血清阴性类风湿关节炎延迟诊断一例并文献复习

Delayed Diagnosis of Serum Negative Rheumatoid: A Case Report and Literature Review

目的:探讨血清阴性类风湿关节炎(serum negative rheumatoid arthritis, SNRA)的临床特征及诊断,提高对SNRA的认识,从而早期诊断及治疗。方法:详细回顾分析一例延迟诊断的SNRA患者的病历资料,并复习国内外相关文献。结果:患者为中年女性,因糖尿病足坏疽入院,7年前开始出现大关节囊肿,先后累及双侧踝、肩、肘、膝关节,均考虑为关节退行性变,多次行关节置换术,心理及身体损伤较大。入院后完善全身多关节超声、CT、自身抗体等指标,考虑为SNRA,给予强的松、羟氯喹联合甲氨蝶呤经验性治疗,1周后患者肩、肘关节疼痛明显好转,确诊为SNRA。结论:SNRA缺乏特异性血清指标,诊断时应注意与其他引起关节肿胀、疼痛类疾病相鉴别,避免漏诊误诊,错过进行干预的机会之窗,治疗延迟,带给患者难以挽回的损失。

Objective: To explore the clinical characteristics and diagnosis of serum negative rheumatoid arthritis (SNRA), and to improve the understanding of SNRA for early diagnosis and treatment. Methods: A case of delayed diagnosis of SNRA was analyzed in detail, and the related literature at home and abroad were reviewed. Results: The patient was a middle-aged female. She was admitted to the hospital because of diabetic foot gangrene. Seven years ago, large joint cyst began to appear, involving bilateral ankle, shoulder, elbow and knee joints successively. Joint degeneration was considered and joint replacement was performed many times. After admission, the indexes such as systemic multi-joint ultrasound, CT and autoantibody were improved. Considering SNRA, prednisone, hydroxychloroquine and methotrexate were given as empirical treatment. After one week, the pain of shoulder and elbow joint was significantly improved, and SNRA was diagnosed. Conclusion: SNRA is lack of specific serum index, so we should pay attention to distinguish it from other diseases that cause joint swelling and pain, avoid misdiagnosis, miss the window of opportunity for intervention, delay treatment, and bring irreparable loss to patients.