类风湿关节炎伴血管炎22例临床特征

Clinical Characteristic of 22 Cases of Rheumatoid Arthritis with Vasculitis

目的探讨类风湿关节炎伴血管炎的临床表现、实验室指标、治疗及预后。方法回顾性分析22例2004年3月至2014年3月在北京协和医院住院的类风湿关节炎伴血管炎患者的临床表现、实验室指标、治疗及结局。结果 2004年3月至2014年3月住院的类风湿关节炎患者共728例,其中伴血管炎22例。类风湿关节炎伴血管炎患者年龄49~72岁,平均（62±5）岁;男女比例5∶17;病程大于5年者14例（63.6%）。22例患者中皮肤溃疡或肢体坏疽18例（82%）,多发神经损害8例（36%）,巩膜炎角膜溃疡3例（14%）,心肌损害1例（5%）,肠道溃疡1例（5%）,肺血管炎1例（5%）;3个系统同时受累者2例（9%）,两个系统同时受累者7例（31.8%）。所有患者红细胞沉降率、C反应蛋白、类风湿因子均高于正常;且均应用足量或冲击剂量糖皮质激素、单用或联用免疫抑制治疗,经过治疗后均好转出院,无死亡病例。结论类风湿关节炎伴血管炎患者病情活动,应积极应用激素和免疫抑制剂治疗。对于类风湿关节炎患者应早期予以正规治疗,降低疾病活动度,避免出现血管炎。肿瘤坏死因子α抑制剂的应用可能为类风湿关节炎伴血管炎药物治疗提供新的选择。

Objective To investigate the clinical manifestations, laboratory examinations, treatment, and outcome of patients with rheumatoid vasculitis（ RA patients with vasculitis）. Methods The clinical manifestations,laboratory examinations,treatment,and outcome of 22 patients with rheumatoid vasculitis in Peking Union Medical College Hospital from March 2004 to March 2014 were retrospectively analyzed.Results A total of 728 hospitalized RA patients（ 22 with vasculitis） were included in the analysis. The age of 22 patients with rheumatoid vasculitis ranged from 49 to 72 years old. The average age was 62 ± 5 years.The ratio of male to female was 5∶ 17. Fourteen cases（ 63. 6%） with the disease course longer than 5 years.Of the rheumatoid vasculitis patients,18（ 82%） presented with skin ulcer or limbs gangrene,8（ 36%）presented multiple nerve damage,3（ 14%） presented with scleritis or corneal ulcer,1（ 5%） presented with myocardial injury,1（ 5%） presented with intestinal ulcer and 1（ 5%） presented as pulmonary vasculitis. At the same time,2 cases（ 9%） presented with three systems involvement,and 7 cases（ 31. 8%） presented with two systems involvement. The erythrocyte sedimentation rate,C-reactive protein,and rheumatoid factor of all patients were higher than normal. All patients were treated with full-dose or pulse infusion of glucocorticoids, alone or in combination with immunosuppressive drugs. After the treatment,all patients were discharged,no death occurred. Conclusion Rheumatoid vasculitis indicates active disease,and should be treated aggressively with glucocoticoid and immunosuppressive drugs. Patients with RA should be treated early to reduce disease activity and to avoid rheumatoid vasculitis. TNF-alpha inhibitors maybe a new choice for patients with rheumatoid vasculitis.