银屑病关节炎中医病因病机及治疗探析

从风寒湿三邪致病、热邪致病、血分致病三个方面详细阐述了银屑病关节炎的病因病机,并从三期辨证,分期治疗及中成药治疗方面对银屑病关节炎的中医治疗进行了探讨,强调了活血化瘀在治疗中的重要性,并认为银屑病关节炎的发生与免疫异常有关,治疗中可酌情应用虫类药,清热燥湿、祛风止痒的中药,引经药及藤类药。     

依那西普治疗重症银屑病关节炎1例并文献复习

目的探讨重症银屑病关节炎的治疗。方法报道1例重症银屑病关节炎的诊断及治疗过程,并进行文献复习。结果经过依那西普治疗,患者的关节、皮肤症状及重度贫血均获得改善。结论肿瘤坏死因子（TNF-α）参与银屑病关节炎的疾病进展,TNF-α抑制剂如依那西普可抑制关节炎症,减少关节侵蚀,改善关节及皮肤症状,纠正贫血,但不良反应也不可忽视。     

阿达木单抗成功治疗严重型银屑病和银屑病关节炎

阿达木单抗是一种拮抗肿瘤坏死因子的完全人源性重组单克隆抗体,对各种活动性类风湿性关节炎有明显疗效。报道2例长期患有难治性银屑病和银屑病性关节炎患者,用多种常规和试验性的抗银屑病药物治疗都失败,而对阿达木单抗治疗都有反应。用阿达木单抗治疗几周后,这2例患者的皮肤和关节症状在临床上都得到明显改善。截至目前文献未见用阿达木单抗治疗银屑病和银屑病性关节炎的相关报道。阿达木单抗成功治疗严重型银屑病和银屑病关节炎@Chew A.-L. @Bennett A. @Smith C.H. @J.Barker$Skin Therapy Research Unit, St. John's I…     

FDA批准etanercept用于银屑病性关节炎的治疗

Immunex公司及惠氏立达公司宣称,美国FDA已经批准其类风湿性关节炎冶疗药物etanercept(英文商品名为Enbrel)用于治疗银屑病性关节炎。 银屑病性关节炎是一种慢性炎症性疾病,可同时有关节和皮肤表现。与其它类型的关节炎不同,银屑病性关节炎常表现为进展性的关节痛和肿胀,伴随皮肤的鳞屑红斑病变。目前临床上还没有专门针对这种疾病的药物。     

武山矿泉水治疗银屑病48例

目的 探讨银屑病关节炎的临床表现及药物、矿泉浴治疗效果.方法 观察每例患者的临床表现,给予非甾体抗炎药治疗,治疗组加矿泉水疗,60天判定疗效.结果 48例患者总有效率91.7%,治疗组比对照组疗效出现更早.结论 应用非甾体抗炎药物与矿泉浴相结合治疗银屑病关节炎,见效快,副作用少,是银屑病关节炎患者较好的选择.     

银屑病关节炎的药物治疗进展

银屑病关节炎（psoiastic arthritis,PsA）是一种与银屑病相关的炎症性关节病变,过去人们曾经认为PSA是银屑病合并类风湿关节炎。直到1964年美国风湿病协会正式命名为银屑病关节炎又名关节病性银屑病,确定它是一种独立的疾病,具有银屑病皮疹和关节炎症表现,该病是一种进行性、致残性的关节病。各国患病率不相同。男女患病比例相近。银屑病主要累及远端指间关节,可有轻微非破坏单关节炎,也可能发展迅速出现毁损性多关节炎,出现骨的溶解及关节强直,至于PSA的预后也没有类风湿关节炎那样明确。     

金明秀教授治疗银屑病关节炎经验探讨

银屑病关节炎由于银屑病属于中医＂疪痹＂的辨证范畴。金明秀教授应用中医药治疗银屑病关节炎,以补益肝肾、养血和营为大法,配合清热利湿、解毒、活血通络、止痛等方法,辨证施治,取得了较好的疗效。     

加味当归饮子联合甲氨蝶呤对银屑病关节炎患者的疗效观察

目的探讨采用加味当归饮子联合甲氨蝶呤对银屑病关节炎患者的临床疗效。方法选择本院确诊并治疗的银屑病关节炎患者40例作受试者,随机分为对照组和实验组,每组20例。对照组采用甲氨蝶呤片治疗,实验组在对照组基础上联合加味当归饮子治疗。观察和比较两组临床疗效、C反应蛋白、血沉水平的变化情况。结果实验组总有效率高于对照组(P0.05);治疗后两组患者C反应蛋白及血沉水平均低于治疗前,且实验组低于对照组,差异具有统计学意义(P0.05)。结论加味当归饮子与甲氨蝶呤片的联合应用可有效提高银屑病关节炎的治疗效果,改善临床症状。     

