缓和性血清阴性对称性滑膜炎伴凹陷性水肿综合征的中医研究进展

缓和性血清阴性对称性滑膜炎伴凹陷性水肿(remitting seronegative symmetrical synovitis with pitting edema, RS3PE)综合征的病因病机主要为正虚感邪、痹阻关节,肺脾肾虚、水液代谢失常。对于本病证型的认识,临床医家各有特点,辨证分型归纳为湿热蕴结,脾肾亏虚型。治疗方面,中药或针灸联合西药治疗本病不仅能够提高疗效,亦能在疾病缓解期使西药稳固撤减,降低不良反应。此外,需注重预后与调护以益于疾病的治疗。目前,中医药治疗RS3PE综合征仍存在许多不足之处,如现有文献多基于临床病例报道,证据强度较低;本病缺乏统一、明确、规范化的诊断、辨证及治疗;对中药、针灸治疗本病的机制研究较少。为此,应当总结中医药治疗RS3PE综合征的经验,积极开展多中心、大样本的循证医学研究,形成统一的具有中医药特色的诊疗规范,同时,加强基础研究以揭示中医药治疗本病的作用机制,从而全面提高中医药治疗的科学性。     

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。     

15例缓解性血清阴性对称性滑膜炎伴凹陷性水肿临床特点分析

目的 分析15例缓解性血清阴性对称性滑膜炎伴凹陷性水肿（RS3PE）的临床特点,以减少误诊和漏诊.方法 收集2008年1-2009年12月于本院就诊RS3PE患者15例,分析其临床特点,特别注意排除是否伴发肿瘤.结果 15例患者中3例合并肿瘤.11例双侧关节受累,76.4%掌指关节受累,8例手背、足背均出现可凹性水肿,双手和双足X线示无骨侵蚀.结论 RS3PE主要发生在老年人,可多关节受累,多有发热和手足水肿,抗环瓜氨酸肽抗体（抗CCP）和抗核抗体（ANA）阴性,无骨侵蚀,需警惕伴发恶性肿瘤.     

缓解性血清阴性对称性滑膜炎伴凹陷性水肿综合征1例报告

缓解性血清阴性对称性滑膜炎伴凹陷性水肿综合征１例报告张江林，黄烽（北京解放军总医院风湿科，１００８５３）１病例报告患者，男，５６岁。主因双下肢浮肿３年，多关节肿痛２个月，于１９８７年４月入院。１９８４年７月无诱因出现双小腿肿胀，呈凹陷性，无自觉不适，...     

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。     

缓解性血清阴性对称性滑膜炎伴凹陷性水肿综合征12例临床分析

目的：回顾性分析缓解性血清阴性对称性滑膜炎伴可凹陷性水肿（RS3PE）综合征的临床表现、实验室及X线检查特点,以期寻找疾病规律,防止误诊和漏诊。方法：对12例患者进行临床表现、家族史、既往史、X线表现、RF、ESR、血常规及治疗转归进行总结。结果：12例患者均是急性起病,均有手足明显凹陷性水肿,侵犯手、肘、肩、颈椎、膝、踝、足关节,出现发热,肘、手、腕关节功能受限,多伴有掌红斑,2年后随访,3例掌指关节、近指间关节微破坏,2例患者症状明显减轻但逐渐出现双手尺偏畸形,2例肘后部位类风湿结节,最后2例发展成典型的类风湿关节炎。8例完全中医辨病辩证施治,关节肿胀疼痛完全消失,但有关节不适感。未发现合并肿瘤患者。结论：RS3PE综合征是异质性临床症候群,与类风湿关节炎有一定的相关性,肌腱鞘滑膜急性炎症和血管炎是RS3PE的主要病理特征,小剂量糖皮质激素及中医辨证施治均可起到较好的疗效。     

对称性滑膜炎伴凹陷型水肿综合征1例

患者,男,65岁。突发双手背对称性发红、肿胀、发热、疼痛,疼痛剧烈,伴双肩部肌肉疼痛及僵硬感。院外予扑炎痛、丹参治疗20余天,症状无缓解。查体:T36.3℃,P 89次/min,R21次/min,BP 130/80mmHg。皮肤无黄染、皮疹、皮下结节,浅表淋巴结无肿大,心、肺、腹无异常,双手背凹陷性水肿     

1例对称性血清阴性滑膜炎的全身骨显像

患者男性,71岁。2个月前无明显诱因出现四肢水肿,以双手、足为重,伴周身疼痛,以双手掌指关节、指间关节及腕关节、双肩、膝关节及腰背为主,活动后明显加重,无晨僵,无发热。10d前于外院以“痛风,肾损害”给予中药治疗8d,周身痛减轻。     

