误诊为类风湿关节炎的Jaccoud关节病临床报告并文献复习

Misdiagnosis of Jaccoud's Arthropathy as Rheumatoid Arthritis:a Case Report and Literature Review

目的探讨Jaccoud关节病(Jaccoud's arthropathy,JA)的临床特点及诊断方法,以减少误诊误治。方法回顾性分析曾误诊为类风湿关节炎的JA 1例的临床资料,并复习相关文献。结果本例为61岁女性,因四肢多关节肿痛20余年入院。曾在我院中医科、南京鼓楼医院诊断为类风湿关节炎,间断服用甲氨蝶呤和羟氯喹。此次入院后查类风湿因子及抗CCP抗体正常;红细胞沉降率33 mm/h;C反应蛋白1.1 mg/L;补体C3 0.85 g/L;抗核抗体胞浆颗粒型1∶1000,颗粒型1∶100;可提取核抗原(ENA)谱抗nRNP/Sm、抗SSA、抗Ro52、抗线粒体抗体(+),抗SSB、抗组氨酸抗体(±)。双手X线检查示局部密度、形态异常改变,未见骨破坏。明确诊断为JA并干燥综合征,予羟氯喹及白芍总苷免疫抑制、调节及抗骨质疏松等治疗,患者未诉关节肿痛,口干稍缓解后出院。结论 JA临床罕见,可继发于多种疾病,受累关节外观表现与类风湿关节炎高度类似,掌握该病临床特点,有助于避免误诊及过度治疗。

Objective To explore clinical features and diagnostic methods of Jaccoud＇s arthropathy（ JA） to avoid misdiagnosis and mistreatment. Methods Clinical data of a patient with JA misdiagnosed as rheumatoid arthritis（ RA） previously were retrospectively analyzed,and related literature was reviewed. Results The 61-year-old female patient was admitted for polyarthrosis for 20 years,who was diagnosed as having RA in Traditional Chinese Medicine Department in our hospital and Department of Rheumatology and Immunology of Nanjing Gulou Hospital.Methotrexate and hydroxychloroquine were taken discontinuously. Some tests conducted after admission revealed negative RF and anti-ccp antibody. The levels of ESR,CRP and complement C3 were 33 mm/h,1.1 mg/L and 0.85 g/L,resptctively. Anti-nuclear antibody（ ANA） was positive 1 ∶ 1000（ granule type） and 1 ∶ 100（ cytoplasmic granule type）. ENA test showed anti-nRNP/Sm,anti-SSA,anti-ro52,and anti-mitochondrial antibody turned out to be positive,and anti-ssb,anti-histidine antibody were positive. There was abnormal changes in local density and morphology but no bone destruction according to X-ray examination of both hands. We diagnosed her with Sjogren＇s syndrome and Jaccoud＇s arthropathy.Subsequently,she was dicharged after treatment by hydroxychloroquine and total glucosides of paeony as well as by regulating and fight osteoporosis. The patient reported no joint swelling and pain,and was discharged home after relief of dry mouth. Conclusion JA is a rare disease that can be secondary to a variety of diseases. The joint appearance of the affected joints is similar to that of rheumatoid arthritis,therefore,understanding of the clinical features of the disease may help to avoid misdiagnosis and overtreatment.