强直性脊柱炎合并类风湿关节炎

COEXISTENCE OF ANKYLOSING SPONDYLITIS AND RHEUMATOID ARTHRITIS

目的：分析强直性脊柱炎（ＡＳ）合并类风湿关节炎（ＲＡ）患者的临床特点。方法：自１９８８年—１９９７年我科临床中共诊断ＡＳ合并ＲＡ患者２０例，通过与单纯ＡＳ（６５例）和ＲＡ（４６例）比较其特点。结果：通过比较发现ＡＳ合并ＲＡ患者病情活动指标高，骨质损害重。类风湿因子（ＲＦ）阳性率为６０％（１２／２０），ＨＬＡＢ２７抗原阳性率为５７９％（１１／１９），二者同时阳性率为４１２％（８／１９），明显不同于ＲＦ在单纯ＲＡ（７８３％）和ＨＬＡＢ２７在单纯ＡＳ（９２６％）的阳性率，而且ＲＦ的滴度（１∶４０）明显低于单纯ＲＡ组（１∶１６０）。结论：ＲＡ与ＡＳ的合并，可能是偶然性重叠，临床中易被漏诊。对两种疾病合并的患者慢作用抗风湿药物应首选柳氮磺胺吡啶。

Objective:To analyze the clinical characters of ankylosing spondylitis (AS) and rheumatoid arthritis (RA) coexisting patients.Methods:Twenty coexisting patients were diagnosed from 1988 to 1997.The clinical characters of coexisting patients were compared with AS (n=65) alone and RA (n=46) alone respectively.Results:Higher disease activity parameters and bony erosion in coexisting patients were observed.The rheumatoid factor (RF) was postive in 12 of 20 (600%) patients and the HLAB27 antigen was present in 11 of 19 (579%) patients.The coincidence rate of RF and HLAB27 was 421%(8/19).The postive rate of RF and HLAB27 in coexisting patients was different from those in RA (783%) alone and AS (926%) alone respectively.Conclusion:The coexistence of the 2 rheumatological entities in the same patient appears to occur by chance and is probably often overlooked.For such patients,sulfasalazine should be chosen first.