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女患,36岁,农民。主因周身关节疼痛四年,发热、尿黄、心悸三天,于1991年4月10日住院。患者四年来先后出现双侧踝关节、腕关节、手指关节及腰背疼痛,呈游走性间歇发作。半年来关节疼痛加重,伴双侧腕踝关节肿胀、活动受限,尤以晨起为著,不能从事家务劳动。曾在本地间断服用安乃近、去疼片及中药治疗。一周来纳差、乏力,三天来发热,体温38～39℃,尿黄、心悸、腰背酸痛,但无剧烈腰痛、酱油色尿及皮肤瘀斑。无输血史,家族史无可记述。查体:T38.9℃,P116次/分,R24次/分,BP13.5/10kPa,发育正常,营养欠佳,神志清楚,面色苍黄,巩膜轻度黄染,双睑结膜苍白。颈无抵抗,无颈静脉怒张。两肺呼吸音粗,无罗音,心界不大,心律齐无杂音。腹平软,肝于右肋下1.5cm、剑突下4cm可触及,质中等硬,轻触痛,脾于左肋下刚可触及,边缘钝,质中等硬,无触痛,腹水征(一)。双下肢无水肿,双手近端指关节呈梭形肿胀,双腕关节,踝关节明显肿胀,活动受限,
Female, 36 years old, farmer. The main cause of joint pain for four years, fever, urine yellow, palpitations three days, April 10, 1991 hospitalization. Patients have bilateral bilateral ankle, wrist, finger joints and back pain four years later, was intermittent episodic walk. Severe joint pain over the past six months, with bilateral wrist and ankle swelling, limited mobility, especially in the morning for the job, can not engage in housework. Had taken intermittently in the local analgin, painkillers and traditional Chinese medicine treatment. One week to anorexia, fatigue, fever for three days, body temperature 38 ~ 39 ℃, urine yellow, palpitations, back pain, but no severe back pain, soy sauce and skin ecchymosis. No history of blood transfusion, no history of family history. Physical examination: T38.9 ℃, P116 times / min, R24 times / min, BP13.5 / 10kPa, normal development, poor nutrition, conscious, pale yellow, scleral mild yellow dye, double eyelid pale. Neck without resistance, no jugular vein engorgement. Breath sounds coarse lungs, no rales, the heart is not big, heart rhythm Qi no noise. Abdominal soft, liver in the right rib 1.5cm, 4cm below the xiphoid can be touched, the quality of medium hard, touch the pain, the spleen just accessible under the left rib cage, blunt edge, medium hard, no tenderness, ascites sign one). No lower extremity edema, bilateral proximal knuckles were spindle-shaped swelling, wrist, ankle joint obvious swelling, limited mobility,