川崎病合并关节炎2例报告并文献复习

Kawasaki disease with arthritis:a report of two cases and literature review

目的分析川崎病(KD)合并关节炎的临床特点,探讨KD合并关节炎和全身型幼年特发性关节炎(SJIA)的鉴别诊断要点。方法回顾分析2例KD合并关节炎患儿的临床资料,并进行文献分析。结果1例患儿以发热、腹痛起病,并发消化道出血及巨噬细胞活化综合征(MAS),激素治疗后好转,恢复期出现关节症状,考虑为KD相关性关节炎;另1例以发热、关节肿痛为首发症状,两次静脉人免疫球蛋白(IVIG)、静脉甲基泼尼松龙及甲氨蝶呤治疗后关节症状缓解不明显,加用注射用重组人Ⅱ型肿瘤坏死因子受体抗体融合蛋白(rhTNFR:Fc)后好转,考虑为KD合并JIA。结论KD合并关节炎和SJIA在临床表现上有高度相似性,目前没有特异性的实验室检查可以区分这两种疾病,需要长期临床观察,建立更精细的诊断标准以及开发更多的实验方法辅助诊断。

Objective To analyze the clinical features of Kawasaki Disease(KD)with arthritis and to explore the differential diagnosis between KD with arthritis and systemic juvenile idiopathic arthritis(SJIA).Methods The clinical data of two KD children with arthritis were retrospectively analyzed and the relevant literature was reviewed.Results One child was admitted witha high fever and abdominal pain complicated with gastrointestinal bleeding and macrophage activation syndrome(MAS),which was improved after hormone therapy.The child developed joint symptoms during the convalescence,and was considered as KD with arthritis.The other patient presented with fever and joint swelling and pain as the first symptoms.After treatment with two intravenous immunoglobulin(IVIG),intravenous methylprednisolone and methotrexate(MTX),the joint symptoms were not relieved significantly,but improved after treatment with recombinant human type II tumor necrosis factor receptor-antibody fusion protein(rhTNFR:Fc),and the child was considered as KD with JIA.Conclusions KD with arthritis and SJIA have high similarities in clinical manifestations.At present,there is no specific laboratory examination to distinguish the two diseases.Long-term clinical observation is needed to establish more precise diagnostic criteria and develop more experimental methods to assist diagnosis.