy evaluation of this interdisciplinary disease, especially in the evaluation of efficacy.
2. The clinical treatment of PsA is mainly non-steroidal anti-inflammatory drugs (NSAIDs), disease modifying anti-rheumatic drugs (DMARDS) and so on. Most of them are combined with several drugs. Patients with mild oligoarthritis can be controlled by NSAIDs. For active or joint, the symptoms of skin lesions are more severe. Heavy patients can be treated with NSAIDs combined with DMARDS.
3. Methotrexate is the most commonly used drug for the treatment of PsA. It has a good effect on psoriatic skin lesions and arthritis symptoms. Low dose MTX combined with other DMARDS can increase the efficacy, and the increase of toxicity and side effects is not significant.
4. Biological agents have the advantages of rapid onset, strong effect, delaying the progress of joint radiology in patients with PsA. They have the characteristics of targeting specificity, safety, good tolerance, easy to use, but the long-term cost is high. The disease was relieved for a long time to maintain a stable condition.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R758.63
【參考文獻(xiàn)】
相關(guān)期刊論文 前10條
1 鄧霞;許建榮;路青;李磊;;磁共振成像在早期類風(fēng)濕性關(guān)節(jié)炎診斷中的價(jià)值[J];磁共振成像;2011年02期
2 王麗紅 ,田琪 ,陳清威;MR診斷銀屑性關(guān)節(jié)炎1例[J];中國CT和MRI雜志;2005年02期
3 ;銀屑病關(guān)節(jié)炎診治指南(草案)[J];中華風(fēng)濕病學(xué)雜志;2004年03期
4 張江林,黃烽,劉湘源;銀屑病關(guān)節(jié)炎臨床特點(diǎn)及與HLA-B27的相關(guān)性研究[J];中華風(fēng)濕病學(xué)雜志;1999年02期
5 張鵬,鄭昱新,石關(guān)桐;軟骨寡聚基質(zhì)蛋白及臨床意義[J];國外醫(yī)學(xué).骨科學(xué)分冊;2005年04期
6 陸威;勞力民;;關(guān)節(jié)病性銀屑病發(fā)病機(jī)制及生物制劑治療的進(jìn)展[J];國外醫(yī)學(xué).皮膚性病學(xué)分冊;2005年06期
7 鄧?yán)?張?zhí)玫?關(guān)節(jié)炎性銀屑病易感基因研究進(jìn)展[J];臨床皮膚科雜志;2004年05期
8 康爾恂,崔盤根,曹元華,劉訓(xùn)荃,林麟,楊雪源,常寶珠,張榮林,鄭家潤;關(guān)節(jié)病性銀屑病52例臨床分析[J];臨床皮膚科雜志;2004年11期
9 羅權(quán),黃振明,林玲,張錫寶;關(guān)節(jié)病型銀屑病患者外周血中血管內(nèi)皮生長因子(VEGF)水平的動(dòng)態(tài)觀測[J];嶺南皮膚性病科雜志;2005年03期
10 常樹霞;陳永鋒;;Th17細(xì)胞與銀屑病[J];皮膚性病診療學(xué)雜志;2010年01期
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