系统性红斑狼疮合并感染性关节炎12例临床特点分析

Clinical characteristics of septic arthritis in patients with systemic lupus erythematosus： an analysis of 12 cases

目的 对SLE合并感染性关节炎患者的临床资料进行回顾性分析,以期指导临床早期诊断和治疗.方法 分析1990年1月至2012年12月北京协和医院住院治疗的12例SLE合并感染性关节炎患者临床资料.结果 12例患者诊断SLE到发现感染性关节炎的病程1个月至10年,中位时间8.5月.所有患者均曾应用相当于1 mg·kg1·d-1的泼尼松及免疫抑制剂治疗,其中5例患者曾接受甲泼尼龙冲击治疗.感染时关节疼痛12例,肿胀5例,局部皮温升高4例,功能障碍8例.12例患者均为寡关节炎,膝、髋关节最常受累.病原学：沙门菌3例,金黄色葡萄球菌4例,结核杆菌3例.结论 对于全身病情稳定且应用中大量激素的SLE患者出现急性寡关节肿痛、CRP明显升高时应警惕感染性关节炎可能.此类患者关节毁损进展快,需及时给予足量、足疗程针对性治疗及外科处理.

Objective To analyze the clinical characteristics of systemic lupus erythematosus （SLE） patients with septic arthritis.Methods Twelve SLE patients with septic arthritis admitted to Peking Union Medical College Hospital from January 1990 to December 2012 were retrospectively analyzed.Results The median duration from onset of SLE to septic arthritis was 8.5 months （ranged from 1 to 120 months）.All patients had received higher doses of steroid therapy （equal to prednisolone 1 mg ·kg-1 ·d-1） and immunosuppressant,and 5 of them had received methylprednisolone pulse therapy.The infectious manifestations included joint pain （all cases）,swelling （5 cases）,reduced joint function （8 cases） and fever （10 cases）.All patients were oligo-arthritis.The hip and knee joints were most commonly involved.Three patients were infected by Salmonella,4 patients were infected by S.aureus,and 3 patients were infected by tuber culosis.Conclusion When SLE patients with long term steroid and immunosuppressant therapy developedacute joint pain and swelling,septic arthritis should be considered.Synovial fluid Gram stain,culture,blood culture and arthroscopy should be performed promptly.Appropriate antibiotics should be administered,and early treatment can improve the outcomes.