在没有类风湿性关节炎的情况下出现的类风湿性血管炎:基于病例的综述
David A J Cromie1, Sarah K Stewart2, Gary D Wright3
1Department of Intensive Care Medicine, Antrim Area Hospital, Northern Health and Social Care Trust, Antrim, Northern Ireland, UK. dcromie04@qub.ac.uk.
Rheumatology international
|July 14, 2025
概括
类风湿性血管炎可能发生在类风湿性关节炎诊断之前,呈现各种症状,如神经病变. 这凸显了在诊断标准中考虑类风湿性血管炎的必要性,即使没有关节参与.
科学领域:
- 类风湿病学 类风湿病学
- 免疫学 免疫学 免疫学
- 神经学 神经学
背景情况:
- 风湿性血管炎 (RV) 是风湿性关节炎 (RA) 的一种严重的关节外表现.
- RV通常影响皮肤和外围神经,但呈现方式各不相同.
- 诊断通常发生在已建立的RA中,但存在非典型的呈现.
研究的目的:
- 报告一个不寻常的RV病例,先诊断为RA.
- 审查现有关于RV的文献,没有并发RA诊断.
- 强调RV作为潜在的RA早期指标.
主要方法:
- 一个58岁的男性患有神经病变,宪法症状和雷诺现象的病例报告.
- 在多个数据库中对没有RA诊断的RV病例进行文献搜索.
- 在确定的病例中分析临床表现和疾病进展.
主要成果:
- 患者呈现了RV症状,阳性类风湿因子 (RF) 和抗CCP抗体,以及神经活检确认,尽管之前没有RA诊断.
- 文献审查确定了18例在RA诊断之前的RV病例,具有不同的临床特征.
- 在5例病例 (6个月至6年) 中,RV先于RA发作;3名患者没有显示关节参与.
- 皮下结节在报告的患者中是一个独特的发现.
结论:
- 类风湿性血管炎可以在类风湿性关节炎发作之前表现出来.
- 在差异诊断中应考虑RV,即使在没有被诊断为RA的患者中也是如此.
- 这些发现表明,RV可能是RA的前身,应该纳入未来的诊断标准.
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