NEJM:类风湿关节炎患者的伸缩式手指-病例报道

2019-12-12 xing.T MedSci原创

患者接受托法替尼、甲氨蝶呤、小剂量泼尼松和伊班膦酸治疗,疼痛和肿胀有所减轻,但并未改变手部功能。

患者为一名69岁的妇女,因严重的关节畸形而到风湿病科就诊。她在18年前被诊断为类风湿关节炎,该病对糖皮质激素、甲氨蝶呤、来氟米特、阿达木单抗、依那西普、阿巴西普和利妥昔单抗的各种药物治疗均难以治愈。

体格检查显示双手尺骨偏斜。双手、腕部、肘部、膝盖和左脚踝的掌指关节有压痛和肿胀。双手检查还显示出手指缩短,活动性手指弯曲受限和无法握拳。施加在手指远端的牵引力使手指得以拉伸,并且当松开时,手指回到其原始位置。



手部X光片显示尺骨远端和桡骨以及腕骨、掌骨和指骨出现严重的骨溶解。观察到的伸缩现象是这种骨吸收的结果。

患者接受托法替尼、甲氨蝶呤、小剂量泼尼松和伊班膦酸治疗,疼痛和肿胀有所减轻,但并未改变手部功能。  

原始出处:

Hasan Satis,et al.Telescoping Fingers in Rheumatoid Arthritis.N Engl J Med 2019;https://www.nejm.org/doi/full/10.1056/NEJMicm1905982

本文系梅斯医学(MedSci)原创编译整理,转载需授权!

版权声明:
本网站所有内容来源注明为“梅斯医学”或“MedSci原创”的文字、图片和音视频资料,版权均属于梅斯医学所有。非经授权,任何媒体、网站或个人不得转载,授权转载时须注明来源为“梅斯医学”。其它来源的文章系转载文章,或“梅斯号”自媒体发布的文章,仅系出于传递更多信息之目的,本站仅负责审核内容合规,其内容不代表本站立场,本站不负责内容的准确性和版权。如果存在侵权、或不希望被转载的媒体或个人可与我们联系,我们将立即进行删除处理。
在此留言
评论区 (5)
#插入话题
  1. [GetPortalCommentsPageByObjectIdResponse(id=1803971, encodeId=934218039e18a, content=<a href='/topic/show?id=62c7e6169ed' target=_blank style='color:#2F92EE;'>#类风湿关节炎患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76169, encryptionId=62c7e6169ed, topicName=类风湿关节炎患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Sat Jan 11 18:43:00 CST 2020, time=2020-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266068, encodeId=bf901266068c8, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334182, encodeId=5baf133418290, content=<a href='/topic/show?id=5306e6164b6' target=_blank style='color:#2F92EE;'>#类风湿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76164, encryptionId=5306e6164b6, topicName=类风湿)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597380, encodeId=b8bd159e3801a, content=<a href='/topic/show?id=fa1710082017' target=_blank style='color:#2F92EE;'>#风湿关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100820, encryptionId=fa1710082017, topicName=风湿关节炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=456818510265, createdName=xuruicheng, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035042, encodeId=88dd103504224, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Dec 12 10:43:00 CST 2019, time=2019-12-12, status=1, ipAttribution=)]
  2. [GetPortalCommentsPageByObjectIdResponse(id=1803971, encodeId=934218039e18a, content=<a href='/topic/show?id=62c7e6169ed' target=_blank style='color:#2F92EE;'>#类风湿关节炎患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76169, encryptionId=62c7e6169ed, topicName=类风湿关节炎患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Sat Jan 11 18:43:00 CST 2020, time=2020-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266068, encodeId=bf901266068c8, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334182, encodeId=5baf133418290, content=<a href='/topic/show?id=5306e6164b6' target=_blank style='color:#2F92EE;'>#类风湿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76164, encryptionId=5306e6164b6, topicName=类风湿)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597380, encodeId=b8bd159e3801a, content=<a href='/topic/show?id=fa1710082017' target=_blank style='color:#2F92EE;'>#风湿关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100820, encryptionId=fa1710082017, topicName=风湿关节炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=456818510265, createdName=xuruicheng, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035042, encodeId=88dd103504224, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Dec 12 10:43:00 CST 2019, time=2019-12-12, status=1, ipAttribution=)]
    2019-12-13 lmm397
  3. [GetPortalCommentsPageByObjectIdResponse(id=1803971, encodeId=934218039e18a, content=<a href='/topic/show?id=62c7e6169ed' target=_blank style='color:#2F92EE;'>#类风湿关节炎患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76169, encryptionId=62c7e6169ed, topicName=类风湿关节炎患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Sat Jan 11 18:43:00 CST 2020, time=2020-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266068, encodeId=bf901266068c8, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334182, encodeId=5baf133418290, content=<a href='/topic/show?id=5306e6164b6' target=_blank style='color:#2F92EE;'>#类风湿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76164, encryptionId=5306e6164b6, topicName=类风湿)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597380, encodeId=b8bd159e3801a, content=<a href='/topic/show?id=fa1710082017' target=_blank style='color:#2F92EE;'>#风湿关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100820, encryptionId=fa1710082017, topicName=风湿关节炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=456818510265, createdName=xuruicheng, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035042, encodeId=88dd103504224, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Dec 12 10:43:00 CST 2019, time=2019-12-12, status=1, ipAttribution=)]
  4. [GetPortalCommentsPageByObjectIdResponse(id=1803971, encodeId=934218039e18a, content=<a href='/topic/show?id=62c7e6169ed' target=_blank style='color:#2F92EE;'>#类风湿关节炎患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76169, encryptionId=62c7e6169ed, topicName=类风湿关节炎患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Sat Jan 11 18:43:00 CST 2020, time=2020-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266068, encodeId=bf901266068c8, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334182, encodeId=5baf133418290, content=<a href='/topic/show?id=5306e6164b6' target=_blank style='color:#2F92EE;'>#类风湿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76164, encryptionId=5306e6164b6, topicName=类风湿)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597380, encodeId=b8bd159e3801a, content=<a href='/topic/show?id=fa1710082017' target=_blank style='color:#2F92EE;'>#风湿关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100820, encryptionId=fa1710082017, topicName=风湿关节炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=456818510265, createdName=xuruicheng, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035042, encodeId=88dd103504224, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Dec 12 10:43:00 CST 2019, time=2019-12-12, status=1, ipAttribution=)]
  5. [GetPortalCommentsPageByObjectIdResponse(id=1803971, encodeId=934218039e18a, content=<a href='/topic/show?id=62c7e6169ed' target=_blank style='color:#2F92EE;'>#类风湿关节炎患者#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=18, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76169, encryptionId=62c7e6169ed, topicName=类风湿关节炎患者)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=a9de34, createdName=shenxlcyp, createdTime=Sat Jan 11 18:43:00 CST 2020, time=2020-01-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1266068, encodeId=bf901266068c8, content=<a href='/topic/show?id=57a53011364' target=_blank style='color:#2F92EE;'>#关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=30113, encryptionId=57a53011364, topicName=关节炎)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=f90281, createdName=lmm397, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1334182, encodeId=5baf133418290, content=<a href='/topic/show?id=5306e6164b6' target=_blank style='color:#2F92EE;'>#类风湿#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=76164, encryptionId=5306e6164b6, topicName=类风湿)], attachment=null, authenticateStatus=null, createdAvatar=https://thirdwx.qlogo.cn/mmopen/vi_32/DYAIOgq83eq2AGzrugK9ZUjU3eJxzM901ophWib0xJDrSicy49ibWl3zB5pbDto7eoR6tnzwOiaKdbq1a8PcbYFFrw/132, createdBy=6ff22500098, createdName=ms4964546379600229, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1597380, encodeId=b8bd159e3801a, content=<a href='/topic/show?id=fa1710082017' target=_blank style='color:#2F92EE;'>#风湿关节炎#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=40, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=100820, encryptionId=fa1710082017, topicName=风湿关节炎)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=456818510265, createdName=xuruicheng, createdTime=Fri Dec 13 22:43:00 CST 2019, time=2019-12-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035042, encodeId=88dd103504224, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Thu Dec 12 10:43:00 CST 2019, time=2019-12-12, status=1, ipAttribution=)]
    2019-12-12 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

