关节病型银屑病28例临床资料分析

发布时间：2018-08-25 17:34

【摘要】：目的:银屑病性关节炎（psoriatic arthritis, PsA），又名关节病型银屑病，是一种与银屑病皮损与关节炎症状同时存在的疾病，关节和周围软组织红肿、疼痛、压痛、关节僵直和运动障碍，有的可出现骶髂关节炎和/或脊柱炎，病程慢性，易反复，疾病晚期可有关节强直、畸形，甚至残疾，严重影响患者生活质量[1].因此，在该疾病正确的诊断、合理的治疗及科学的疗效评价，对于皮肤科医生和免疫风湿科医生都是极大的挑战。由于该病的临床特点病人可就诊于皮肤或免疫风湿科，因此接受这个挑战成为两科医生必须面对的问题。为了使这个跨学科的疾病在诊断、治疗及疗效评价能得到系统、完整的有指导作用的参考信息，我们将回顾近五年来的实际临床工作，以期得到完整的临床资料提出有意义的参考信息。本研究通过对河北医科大学第二医院免疫风湿科和皮肤性病科2006年01月至2011年06月的住院的关节型银屑病患者的诊断、治疗及疗效评价做回顾性分析，以初步了解目前我们对于PsA的诊断、治疗及疗效评价的现状，以期今后能为两科的医生提供对于该病在以上几方面有指导作用的信息。方法:本研究通过对河北医科大学第二医院免疫风湿科和皮肤性病科2006年01月至2011年06月的住院的关节型银屑病28例患者的诊断、治疗、疗效评价做回顾性研究。结果: 1．本组病例中平均发病年龄为37.2岁，男女比例为1.55：1，28例患者中皮损先发生者20例（71.43%），关节炎先发生者4例（14.28%）；皮损与关节炎同时发生者4例（14.28%）。 2．按照1973年Moll-Wright[2]的分型标准分型，非对称性少数关节炎型13例（占46.42%），，对称性多关节炎型3例（占10.71%）；残毁型关节炎型4例（占14.28%）；远端指间关节炎型5例（占17.85%）；脊椎关节病型3例（占10.71%）。临床分型中以非对称性少关节炎型为主，而本文中13例（46.42%）为多关节炎型（至少为5个关节受累）。各型银屑病皮损均可发生关节病变。以远端指间关节最常见（53.57%），其次为膝关节（39.28%）及踝关节（39.28%）。 3.28例PsA患者中有18例进行了病变关节X线检查，其中16例有阳性改变，病变关节多见的X线表现为：关节周围软组织肿胀，关节面模糊，关节间隙变窄，骨质疏松，可见囊状低密度影，虫蚀状骨质缺损，其中4例有手关节融合畸形，发生于远端指间关节；1例提示足趾间关节融合；1例为腰椎关节间隙变窄，椎体成竹节样改变。 4．28例PsA患者治疗方法多种，生物制剂治疗者8例，其用药后关节平均开始显效时间为3天，皮损平均开始显效时间为8天；甲氨喋呤与非甾体抗炎药、来氟米特、柳氮磺胺吡啶合用者7例，用药后关节平均开始显效时间为7天，皮损平均显效时间为10天；环孢素A联合非甾体抗炎药扶他林治疗3例，皮损及关节显效时间均为2.5天。结论: 1.对于这个跨学科的疾病在其诊断、治疗及疗效评价过程中亟待得到系统、完整的有指导作用的信息，尤其是在疗效评价方面。 2. PsA临床治疗以传统的非甾体抗炎药（Non-steroidal anti-inflammatorydrugs, NSAIDs）、改变病情抗风湿药（Disease modifying antirheumatic drugs,DMARDS）等为主，多为几种药物联合应用，轻微缓和的寡关节炎患者可用NSAIDs控制，对于活动性或关节、皮损症状较重的患者可用NSAIDs联合DMARDS联合治疗。 3.甲氨蝶呤是最常用于治疗PsA的药物，对银屑病皮损及关节炎症状均有较好效果。小剂量MTX与其他DMARDS合用可增加疗效，并且其毒副作用增加不显著。 4.生物制剂起效快，作用强，可延缓PsA患者关节放射学进展，具有靶向特异性、安全、耐受性好等特点，使用方便，但长期使用费用较高。根据患者病情可在病情较重时使用生物制剂缓解控制病情，待病情控制后渐减量辅以传统用药，以达到病情长期缓解，维持病情稳定。
[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.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R758.63

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