患有精神疾病的儿童的关节炎:一个病例系列
Meiqian Ma1, Jesse Sandberg2, Bahare Farhadian1,3
1Pediatric Divisions of Allergy, Immunology and Rheumatology, Stanford University School of Medicine, Palo Alto, California, USA.
Developmental neuroscience
|May 26, 2023
概括
儿科急性发病神经精神综合征 (PANS) 和相关疾病可以在大量患者中引起慢性关节炎. 成像对于诊断关节问题,指导治疗和管理这些复杂病例至关重要.
科学领域:
- 儿科风湿病学 儿科风湿病学
- 儿科神经学 儿科神经学
- 自身免疫性疾病 自身免疫性疾病
背景情况:
- 儿科急性发病神经精神综合征 (PANS) 和相关的后感染性精神疾病与影响基底腺的炎症/自身免疫机制有关.
- 这些情况往往呈现出复发缓解的过程,一些患者发展出严重的,耐治疗的精神症状.
- 慢性关节炎是这些患者经常观察到的并发症.
研究的目的:
- 研究患有PANS和相关神经精神疾病的儿科患者慢性关节炎的发生和特征.
- 描述这些患者免疫调节疗法的临床表现,成像发现和治疗结果.
- 强调成像在诊断关节炎中的重要性以及重叠的精神病和关节症状所带来的挑战.
主要方法:
- 对7名患有PANS和相关慢性关节炎的儿科患者以及一名兄弟姐妹进行了回顾性分析.
- 详细的临床评估,包括体检和高级成像 (例如超声波) 以检测微妙的关节溢出和炎症.
- 审查治疗方案,包括NSAIDs,DMARDs和生物药物,以及它们对关节炎和精神病症状的影响.
主要成果:
- 28%的PANS患者和21%的患有相关精神问题的人患有慢性关节炎.
- 患者经常出现"干燥"的关节炎,有微妙的溢出和脊髓关节炎的特征,肠炎和突炎.
- 关节囊加厚是一个常见的发现,在儿科病例中以前没有报告过.
- 免疫调节治疗对关节炎和精神病症状都有不同的影响.
结论:
- 患有PANS和相关神经精神疾病的儿科患者中有很大一部分患有慢性关节炎,可能具有统一的自身免疫病因.
- 影像在关节炎的诊断和分类中起着至关重要的作用,特别是当体检受到精神症状或感官失调的限制时.
- 使用成像的多学科方法对于为这种复杂的患者群体量身定制和协调治疗至关重要.
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