相关资讯

类风湿关节炎的惊人发现

这一发现指出了一种新的治疗自身免疫性疾病的方法,也可能允许使用一种简单的血液测试来检测患这种疾病的高危人群。该研究发表在Nature Immunology杂志上。

锝[99Tc]亚甲基二膦酸盐注射液治疗类风湿关节炎专家共识

锝[99Tc] 亚甲基二膦酸盐注射液( 以下简称“99Tc-MDP”) 为中国原研药物,被批准用于治疗类风湿关节炎( RA) 等风湿免疫病,能够靶向浓聚在异常骨代谢的骨组织部位,调节骨免疫,增加骨密度,修复骨微结构,起到治疗作用。 自2000 年上市以来,99Tc-MDP广泛应用于RA等的治疗,积累了大量的实践经验。根据国家风湿病数据中心( CRDC) 的统计,2017 年99Tc-MDP在中国R

骨关节炎、类风湿关节炎、强直性脊柱炎三者分不清?专家教您鉴别

骨关节炎、类风湿关节炎、强直性脊柱炎三者常常分不清楚,北京大学人民医院关节病研究所魏威主任教您如何鉴别。

FDA批准了新的甲氨蝶呤注射制剂RediTrex用于治疗类风湿关节炎

美国食品和药物管理局(FDA)已批准RediTrex,这是一种新的甲氨蝶呤产品,旨在治疗类风湿关节炎的成人和儿童患者以及牛皮癣的成人患者。

当类风湿关节炎遇到痛风,会擦出怎样的火花?

患者为44岁中国女性,10个月前开始出现多关节肿痛。查体可见患者右手近端和远端指间关节外形呈梭形肿胀,有压痛,双腕关节及膝关节肿胀、压痛,晨僵时间>30min,X线片(见图1)示双侧手腕关节、指间关节间隙缩小。

Genome Med:一对儿同卵双胞胎,怎么你有关节炎我没有?

同卵双胞胎拥有相同基因组,是用于研究表观遗传修饰作用(在不改变DNA序列本身的情况下改变控制基因表达的DNA)的理想对象。近期发表在Genome Medicine的一篇文章研究了79对同卵双胞胎,每对双胞胎中有一人患有类风湿关节炎,另一人没有患此类疾病,该研究旨在探究可能与类风湿关节炎有关的表观遗传学因素。