缓和的血清阴性的对称性滑膜炎伴凹陷性水肿一例报告

临床资料　患者 ,男性 ,6 9岁。因发热伴多关节肿痛 1个月余于 2 0 0 2年 9月 17日入院。患者 1个月前因受凉后出现反复发热 ,体温 37.5～ 38.5℃ ,抗感染治疗无效 ,发热 10 d后 ,出现双膝关节及手部关节对称性肿胀、疼痛 ,伴晨僵现象 ,持续时间大于 1h,并有活动障碍。入院第 18天 ,出现双侧手背、足背对称性水肿 ,无风湿病家族史。查体 :T37.4℃ ,心肺腹无异常 ,双侧膝关节及双侧腕关节及各手指近端指间关节肿胀 ,压痛 (+) ,活动受限 ,双手背、足背呈凹陷性水肿。实验室检查 :WBC 5 .99× 10 9/ L ,RBC 3.71× 10 1 2 / L ,Hb 10 1g/ …     

Remitting seronegative symmetrical synovitis with pitting edema. RS3PE syndrome

Eight elderly men and two elderly women presented with symmetrical polysynovitis of acute onset involving most of their appendicular joints and flexor digitorum tendons associated with pitting edema of the dorsum of both hands and both feet. Onset of seven of the ten cases could be pinpointed almost to the hour. Rheumatoid factors were absent from serum samples in all, and no radiologically evident erosions developed. Clinical and laboratory signs of inflammation and the edema disappeared gradually in each case. Treatment consisted of aspirin or other nonsteroidal anti-inflammatory drugs. Hydroxychloroquine, 200 to 400 mg/day, was given in six and gold therapy in two cases. Painless limitation of motion of the wrists and/or fingers persisted in all, although the patients were both unaware of and unhampered by this abnormality. Six of eight cases where typing was possible were positive for HLA-B7, CW7, and DQW2 (relative risk for B7, 9.5). Three cases of this syndrome were found in a consecutive series of 52 men diagnosed as having definite "rheumatoid arthritis," and thus represent a distinctive condition with an excellent prognosis.     

缓和性血清阴性对称性滑膜炎伴凹陷性水肿综合征的临床分析

目的了解缓和性血清阴性对称性滑膜炎伴凹陷性水肿综合征的临床和实验室特点。方法回顾性分析7例RS3PE综合征患者的临床资料。结果 7例患者中男5例,女2例,年龄45-69岁,平均61岁。均表现为突发双手、足背凹陷性水肿及多关节炎。血沉平均85mm/h,C反应蛋白平均65.9mg/L。3例患者手足关节X线表现为骨质疏松、关节间隙变窄。小剂量醋酸泼尼松和慢作用抗风湿药物治疗后临床症状缓解,1例3个月后合并过敏性紫癜。结论 RS3PE综合征是异质性临床症候群,小剂量醋酸泼尼松和慢作用抗风湿药物治疗有效,但该病与风湿性、肿瘤性、感染性疾病密切相关,积极治疗合并症可减少复发。     

RS3PE综合征与肿瘤相关性的探讨(附八例报告)

目的 了解缓和性血清阴性对称性滑膜炎伴凹陷性水肿综合征(RS3PE)的临床特点及与肿瘤的关系。方法 回顾分析8例RS3PE患者的临床表现、实验室检查资料，并复习有关文献。结果 8例均表现为双手及双足的突发性肿胀，血清类风湿因子阴性。8例均有不同肿瘤标记物阳性，其中3例合并肿瘤。结论 8例RS3PE综合征与肿瘤有相关性。     

The clinical entity of remitting seronegative synovitis with pitting edema (RS3PE syndrome)

Remitting seronegative symmetrical synovitis with pitting edema is a clinical entity distinct from polymyalgia rheumatica arthritis appearing in elderly patients. Distal pitting edema and tenosynovitis of the digitorum tendons are characteristically seen in this disorder. In contrast to polymyalgia rheumatica and rheumatoid arthritis, treatment with low-dose glucocorticoids usually produces a prompt and enduring remission after several months. Follow-up evaluations are necessary not only to assure this diagnosis is posterior, but also to observe for the possible occurrence of associated neoplasms.     

