系统性硬化病合并关节炎的临床分析

The prevalence and clinical significance of arthritis in patients with systemic sclerosis

目的 探讨系统性硬化病（SSc）合并关节炎的临床特征.方法 横断面分析SSc合并关节炎患者的临床表现和实验室检查资料.结果 248例SSc患者发病年龄（37.1±13.7）岁,102例合并关节炎,发病率为41.1％.SSc合并关节炎者关节痛（95.1％）、肌无力（38.2％）、活动后气短（60.8％）及间质性肺疾病（64.7％）的发生率高于SSc未合并关节炎者（15.1％、24.7％、45.2％、49.3％）,差异有统计学意义（P值均＜0.05）.SSc合并关节炎者C反应蛋白升高者比例（61.4％）、抗Sm抗体阳性率（11.4％）、抗CCP抗体阳性率（28.1％）高于SSc未合并关节炎者（43.9％、2.5％、2/16;P值均=0.01）.两者间在Rodnan皮肤硬皮评分、指端溃疡、肺动脉高压和6分钟步行距离试验比较差异无统计学意义（P值均＞0.05）.结论 SSc合并关节炎的发生率高,且可能与疾病炎症程度和继发间质性肺疾病有相关性,临床医生应重视SSc合并关节炎的早期识别.

Objective To explore the prevalence and independent influencing factors of arthritis in Chinese patients with systemic sclerosis（SSc）.Methods A total of 248 SSc patients were enrolled in this prospective cross-sectional study in Peking Union Medical College Hospital.Demographic,clinical and laboratory data were compared in arthritis group and non-arthritis group.Results Of 248 Chinese SSc patients,mean age of onset was （37.1 ± 13.7） years old and disease duration was （7.4 ± 5.2） years.Overall prevalence of arthritis was 41.1% （102/248）.The presence of arthralgia（95.1% vs 15.1%）,muscle weakness（38.2% vs 24.7%）,short of breath （60.8% vs 45.2%）,and intestinal lung disease （64.7% vs 49.3%） occurred more frequently in patients with arthritis than those without arthritis （P 〈0.05）.The elevation of C reactive protein,anti-Sm and anti-cyclic citrullinated peptide were more common in arthritis group than in non-arthritis group（61.4% vs 43.9%,11.4% vs 2.5% and 28.1% vs 2/16,respectively）.There were no obvious differences in the Rodnan score,digital ulcers,pulmonary arterial hypertension,and six-minute walk test between two groups（P 〉 0.05）.Conclusion This study reveals the significant prevalence of arthritis in a large cohort of SSc patients in China.Compared to non-arthritis patients,the SSc patients with arthritis have a more severe inflammation reaction and a higher rate of intestinal lung disease.