RS3PE综合症一例报告及文献复习

1临床资料患者女,54岁。因双膝关节肿痛伴下肢肿胀三周就诊,不发热。体检:一般情况良好,双膝关节明显肿胀,下肢肿胀明显,局部皮温稍高,按压疼痛。血常规:WBC5.4×109/L,N72%,L27%,E1%;ASO(-);ESR89mm/h,CRP220mg/L,RF(-),ENA酶谱(-),ANA酶谱(-),IgG、IgM正常,IgA稍升高,肝肾功能正常,尿检正常。彩色多谱勒提示月国窝囊肿,下肢静脉造影示月国静脉受压。X线检查示双膝关节退行性变。用消炎镇痛药物治疗无效。收住血管外科经抬高肢体、大剂量青霉素消炎,待肢体肿胀有所消退后拟诊月国窝囊肿行囊肿切除术,术中未见囊肿,月国窝脂肪…     

恶性淋巴瘤继发的RS3PE综合征(附一例报告)

报告以缓解型血清阴性对称性滑膜炎伴凹陷性水肿(RS3PE)综合征为首发症状的恶性淋巴瘤1例，并复习文献。RS3PE综合征只是一种临床综合征，而非一个独立的疾病，有原发性与继发性之分。继发性RS3PE综合征常与肿瘤、风湿性疾病、血液病等密切相关。其预后与原发疾病密切相关。诊断和治疗时应注意查找其原发疾病。与肿瘤合并出现且随着肿瘤治疗缓解消失的RS3PE综合征称为副瘤性RS3PE综合征。当伴随全身症状与体征、血嗜酸细胞计数和(或)乳酸脱氢酶水平升高时应警惕恶性淋巴瘤。     

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.     

Remitting seronegative symmetrical synovitis with pitting oedema associated with rifampicin

Background  

Remitting seronegative symmetrical synovitis with pitting oedema (RS3PE syndrome) is a very rare condition incorporating a tenosynovitis of the hands and wrists, as well as the feet, ankles and shoulders. The aetiology of RS3PE syndrome is unknown, although it has been linked with infectious agents (including mycobacteria), other rheumatological conditions, HLA serotypes and malignancies.     

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.     

类风湿关节炎合并色素沉着绒毛结节性滑膜炎1例及文献回顾

报道北京大学人民医院风湿免疫科诊治的1例类风湿关节炎(rheumatoid arthritis, RA)合并色素沉着绒毛结节性滑膜炎(pigmented villonodular synovitis, PVNS)的临床诊疗过程,并回顾国内外相关文献报道,对该病的诊断、治疗及预后进行综合分析,总结疾病特点,提高对该病的认识,减少漏诊并促进及早诊断。本例患者为45岁女性,RA病史15年,未进行规律治疗,近3个月右膝关节肿痛加重,关节腔穿刺发现大量RA病情难以解释的血性关节液。膝关节磁共振 (magnetic resonance imaging, MRI)提示T1及T2加权像均为低信号的含铁血黄素沉着。患者行膝关节镜检查,镜下表现及组织病理检查符合PVNS的诊断,给予患者切除增生滑膜。术后给予患者积极的功能锻炼及慢作用抗风湿药物规范治疗,随访半年恢复良好,右膝关节未再出现肿胀。RA是以慢性滑膜炎和关节破坏为特征的自身免疫疾病,PVNS是一种以滑膜增殖为特征的侵蚀性关节疾病,二者均为滑膜受累,且临床表现相似,RA合并PVNS的病例罕见,明确诊断具有难度。本研究分别在万方数据知识服务平台和中国知网以“类风湿关节炎”和“色素沉着绒毛结节性滑膜炎”为检索词检索相关文献,未检索到中文文献。在PubMed中以“rheumatoid arthritis”与“pigmented villonodular synovitis”为检索词检索,共检索到2篇英文文献。对于该病,临床医生需充分了解患者的病程发展,通过MRI及组织病理检查做出正确诊断,并进行有针对性地治疗。     

Crystal methamphetamine-induced acute pulmonary edema: a case report

"Crystal methamphetamine" is a crystalline form of amphetamine, the abuse of which is growing rapidly in popularity in Japan, Hawaii and the West Coast. Drug experts and law enforcement officials say that the use of crystal meth is spreading east from California. It may produce permanent addiction and can produce violent schizophrenic behavior. Introduced along the Leeward Coast of Hawaii about 3 years ago, it is now being used throughout Oahu and is starting to rival cocaine as the illicit drug of choice in Hawaii. It is also the major drug problem in Japan, where the powder form is called "shabu." The smoking of crystal ("ice") in a glass pipe is more common in Hawaii, whereas other routes of administration, such as snorting or intravenous use, are more common on the West Coast. We present the case of a young woman who was admitted to Kaiser Moanalua Medical Center with near fatal acute pulmonary edema consequent to the use of crystal meth.     

Extraarticular pigmented villonodular synovitis of the distal forearm: a case report

Extraarticular pigmented villonodular synovitis (PVNS) is very rare in the distal forearm. There has only been one previous case report of this disease in the extensor tendons of a child. We report a case of PVNS of the distal forearm that presented as two nodules over the radial aspect and a separate nodule on the ulnar aspect beneath the flexor carpi ulnaris tendon. Surgical exploration revealed an extensive extraarticular PVNS over the first and second dorsal compartment extensor tendons. On the anterior aspect it extended in the deep plane between the flexor tendons and the pronator quadratus and encased the radial artery completely. Complete excision of the tumour with the radial artery was done.