摘要
目的提高对以多关节炎为首发表现的多发性骨髓瘤的认识。方法总结5例以多关节炎为首发表现的多发性骨髓瘤患者的临床资料，并结合文献报道的11例病例，对其临床表现及实验室检查结果进行分析总结。结果本研究5例及文献报道11例患者均以多关节炎为首发表现，受累关节以小关节为主，分别累及近端指间关节、掌指关节、腕关节、肘关节、肩关节、膝关节、踝关节、颞颌关节、骶髂关节及颈椎。16例中有14例均曾经被误诊为RA，88％（14／16）出现肾损害，表现为不同程度血肌酐升高或尿蛋白阳性；13例患者血清炎性指标均不同程度升高；9例患者出现贫血，以中度为主；6例患者出现高钙血症；6例出现高球蛋白血症；除2例患者血尿M蛋白阴性外，余14例患者血／尿M蛋白检测均为阳性。行自身抗体检测的14例患者中，仅1例类风湿因子阳性。结论对血清阴性多关节炎，特别是伴有肾损害、贫血、高球蛋白血症的患者应警惕多发性骨髓瘤。
Objective We reported 5 unusual cases of muhiple myeloma （MM） initially presented as polyarthritis. Special attention should be paid to this very unusual scenario. Methods Five cases who presented initially as polyarthritis and finally diagnosed as MM were administered to Peking University People＇s Hospital and 11 cases from literature were reported. The clinical symptoms and laboratory parameters were analyzed respectively. Results The primarily affected joints were small joints, such as metacarpophalangeal joints, proximal interphalangeal joint, metatarsophalangeal and temporomandibular joints, but large joints such as wrists, elbows, shoulders, knees, ankle joints could be involved, too. Fourteen of 16 patients were misdiagnosed as rheumatoid arthritis （RA）. Renal dysfunction presenting as high level of serum creatinine or proteinuria was detected in 14 cases. Laboratory tests showed elevated erythrocyte sedimentation rate or C re- active protein level in 13 cases. Anemia was detected in 9 cases. Hypercalcemia was detected in half of the patients. Hyperglobu-linemia was detected in 6 cases. The serum level of free M-protein was markedly elevated in 14 cases. Auto-antibodies were negative, except that rheumatoid factor was positive in 1 case. Conclusion It is important to pay attention to the clinical pictures presented as polyarthritis with negative autoantibodies, and associated with renal dysfunction, anemia and hypergammaglobulinemia. MM is important in the differen- tial diagnosis.
出处
《中华风湿病学杂志》
CAS
CSCD
北大核心
2014年第3期195-198,共4页
Chinese Journal of Rheumatology
