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背景:类风湿关节炎(rheumatoidarthritis,RA)以慢性、对称性多关节炎为主要表现的系统性疾病。RA并发周围神经系统病变不常见。设计:以患者为观察对象的回顾性病例分析。目的:分析5例RA患者伴发周围神经病的临床和实验室特点。单位:北京协和大学医院的风湿免疫科。对象:北京协和医院自1983-01/2002-12收治RA患者567例,其中5例伴发周围神经病变,全部病例均符合美国风湿病学会分类诊断标准。其中5例并发神经系统损害不能以其它疾病解释。5例均处于疾病活动期,实验室指标符合RA活动性核心标准。方法:分析5例RA患者病案资料,所记载的周围神经病变症状及电生理学检测记录和实验室检查指标。主要观察指标:性别、年龄、病程、肌力障碍及感觉障碍程度、肌电图、肌活检及神经活检、相关实验室指标。结果:5例中男2例,女3例,年龄42～60岁,平均52岁。病程1～14年,平均5.4年。以神经系统为主诉就诊的4例,占80%(4/5),另1例入院后查体肌力下降,痛觉减退。四肢无力麻木、肢体远端痛觉减低4例,感觉异常3例,足下垂2例,腕下垂1例,肌萎缩3例,肌力下降5例,腱反射消失3例。出现周围神经病变或病变加重时4例伴关节肿痛,5例均有血沉增快,C反应蛋白升高,类风湿因子高滴度阳性,X射线示关节间隙变窄、关节面侵蚀破坏。伴血管炎3例,类风湿结节2例。肌电图显示4例周围神经源性损害,另1例肌活检证实为神经源性损害。1例神经活检示慢性中度轴索性神经病。结论:本组RA患者伴多发性周围神经病发生率为1%(5/569),发生于RA活动期或在活动期有所加重,100%(5/5)肌力下降,并有60%(3/5)出现肌萎缩。80%(4/5)肌电图有周围神经损害表现,有助于早期诊断。
BACKGROUND: Rheumatoid arthritis (RA) is a systemic disease characterized primarily by chronic, symmetrical polyarthritis. RA complicated peripheral nervous system lesions are not common. Design: Retrospective case analysis with patient as observation. Objective: To analyze the clinical and laboratory features of 5 patients with RA with peripheral neuropathy. Unit: Peking Union Medical College Hospital Department of Rheumatology. PARTICIPANTS: 567 RA patients were admitted to Peking Union Medical College Hospital from January 1983 to February 2002, including 5 cases with peripheral neuropathy. All cases were in accordance with the American College of Rheumatology classification diagnostic criteria. Five cases of concurrent neurological damage can not be explained by other diseases. 5 cases were in active disease, laboratory indicators in line with RA activity core standards. Methods: The clinical data of 5 RA patients were analyzed, the symptoms of peripheral neuropathy and electrophysiological examination record and laboratory test were recorded. MAIN OUTCOME MEASURES: Gender, age, duration of disease, muscular dysfunction and degree of sensory disturbances, electromyography, muscle biopsy and nerve biopsy, and related laboratory parameters. Results: There were 2 males and 3 females in 5 cases, ranging in age from 42 to 60 years with an average of 52 years. Duration of 1 to 14 years, an average of 5.4 years. 4 cases were mainly complained of neurological complaints, accounting for 80% (4/5). The other 1 case showed decreased muscle strength and pain relief after admission. Limbs weakness numbness, distal limb pain reduction in 4 cases, 3 cases of sensory abnormalities, foot ptosis in 2 cases, wrist ptosis in 1 case, muscle atrophy in 3 cases, decreased muscle strength in 5 cases, tendon reflex disappeared in 3 cases. 4 cases of peripheral neuropathy or pathological changes with swelling and joint pain, 5 cases of erythrocyte sedimentation rate increased, C-reactive protein, high titer of rheumatoid factor positive, X-ray showed joint space narrowing, articular erosion damage. With vasculitis in 3 cases, 2 cases of rheumatoid nodules. Electromyography showed peripheral neurogenic injury in 4 cases, and muscle biopsy in another case confirmed neurogenic damage. One case of biopsy showed chronic moderate axonal neuropathy. CONCLUSIONS: The incidence of multiple peripheral neuropathy in RA patients is 1% (5/569) in this RA group. It occurs in RA active stage or in active stage, with 100% (5/5) muscle strength declining and 60% (3/5) muscle atrophy. 80% (4/5) EMG peripheral nerve damage performance, contribute to early diagnosis.