结缔组织疾病合并关节结核的临床特征

Clinical Characteristics of Connective Tissue Disease with Osteoarticular Tuberculosis

目的探讨结缔组织疾病合并关节结核的临床表现及实验室检查特点,提高对关节炎的认识,以利早期诊断。方法对9例合并关节结核的结缔组织疾病患者进行回顾性分析,收集其临床资料、实验室检查结果及影像学表现。结果9例患者中,5例系统性红斑狼疮,2例原发性干燥综合征,1例肌炎、1例系统性硬化症,均有激素和(或)免疫抑制剂使用史。受累关节数1~3个/例(共15个关节),其中腕关节受累8个(53.3%)、踝关节5个(33.3%)、肩关节及肘关节各1个(6.7%)。11个关节周围形成脓肿,5个关节有窦道形成。PPD实验除1例阴性,1例强阳性外,其均为(+)^(++)。9例患者均进行关节液或关节周围脓液检查,抗酸杆菌均涂片(-),培养仅1例阳性,其中8例结核DNA呈阳性。9例患者MRI检查发现骨髓水肿、骨质破坏、滑膜增厚等改变。7例进行关节病理活检均证实为结核。结论当结缔组织疾病出现原发病不能解释的关节炎时,需考虑关节结核的可能,需仔细检查,尽早确诊,避免关节不可逆损害。

Objective To investigate the clinical and laboratory characteristics of connective tissue disease with osteoarticular tuberculosis and improve the recognition of arthritis for early diagnosis. Methods Nine cases of connective tissue disease with osteoarticular tuberculosis were analyzed retrospectively, including the clinical features,laboratory findings and imaging manifestations. Results Among the 9 cases,5 were systemic lupus erythematosus,2 were primary Sjgren＇s syndrome,1 was myositis,and 1 was systemic sclerosis. All patients were treated with glucocorticoid and/or immunosuppressive agents. One to three joints per case（ a total of 15 joints） were infected with tuberculosis,including 8 wrist joints（ 53. 3%）,5 ankle joints（ 33. 3%）,1 shoulder joint and 1 elbow joint（ 6. 7%）. Eleven joints had periarticular abscess formation and 5 joints had sinus formation. For PPD test of all patients,1 was negative,1 was strongly positive,the others were（ ＋）-（ ＋ ＋）. The levels of ESR and/or CRP of most patients were increased at different degrees and serum anti-tuberculosis antibody were all negative. The results of joint fluid or periarticular pus examination of 9 cases showed smear-negative acid-fast bacilli in all cases, culturespositive acid-fast bacilli in only 1 case and tuberculosis DNA positive by PCR in 8 cases. Bone marrow edema,bone destruction,synovium thickening were found in 9 patients by MRI and joint biopsy of 7 casesconfirmed the diagnosis of tuberculosis. Conclusions When the occurrence of arthritis can＇t be explained by primary connective tissue diseases, joint tuberculosis should be considered. Meanwhile, to avoid irreversible damage of joints,careful examination and early diagnosis are needed.