甲巯咪唑致关节炎综合征系统文献分析

Systematic Retrospection and Review of Thiamazole Induced Arthritis Syndrome

目的总结并分析甲巯咪唑致关节炎综合征的临床特点,为临床实践提供证据和建议。方法计算机检索PUBMED、EMBASE、CBM、CNKI、VIP和万方数据库,截止到2020年5月,纳入甲巯咪唑致关节炎综合征的中英文病例报道,2位研究者独立对文献进行筛选、数据归纳及统计。结果共检索出中英文文献262篇,最终纳入20篇,27名患者。74%为女性患者,中位年龄30岁,其中25.9%为18岁以下儿童,多数患者无基础疾病,33.3%患者联合应用β受体阻断剂。ADR表现为阵发性、游走性关节疼痛,累及全身各处大小关节,严重者可影响自主活动,不能行走,66.7%的患者出现发热、瘙痒或皮疹等合并症状,14例伴有血沉(ESR)升高,16例伴有C反应蛋白(CRP)升高。85.2%的患者在服药30 d内出现不良反应(ADR)症状,时间最长在用药58 d后出现,治疗措施包括立即停药和对症治疗(主要使用NSAID、H1受体阻滞剂、激素),多数患者(81.5%)在治疗7 d内症状得到改善,中位累积药量490 mg,最小累积药量180 mg,最大为1980 mg。ADR关联性评价为肯定有关1例,很可能有关26例。结论关节炎综合征为甲巯咪唑少见的不良反应,发生时多数患者伴有发热、皮疹以及ESR和CRP升高,在服药后2个月内,应高度警惕关节症状的发生。临床医生应当主动告知患者一旦发现关节疼痛症状,需立即就诊,及时停药,对症治疗。

OBJECTIVE To systematically review and analyze the clinical characteristics of thiamazole induced arthritis syndrome,so as to provide evidence and suggestions for clinical practice.METHODS Databases of PUBMED,EMBASE,CBM,CNKI,VIP and WANGFANG data(from built to May 2020)were conducted for case reports published in English or Chinese involving thiamazole induced arthritis syndrome,Literatures were screened,extracted and statistic analysed by two authors independently.RESULTS A total of 262 Chinese and English literatures were retrieved,and finally 20 articles were included with 27 patients.The 74%of them were female patients,the median age of 30 years old,and 25.9%of them were children under 18 years old,most of the patients had no underlying diseases,and 33.3%of the patients received beta blockers.ADR is characterized by paroxysmal and wandering joint pain,involving all joints of the whole body.In severe cases,it may affect the autonomic activity and cannot walk,66.7%of the patients had fever,pruritus or rash,ESR(erythrocyte sedimentation rate)was elevated in 14 cases,and CRP(C-reactive protein)was elevated in 16 cases.The 85.2%of the patients had ADR symptoms with in 30 days,and the longest time was 58 days after medication,treatment measures include immediate withdrawal and symptomatic treatment(NSAID,H1 receptor antagonists,GC),most patients(81.5%)had improved symptoms within 7 days after treatment,the median cumulative dose of 490 mg,a minimum cumulative dose of 180 mg,and a maximum of 1980 mg.The correlation evaluation of ADR was definite and probable in 1 and 26 case,respectively.CONCLUSION Arthritis syndrome is a rare adverse reaction of thiamazole,most patients had fever,rash and elevated ESR and CRP,within 2 months after taking the medicine,we should pay close attention to the occurrence of joint symptoms.Clinicians should take the initiative to inform patients that once the symptoms of joint pain are found,they need to see a doctor immediately,stop taking medicine in time,and treat symptomatically.