系统性硬化症重叠类风湿关节炎患者的临床特征

Clinical characteristics of patients with systemic sclerosis-rheumatoid arthritis overlap syndrome

目的通过分析系统性硬化症重叠类风湿关节炎(systemic sclerosis-rheumatoid arthritis,SSc-RA)患者的临床表现和实验室检查,了解SSc-RA患者的临床特点,以期早期诊断,指导治疗。方法收集2002年8月至2021年2月北京协和医院住院及门诊患者中SSc-RA患者的临床资料,按照1∶3的比例进行性别、年龄匹配后随机选取SSc未重叠其他结缔组织病(单纯SSc)的患者作为对照,对其临床特征、实验室检查进行比较分析。同时对SSc-RA患者进行随访分析。结果SSc-RA患者共18例,均为女性,RA发病年龄为(35.5±8.2)岁,SSc发病年龄为(39.0±7.0)岁,RA先于SSc起病者更多见(10例),同时起病者3例。与单纯SSc(54例)相比,SSc-RA患者中关节炎(100.0%vs.18.5%,P<0.001)、反流性食管炎(66.7%vs.37.0%,P=0.028)更常见,镜下血尿(0.0%vs.25.0%,P=0.039)少见。实验室检查,SSc-RA患者血沉升高(77.8%vs.47.1%,P=0.030)、超敏C反应蛋白升高(50.0%vs.13.2%,P=0.006)、类风湿因子阳性(100.0%vs.36.4%,P<0.001)比例均显著多于单纯SSc患者;但肺功能用力肺活量Act/ActPred[(74.0±17.0)%vs.(86.6±14.4)%,P=0.043]和一秒用力呼气量Act/ActPred[(67.5±13.4)%vs.(85.1±13.7)%,P=0.003]在SSc-RA患者更低。结论SSc-RA患者更易出现反流性食管炎,炎症指标更高,可能需要更强的抗炎症治疗。

Objective To analyze the clinical characteristics of patients with systemic sclerosis(SSc)-rheumatoid arthritis(RA)overlap syndrome(SSc-RA),in order to diagnose earlier and improve outcome.Methods The data of patients with SSc-RA admitted in Peking Union Medical College Hospital and outpatients from August 2002 to February 2021 were collected retrospectively.SSc patients without other connective tissue disease(pure SSc)were randomly matched by sex and age as controls in a ratio of 1∶3.The clinical characteristics and laboratory results were compared and analyzed between SSc-RA and pure SSc.Patients with SSc-RA were followed up.Results 18 patients with SSc-RA were all females.The mean age of onset of RA was(35.5±8.2)years old,and the mean age of onset of SSc was(39.0±7.0)years old.The onset of RA was prior to the onset of SSc in 10 cases,and at the same time in 3 cases.Compared with pure SSc(54 cases),arthritis(100.0%vs.18.5%,P<0.001)and gastroesophageal reflux disease(66.7%vs.37.0%,P=0.028)were more common,and microscopic hematuria was less(0.0%vs.25.0%,P=0.039)in patients with SSc-RA.Elevated ESR(77.8%vs.47.1%,P=0.030),elevated hsCRP(50.0%vs.13.2%,P=0.006),and RF positivity(100.0%vs.36.4%,P<0.001)were more common in patients with SSc-RA than in pure SSc;but forced vital capacity(FVC)Act/ActPred(74.0±17.0)%vs.(86.6±14.4)%,(P=0.043)and forced expiratory volume in one second(FEV1)Act/ActPred(67.5±13.4)%vs.(85.1±13.7)%,(P=0.003)were more lower in patients with SSc-RA.Conclusions The patients with SSc-RA are more likely to have gastroesophageal reflux disease and higher inflammatory markers.Intensive anti-inflammatory therapy maybe should be considered in patients with SSc-RA.