同时治疗银屑病及银屑病型关节炎的生物及小分子药物研究进展

在银屑病的发病过程中,约1/4的患者会并发银屑病型关节炎的临床表现,如果能有一种药物可以同时作用于银屑病皮肤和关节,那么无疑对患者是有益的.目前新兴的生物药物包括:肿瘤坏死因子抑制剂,如阿达木单抗、伊那西普、英夫利昔单抗、戈利木单抗和赛妥珠单抗;抗IL-12/IL-23 p40药物,如乌司奴单抗;抗IL-17药物,包括苏金单抗、brodalumab.它们都对银屑病和银屑病型关节炎有良好的临床疗效和安全性.最近,另有一些小分子化学物质应运而生,如磷酸二酯酶4抑制剂阿瑞米拉和JAK抑制剂托法替尼、INCB018424等,它们都有一定的治疗意义.本文就能够同时治疗银屑病、银屑病型关节炎的生物及小分子药物作一综述.     

银屑病关节炎

1　概念银屑病关节炎是一种炎症性关节炎 ,伴银屑病 ,其主要特征是累及远端之间关节 ,类风湿因子通常阴性 ,病程慢性 ,病因不清 ,男女发病差别不大 ,平均发病年龄为 32～ 4 5岁。银屑病关节炎的发病机制尚未明确 ,皮肤和关节病变可能由相同的机制起作用。遗传、免疫和环境因素被认为是参与发病的重要因素。银屑病关节炎与ＨＬＡ -Ｂ2 7相关 ,尤其是银屑病脊柱炎 ,其ＨＬＡ -Ｂ2 7阳性率可达 4 6 %～ 78%。一般认为银屑病关节炎患者免疫功能减低 ,细胞因子的异常在该病的发病中有重要意义。另外 ,精神因素、外伤、季节变化、内分泌改变及某些…     

银屑病关节炎的治疗进展

银屑病患者10%～30%会出现自身免疫性炎性关节炎,通常称为银屑病关节炎（PsA）.其主要治疗方法是药物治疗,包括非甾体消炎药、糖皮质激素以及改善病情类抗风湿药（DMARDs）,其中甲氨蝶呤最为常用.目前对生物制剂的研究较多,最常用的为肿瘤坏死因子α抑制剂.针对PsA这种自身免疫性炎性疾病,粒细胞/单核细胞除滤输血是一种新的治疗方式,可以消除致病性白细胞.局部用药和物理疗法可以作为辅助治疗措施.如果出现关节变形和僵硬,可考虑外科治疗干预.     

Elevated serum Dickkopf-1 is a biomarker for bone erosion in patients with psoriatic arthritis

Background:Psoriatic arthritis (PsA) is an inflammatory arthropathy characterized by psoriasis and bone erosion on radiology. Dickkopf-1 (Dkk-1) is considered to be the main inhibitor of the Wnt signaling pathway and results in reduced osteoblast proliferation. The aim of this study was to investigate the serum level of Dkk-1 and its association with bone erosion in PsA patients.Methods:Serum Dkk-1 levels were measured by enzyme-linked immunosorbent assay (ELISA) in 69 patients with PsA and 60 controls, including 39 rheumatoid arthritis (RA) patients, and 21 healthy controls (HCs). Rheumatoid factor and anti-cyclic citrullinated peptide levels were also determined by ELISA. The association of Dkk-1 level with clinical and laboratory features of PsA was analyzed. Logistic regression analysis was used to analyze the risk factors for bone erosion in PsA.Results:Dkk-1 was elevated in 68.1% (47/69) of the patients with PsA, 46.2% (18/39) of RA patients, and 9.5% (2/21) of HCs. Serum Dkk-1 concentration was significantly higher in PsA patients compared with that in HCs. The level of serum Dkk-1 was correlated with a swollen joint count, and levels of complement components 3 and 4. Elevated Dkk-1 level (odds ratio = 4.440, 95% confidence interval: 1.246–15.817, P = 0.021) was identified as the risk factor for bone erosion in PsA.Conclusions:The serum level of Dkk-1 is abnormally elevated in PsA patients. The elevation of Dkk-1 might be involved in the mechanism of bone erosion in patients with PsA.     

