论文部分内容阅读
目的总结SAPHO综合征(主要包括滑膜炎、痤疮、脓疱病、骨肥厚和骨炎、以骨关节及皮肤受累为主要表现的风湿性疾病)的临床特征,为临床避免临床漏诊、误诊及探讨有效治疗方法提供经验。方法收集2012年1月至2016年12月包头医学院第一附属医院住院及门诊诊治的SAPHO综合征13例,分析其临床表现、实验室检查及治疗转归,并结合文献复习进行讨论。结果 13例中男性3例,女性10例。病程中骨关节受累部位:上胸壁处13例,外周关节11例,骶髂关节7例,脊柱关节6例。外周关节受累的主要部位依次为:肩关节、手小关节、膝关节、肘关节。13例中12例行~(99m)Tc标记的亚甲基二磷酸盐(~(99m)Tc-MDP)全身骨扫描,1例行正电子发射计算机体层摄影(PET-CT)检查,结果均提示:受累关节部位骨盐代谢增强。9例患者均同时给予非甾体抗炎药、甲氨蝶呤及阿仑膦酸钠联合治疗,症状明显缓解,但皮疹仍有反复;2例采用肿瘤坏死因子(TNF)-α拮抗剂英夫利昔单抗注射液联合甲氨蝶呤片治疗效果好;1例英夫利昔单抗治疗失败的难治性患者应用阿达木单抗有效。结论 SAPHO综合征皮肤改变主要为掌跖脓疱病;骨关节改变以上胸壁处受累最多见。全身骨扫描和PET-CT检查对该病的诊断最有价值。非甾体抗炎药联合甲氨蝶呤及阿仑膦酸钠对改善关节症状效果明显。TNF-α拮抗剂对难治性SAPHO综合征有效;重症患者治疗效果不好者,可尝试阿达木单抗。
Objective To summarize the clinical features of SAPHO syndrome (including rheumatic diseases mainly including synovitis, acne, impetigo, osteomalacia and osteitis, bone and joint involvement and skin involvement) Explore effective treatment methods to provide experience. Methods From January 2012 to December 2016, 13 cases of SAPHO syndrome in hospital and outpatient department of First Affiliated Hospital of Baotou Medical College were collected, and their clinical manifestations, laboratory tests and treatment outcomes were analyzed and discussed in the literature review. Results 13 cases of males in 3 cases, 10 females. Duration of bone and joint involvement in the site: 13 cases of upper chest wall, 11 cases of peripheral joints, sacroiliac joint in 7 cases, 6 cases of spondylolisthesis. Peripheral joints involving the main parts were: shoulder joints, hand joints, knee, elbow. Twenty-two patients underwent 99m Tc-labeled methylene diphosphate (~ (99m) Tc-MDP) bone biopsy in 13 cases and PET-CT in 1 case. All tips: affected parts of the bone mineral metabolism increased. 9 patients were given both NSAIDs, methotrexate and alendronate sodium combination therapy, the symptoms were relieved, but the rash is still repeated; two cases using tumor necrosis factor (TNF) -α antagonist Infu Treatment with lixibizumab in combination with methotrexate was effective, and adalimumab was effective in 1 refractory patients who failed infliximab. Conclusion SAPHO syndrome skin changes mainly palmoplantar pustulosis; bone and joint changes above the chest wall at the most common. Whole body bone scan and PET-CT examination of the disease is the most valuable diagnosis. Non-steroidal anti-inflammatory drugs combined with methotrexate and alendronate sodium to improve joint symptoms. TNF-α antagonists for refractory SAPHO syndrome; critically ill patients with poor treatment, try adalimumab.