强直性脊柱炎合并多发性骨髓瘤三例报道及文献复习

Clinical analysis of 3 patients who were diagnosed ankyiosing spondylitis concurrent with multiple mye-loma

目的探讨强直性脊柱炎（AS）合并多发性骨髓瘤（MM）的临床特点及潜在机制。方法报道3例As合并MM患者临床资料，结合文献复习对临床特点、潜在机制、诊治要点进行探讨。结果患者在处于较长时间AS症状静止期后发生MM，表现为持续、剧烈的腰背痛或关节痛，易发生病理性骨折，伴血液、肾脏、神经系统损害等，对非甾体抗炎药不敏感，预后差。结论长程As患者病情处于较长时间静止期后症状再次反复，伴有病理性骨折、贫血、反复感染、蛋白尿、红细胞沉降率明显增快、免疫球蛋白异常增高及全身症状等表现时，常规疗效差者，要警惕MM可能。

Objective To investigate the pathogenesis and clinical features of ankylosing spondylitis （AS） concurrent with multiple myeloma （MM）. Methods The clinical characteristics, pathogenesis, diagnosis and treatment of 3 cases who were diagnosed as AS concurrent with MM were analyzed and relevant literatures were reviewed. Results MM was confirmed in patients who had long-term stable AS. A wide variety of manifestations, including persistent pain in spine and thorax, pathologic fracture, anemia, kidney damage and nervous system abnormalities were frequently presented. These patients were insensitive to non- steroidal anti-inflammatory drug treatment, and they had a unfavorable prognosis. Conclusion Patients who are diagnosed as AS concurrent with MM can present with a variety of clinical features. Manifestations which are difficult to explain clinically by AS and poor response to treatment especially when the patients have long- term stable AS are potential clues for MM.