寻常型及关节型银屑病附着点炎超声特征对比分析

目的探讨并比较关节型银屑病（PsA）及寻常型银屑病（non-PsA）附着点炎的超声特征。方法纳入39例PsA患者（PsA组）、60例non-PsA患者（non-PsA组）及60例健康体检者（对照组）为研究对象。二维及彩色多普勒超声扫查双侧股四头肌腱、髌腱、跟腱、跖筋膜、屈肌总腱及伸肌总腱附着处。比较各组附着点炎发生部位、累及百分率及不同超声征象。结果对照组27例（45.00%）发生附着点炎,主要累及跟腱与股四头肌腱,所有病变均无血流信号。non-PsA组38例（63.33%）发生附着点炎,主要累及跟腱与股四头肌腱,4个病变部位具有血流信号。PsA组33例（84.62%）发生附着点炎,所有部位均可见累及,累及最多为跟腱、股四头肌腱及跖筋膜,18个病变部位具有血流信号。附着点炎的累及百分率,PsA组>non-PsA组>对照组（P均<0.01）。附着处肌腱回声减弱及附着处骨皮质表面骨赘,各组间差异无统计学意义;PsA组及non-PsA组附着处肌腱增厚发生率均高于对照组（P均<0.01）,但PsA组与non-PsA组间差异无统计学意义;附着处肌腱内钙化、骨皮质表面骨侵蚀及肌腱内血流信号,PsA组高于non-PsA组及对照组（P<0.01）,non-PsA组与对照组间差异无统计学意义。结论正常人、non-PsA附着点炎好发于跟腱与股四头肌腱;PsA附着点炎好发于跟腱、股四头肌腱及跖筋膜。PsA患者附着点炎的发生率>non-PsA患者>正常人。PsA患者较另两者更易发生钙化和骨侵蚀,血供也更加丰富。      

银屑病关节炎抑郁和焦虑患病情况及相关因素

目的:评估银屑病关节炎(psoriatic arthritis,PsA)患者抑郁及焦虑的患病率,比较与类风湿关节炎(rheumatoid arthritis,RA)患者之间的差异,探索PsA患者发生抑郁及焦虑的相关因素。方法:连续入选2018年5月至2019年9月就诊于北京大学第一医院风湿免疫科门诊的PsA和RA患者,采用抑郁自评量表和焦虑自评量表评估患者抑郁和焦虑情况,并进行对比。收集PsA患者的人口学及临床数据,包括性别、年龄、病程、疾病活动度及用药情况等,同时应用能量多普勒与灰阶超声评价关节及附着点病变。采用多因素Logistic回归分析相关因素。结果:入选114例PsA患者,37例(32.5%)患有精神障碍,其中36例(31.6%)合并抑郁,15例(13.2%)合并焦虑。与201名RA患者相比较,PsA患者合并抑郁的比例更高(31.6% vs. 18.9%,P=0.011), 经过校正分析发现PsA比RA发生抑郁的风险更高(校正OR=2.7,95%CI:1.1~6.4);合并焦虑患者的比例也较RA有升高趋势(13.2% vs. 8.5%,P=0.185),但差异无统计学意义。在PsA患者中,年龄(OR=0.95,P=0.008)、银屑病病程(OR=0.94,P=0.018)、疼痛视觉模拟评分(OR=1.47,P=0.011)、银屑病皮损面积及严重程度指数(psoriasis area and severity index,PASI)(OR=1.07,P=0.007)、超声附着点炎阳性(OR=4.13,P=0.009)是抑郁的相关因素;PASI(OR=1.07,P=0.001)是焦虑的相关因素。结论:PsA患者患抑郁与焦虑的比例较高,其中抑郁患病风险更是高于RA患者。年龄小、银屑病病程短、银屑病皮疹重、疼痛评分高、存在超声附着点炎症的PsA患者更容易出现抑郁,银屑病皮疹重是PsA患者发生焦虑的相关因素。     

AA amyloidosis in psoriatic arthritis

Background  

Amyloidosis is an extremely rare complication of psoriatic arthritis (PsA) and is associated with a poor prognosis. We report a case of amyloidosis secondary to severe PsA in a young patient and the course of his disease over a 13-year period of aggressive immunosuppression.     

银屑病性关节炎的临床特点及影像表现

目的探讨银屑病性关节炎(PsA)的临床特点及影像表现。方法对35例银屑病性关节炎的临床资料进行分析。结果21例皮损先于关节炎出现,5例皮损和关节症状同时发生,关节炎先发者9例。27例伴指、趾甲损害。不对称少关节炎型16例;脊椎炎型4例;远端指(趾)关节炎型2例;对称多关节炎型12例;掌跖脓疱病伴胸锁骨关节炎型1例。共32例患者接受X线检查,25例有PsA的X线征象。其中远端小关节受累13例(40.6%),膝关节受累8例(25%),踝关节受累7例(21.9%),骶髂关节受累3例(9.4%),其中6例为多关节同时受累(包括脊柱及髋关节受累)。11例患者接受CT检查,7例有PsA的CT改变。结论远端指(趾)关节受累是PsA的特征性表现。若传统的X线检查所见仍不足以为临床高度怀疑PsA患者提供诊断依据时或需监测早期PsA疗效时,可根据实际情况选择CT或磁共振成像作进一步检查。     

