摘要
目的回顾性分析类风湿关节炎(rheumatoid arthritis,RA)并发感染性关节炎(septic arthritis,SA)的临床特点。方法分析1997年1月至2017年1月北京协和医院收治住院的RA并发SA患者的临床特点。结果共9例RA并发SA病例。受累关节均为外周单个大关节,RA平均病程(8.4±8.8)年,所有并发SA患者RA均处于疾病活动期,8例患者在原有慢性关节炎的基础上出现单关节炎加重。所有患者血沉、超敏C反应蛋白均显著增高。病原体分别为葡萄球菌3例,结核菌2例,铜绿假单胞菌、伤寒沙门菌、产气肠杆菌、缓症链球菌各1例,葡萄球菌最常见。所有患者经过积极抗感染及外科治疗后病情明显好转。结论对于慢性RA患者出现急性单关节炎加重,应警惕RA并发SA可能。并及时行关节腔穿刺或关节镜以明确病原体,予以针对性的足疗程抗生素治疗,并联合外科处理。
Objective To investigate the clinical characters of rheumatoid arthritis(RA)complicated by septic arthritis(SA).Methods RA patients with SA admitted to Peking Union Medical College Hospital from January 1997 to January 2017 were retrospectively analyzed.Results Nine cases of RA complicated by SA were defined.All the infected joints were single large joints.The average duration of RA was(8.4±8.8)years.All rheumatoid arthritis patients had a high disease activity.Eight patients presented with acute monoarthritis on the basis of chronic arthritis.Erythrocyte sedimentation rate,hypersensitivity C reactive protein and other inflammatory markers were significantly elevated.Three patients were infected by staphylococcus,2 patients were infected by tuberculosis,and the rest 3 patients were infected by pseudomonas aeruginosa,salmonella typhi,and streptococcus mitigates respectively.Staphylococcus infection was the most common among them.All patients were relieved after active antibiotics and surgical treatment.Conclusions For chronic RA patients who have aggravated acute monoarthritis,we should be alert to the possibility of RA complicated by SA.Joint cavity puncture or arthroscopy should be performed promptly to identify the pathogens.Appropriate and sufficient antibiotics should be usedwith surgical treatment.
作者
杨云娇
俞建钰
吴迪
尹月
李菁
费允云
曾小峰
张奉春
YANG Yun-jiao;YU Jian-yu;Wu Di;YIN Yue;LI Jing;FEI Yun-yun;ZENG Xiao-feng;ZHANG Feng-chun(Department of Rheumatology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Medical College,Key Laboratory of Rheumatology and Clinical Immmunology,Ministry of Education.Beijing 100730,China)
出处
《中华临床免疫和变态反应杂志》
2019年第1期48-53,共6页
Chinese Journal of Allergy & Clinical Immunology
基金
国家自然科学基金(81501410,81671620)。