Mild haemolysis associated with flu-syndrome during daily rifampicin treatment--a case report

We describe a woman with the 'flu' like syndrome and haemolysis whilst on a supervised daily rifampicin regimen for the treatment of pulmonary tuberculosis. Although these are known complications of rifampicin therapy, they often occur when therapy is intermittent or interrupted. Hence the case we describe is unique and is the first of its kind to be reported in Singapore.     

缓解性血清阴性对称性滑膜炎伴凹陷性水肿并肺癌一例及文献复习

缓解性血清阴性对称性滑膜炎伴凹陷性水肿(RS3PE)是一种好发于老年男性的罕见疾病,主要表现为对称性手足远端滑膜炎及凹陷性水肿,而实验室检查常提示类风湿因子阴性,多合并肿瘤、感染等疾病。本文报告了1例临床表现为急性起病、对糖皮质激素敏感且依赖的RS3PE合并肺癌,并对另外6例国外关于RS3PE并肺癌病例的发病特点及治疗预后进行了总结。     

Fatal haemorrhagic pulmonary oedema and associated angioedema after the ingestion of rofecoxib

Angioedema is a recognised side effect of rofecoxib, a cyclo-oxygenase-2 (COX-2) inhibitor. But death resulting from a haemorrhagic pulmonary oedema after its ingestion has not been recorded. The case of a 60 year old man who died from haemorrhagic pulmonary oedema in the presence of angioedema after the ingestion of two doses of 12.5 mg of rofecoxib is reported.     

ACE等位基因多态性与血清阴性脊柱关节病的关联研究

目的检测分析血管紧张素Ⅰ转换酶（ACE）等位基因多态性在中国重庆地区黄种汉族人群中的分布特点,探寻ACE基因与血清阴性脊柱关节病（SpA）的相关性。方法采用PCR方法分别对95例正常对照和105例SpA患者进行ACE等位基因多态性检测。结果在SpA患者中检测到纯合子缺失型（D／D）占46．7％（49／105）,纯合子插入型（I／I）占7．6％（8／105）,杂合子插入／缺失型（I／D）占45．7％（48／105）,D与I等位基因出现频率分别为0．695和0．305;在正常对照中检测到纯合子缺失型（D／D）占18．9％（18／95）,纯合子插入型（I／I）占41．1％（39／95）,杂合子插入／缺失型（I／D）占40．0％（38／95）,D与I等位基因出现频率分别为0．389和0．611。经x^2检验SpA患者与正常对照相比,D／D型和I／I型差异比较有统计学意义（x^2=6．03,5．69,P〈0．05）,D／I型比较差异无统计学意义（x^2=1.25,P〉0．05）;D与I等住基因出现频率差异有统计学意义（x^2=4．98,P〈0．05）。结论以强直性脊柱炎（AS）为代表的SpA与ACE基因存在相关性。ACE等位基因多态性检测是否可作为判断AS患者心脏受累、病情严重程度及预后的指标,有待扩大样本例数再做进一步探讨。     

A rare case of seronegative culture--proven infection with Brucella suis

Brucellosis is a chronic infection produced by members of the Brucella family. Diagnosis of this condition requires either isolation of the organism in culture or positive serological tests.We describe a 27-year-old male admitted as a case of pyrexia of unknown origin (PUO), who tested negative for Brucella IgM ELISA test on preliminary evaluation but was subsequently diagnosed on the strength of positive blood and bone marrow cultures to be a case of brucellosis secondary to Brucella suis infection. In addition to highlighting the pathogenic potential of an unusual organism, this case demonstrates the unreliability of standard serological tests based on the Brucella melitensis antigen for infection with other species of Brucella.