Remission-inducing drugs in rheumatoid arthritis

The administration of certain drugs to patients with established rheumatoid arthritis frequently results in improvement that is slow to appear but persists for long periods, even after the drug is discontinued. The three main drugs with this effect, whose efficacy and toxicity are reviewed in this paper, are gold salts, D-penicillamine and chloroquine. The cytotoxic agents used to treat rheumatoid arthritis, which likely have nonspecific anti-inflammatory actions and have serious long-term side effects, are also briefly reviewed. A new drug, levamisole, is currently being tested in patients with rheumatoid arthritis. It is suggested that the time for considering the introduction of a remission-inducing drug in patients with progressive rheumatoid arthritis is after an adequate trial of therapy with salicylates or other nonsteroidal anti-inflammatory agents, or both, and before the oral administration of steroids. It is difficult, however, on the basis of rigorous clinical comparisons, to recommend which of the three main remission-inducing drugs should be tried first, although gold salts have been used the most. Patients who have improved with 6 months of chrysotherapy may continue treatment for at least 3 years, during which time the frequency of mucocutaneous and renal toxic effects will steadily decrease. Some aspects of the medical economics of therapy with remission-inducing drugs for rheumatoid arthritis are discussed.     

Update in rheumatoid arthritis therapy

Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by polyarticular symmetrical arthritis. Inflammatory mediators targeting joint structures produce joint inflammation with pain, functional loss, joint destruction and permanent deformity. Currently, no cure for RA exists but the increasing use of combination therapy and immunomodulatory agents has led to improved quality of life and long-term outlook for many of these patients. While traditionally employed therapies have provided limited disease suppression, advances in our understanding of the molecular pathogenesis of RA have resulted in new therapies targeting very specific components of the inflammatory process. These new treatments have shown very promising results with improved efficacy and an overall decreased toxicity profile. This review provides an overview for practicing clinicians of the current immunosuppressive therapies in RA with an emphasis on newer biological agents regarding their mechanisms of action, efficacy, side effects and monitoring recommendations. Developing therapeutics will be briefly discussed.     

中医外治法在类风湿关节炎患者中研究近况

类风湿关节炎（RheumatoidArthritis,KA）是一种以累及周围关节为主的多系统性炎症性的自身免疫性疾病。目前国内外仍无特效治疗方法。西医常采用非甾体类抗炎药、慢作用抗风湿药、糖皮质激素、免疫及生物制剂等,均有较大的不良反应。而近年来中医药治疗RA,因其具有毒副作用小、疗效确切的优势,越来越受到关注。中医治疗KA除了内服用药外,还有许多外治法的运用。结合相关研究报道,对中医外治法在类风湿关节炎中的研究进展做一综述。     

肌肉骨骼超声在指导银屑病关节炎临床分型中的价值

目的:拟探索结合超声检查与单纯根据临床查体两种临床场景下银屑病关节炎(psoriatic arthritis,PsA)患者临床分型的差异。方法:入选2010年1月至2020年10月就诊北京大学第一医院风湿免疫科且临床和超声结果完整的PsA患者,根据患者的临床资料对其进行表型分类,再进一步结合能量多普勒与灰阶超声所发现的附着点炎及指(趾)炎对所有患者进行再次的表型分类,应用韦恩图表示纳入超声前后PsA各临床表型分组,临床表型构成比采用χ²检验或Fisher’s精确检验,纳入超声前后临床表型差异应用Wilcoxon符号秩检验。结果:共纳入227例PsA患者,分别存在一种或多种临床表现。临床查体发现:209(92.1%,209/227)例患者有银屑病皮损,98(43.2%, 98/227)例患者有指(趾)甲病变,219(96.5%,219/227)例患者有外周关节炎表现,25(11.0%,25/227)例患者脊柱受累,80(35.2%,80/227)例患者存在指(趾)炎,18(7.9%,18/227)例患者存在附着点炎。纳入超声评估后,发现另外18例患者超声下有指(趾)炎表现,另外80例患者超声下有急性附着点炎表现,其中异常回声减低55例,肌腱增厚62例,48例可见多普勒血流信号。与单纯根据临床查体分型相比,联合超声检查后对227例患者进行分型,发现最常见的单纯外周关节炎型患者明显减少(49.8% vs. 27.8%,P<0.001), 外周关节炎合并附着点炎患者比例明显增多(4.4% vs. 18.1%,P<0.001),外周关节炎合并附着点炎和指(趾)炎的患者也明显增多(1.8% vs. 17.6%,P<0.001)。结论:超声是发现附着点炎及指(趾)炎的有利工具,借助超声检查可以有效辅助风湿科医生更好地鉴别PsA的病变性质和类型,准确划分临床表型,并进一步指导治疗。