类风湿关节炎伴周围神经病7例

Peripheral Neuropathy in Seven Patients with Rheumatoid Arthritis

目的探讨类风湿关节炎(rheumatoid arthritis,RA)伴周围神经病变的临床特点、治疗及预后。方法回顾性分析7例RA伴周围神经病变患者的临床资料。结果 7例患者均有不同程度的四肢肌力下降,血细胞沉降率、C反应蛋白及类风湿因子水平均明显增高,肌电图提示神经源性损伤。7例患者均予糖皮质激素和(或)免疫抑制剂治疗,且2例联用肿瘤坏死因子抑制剂依纳西普。所有患者炎性指标均得到控制,四肢麻木、肢体远端感觉减退等症状改善,但肌萎缩、腕下垂、足下垂等症状无明显变化。结论 RA伴周围神经病变早期表现较轻,易被临床忽视而延误病情,造成不可逆的后遗症,因此应早期诊断、早期治疗,以改善预后。

Objective To investigate the clinical features and prognosis of rheumatoid arthritis （RA） associated with multiple peripheral neuropathy and to raise awareness of the disease. Methods A retrospective analysis of clinical data from seven cases of rheumatoid arthritis with peripheral neuropathy. Results seven patients all showed various degrees of limb muscle strength decline and significantly increased erythrocyte sedimentation rate, C reactive protein, rheumatoid factor. Electromyography revealed neurogenic injury in all patients. Patients were given glucocorticoid and immunosuppressants treatment, and 2 cases were treated with etanercept. The inflammatory markers were improved significantly, symptoms of numbness of the limbs, distal hypoesthesia were improved as well. However, muscle atrophy, wristdrop and footdrop didn＇ t show significant changes. Conclusions The early symptom of multiple peripheral neuropathy associated with RA is not obvious, and is easily overlooked, even leading to irreversible consequence. Early diagnosis and treatment is important for good prognosis.