来氟米特致外周神经病变2例并文献复习

Peripheral neuropathy induced by leflunomide:A report of two cases and literature review

目的提高临床医生对来氟米特致外周神经病变的认识。方法报道2例风湿病患者服用来氟米特后出现外周神经病变并复习文献,对发生机制、危险因素、预防、治疗措施及预后进行总结。结果 1例60岁女性类风湿关节炎和1例61岁男性重叠综合征患者分别在服用来氟米特治疗后2个月及4年后逐渐出现双手、足麻木、疼痛及双足下垂表现,在排除了风湿性疾病自身继发外周神经病变以及其他药物致外周神经病变可能后,及时停用来氟米特后上述症状迅速好转,确定此2例患者外周神经受累症状病因与来氟米特治疗相关。结论来氟米特导致的外周神经病变在30d内停药可改善患者临床预后。

Objective To improve the understanding of leflunomide-induced peripheral neuropathy（PNP） in clinicians.Methods PNP in 2 patients with rheumatic disease after treatment with leflunomide was reported,with its related literature was reviewed,and its pathogenesis,risk factors,prevention,treatment and prognosis summarized.Results Progressive numbness in hands,paraesthesia and pain in feet occurred in a 60-year old female patient with rheumatic arthritis（RA） and a 61-year old male patient with overlap syndrome 2 months and 4 years,respectively,after treatment with leflunomide.After PNP secondary to rheumatic disease or induced by other drugs was excluded,it was found to be related with the use of leflunomide since the symptoms of the 2 patients improved after withdrawal of leflunomide.Conclusion The clinical prognosis of patients with leflunomide-induced PNP improves within 30 days after withdrawal of leflunomide.