类风湿血管炎性周围神经病3例临床特点分析并文献复习

Rheumatoid vasculitis peripheral neuropathy:analysis of 3 cases'clinical characteristics and literature review

目的通过3例类风湿血管炎性周围神经病患者临床资料的分析及文献复习,提高临床医生对该病的认识,尽早诊断和治疗。方法回顾性分析武汉市第一医院神经内科2020年10月-2021年10月收治的3例类风湿血管炎性周围神经病患者的病史及实验室检查、肌电图,并进行文献复习。结果3例患者均有较长的类风湿关节炎病史,以疼痛、麻木、肌无力为主诉就诊,肌电图以多发性单神经损害(2例)及多发性周围神经损害(1例)为主要表现,并合并不同程度的其他脏器损害,经实验室检查并排除其他可能的原因后最终明确诊断。2例予以TNF-α抑制剂规范治疗后好转,1例加用托法替布后症状进展并加重。结论类风湿血管炎性周围神经病常出现在长病程、血清RF和(或)A-CCP阳性、高CRP、ESR、低补体、低蛋白的RA患者,异质性高,及时完善实验室检查及肌电图有助于早期诊断和治疗,TNF-α抑制剂为有效治疗手段。

Objective To improve clinicians'vigilance,early diagnosis and treatment of rheumatoid vasculitis peripheral neuropathy by analyzing the clinical data of 3 patients with rheumatoid vasculitic peripheral neuropathy and reviewing the literature.Methods The medical history,laboratory examination and electromyogram of 3 patients with rheumatoid vasculitis peripheral neuropathy admitted to the Department of Neurology of Wuhan First Hospital from October 2020 to October 2021 were retrospectively analyzed,and literature review was conducted.Results All 3 patients had a long history of rheumatoid arthritis,and the main complaints were pain,numbness,and muscle weakness.The electromyogram showed multiple single nerve damage(2 cases)and multiple peripheral nerve damage(1 case)as the main symptoms.manifestations,combined with different degrees of other organ damage,diagnosed after laboratory examination and exclusion of other possible causes.2 cases improved after standard treatment with TNF-αinhibitor,and 1 case progressed and worsened after adding tofacitinib.Conclusion Rheumatoid vasculitic peripheral neuropathy often occurs in RA patients with a long course of disease,positive serum RF and/or A-CCP,high CRP,ESR,low complement,and low protein,with high heterogeneity,and timely improvement of laboratory tests and EMG Figure is helpful for early diagnosis and treatment,and TNF-αinhibitor is an effective treatment method.