北京大学学报(医学版) ›› 2020, Vol. 52 ›› Issue (6): 1157-1161. doi: 10.19723/j.issn.1671-167X.2020.06.030

• 短篇论著 • 上一篇    下一篇

类风湿关节炎合并淋巴水肿2例及文献回顾

钟剑球(),曾沛英,王庆文   

  1. 北京大学深圳医院风湿免疫科,广东深圳 518048
  • 收稿日期:2020-07-31 出版日期:2020-12-18 发布日期:2020-12-13
  • 通讯作者: 钟剑球 E-mail:zhongjianqiu_sd@163.com
  • 基金资助:
    北京大学深圳医院“三名工程”项目(SZSM201612009);广东省自然科学基金(2019A1515011112);国家自然科学基金(81974253)

  • Received:2020-07-31 Online:2020-12-18 Published:2020-12-13
  • Supported by:
    Shenzhen Sanming Project of Shenzhen Municipal Health Commission(SZSM201612009);Natural Science Foundation of Guangdong Province(2019A1515011112);National Natural Science Foundation of China(81974253)

RICH HTML

  

摘要:

关键词: 类风湿关节炎, 淋巴水肿, 淋巴造影术, 放射性核素淋巴显像

中图分类号: 

  • R593.22

图1

治疗前后淋巴水肿的变化对比"

表1

50例患者人口学特征及临床特点"

Items Value
Male/Female* 20 (42%)/28 (58%)
Age of presentation/years* 56 (14-73)
Age of RA onset/years 45±13
Age of lymphedema onset/years 53.0±11.6
Duration before lymphedema/year* 5 (0-32)
≤1 year 10 (21%)
≥2 years 38 (79%)
Site of lymphedema
Upper limbs 37 (74%)
Bilateral 19 (38%)
Unilateral 18 (36%)
Lower limbs 12 (24%)
Bilateral 9 (18%)
Unilateral 3 (6%)
Upper and lower limbs 1 (2%)
Rheumatoid factor (n=48)*
Positive 31 (65%)
Negative 17 (35%)
Activity of RA#
Active 20 (50%)
Quiescent 20 (50%)
[1] Kalliomäki JL, Vastamäki M. Chronic diffuse oedema of the rheumatoid hand: a sign of local lymphatic involvement[J]. Ann Rheum Dis, 1968,27(2):167-169.
doi: 10.1136/ard.27.2.167 pmid: 5651232
[2] Hart FD. Rheumatoid arthritis: extra-articular manifestations[J]. Br Med J, 1970,2(5712):747-752.
doi: 10.1136/bmj.2.5712.747 pmid: 5428736
[3] de Silva RT, Grennan GM, Palmer DG. Lymphatic obstruction in rheumatoid arthritis: a cause for upper limb oedema[J]. Ann Rheum Dis, 1980,39(3):260-265.
doi: 10.1136/ard.39.3.260 pmid: 7416816
[4] Kyle VM, de Silva M, Hurst G. Rheumatoid lymphedema[J]. Clin Rheumatol, 1982,1(2):126-127.
doi: 10.1007/BF02275602 pmid: 6926809
[5] Grillet B, Dequeker J. Rheumatoid lymphedema[J]. J Rheumatol, 1987,14(6):1095-1097.
pmid: 3509983
[6] Wijnands MJ, Corstens FH, van der Heijde DM, et al. Lymphatic obstruction as a cause of oedema in rheumatoid arthritis[J]. Neth J Med, 1988,33(3/4):140-143.
[7] Dacre JE, Scott DL, Huskisson EC. Lymphedema of the limbs as an extra-articular feature of rheumatoid arthritis[J]. Ann Rheum Dis, 1990,49(9):722-724.
pmid: 2241291
[8] Bamji A. Limb lymphoedema in rheumatoid arthritis[J]. Ann Rheum Dis, 1991,50(6):407.
doi: 10.1136/ard.50.6.407 pmid: 2059087
[9] Lacroix HR, Gruwez JA, Daele CV, et al. Lymphedema of the leg associated with rheumatoid arthritis[J]. Lymphology, 1991,24(2):68-70.
pmid: 1921478
[10] Gschwind C, Pfeiffer KM. Rheumatoid lymphedema: a case report[J]. J Hand Surg Am, 1993,18(6):992-994.
pmid: 8294761
[11] Joos E, Bourgeois P, Famaey JP. Lymphatic disorders in rheumatoid arthritis[J]. Semin Arthritis Rheum, 1993,22(6):392-398.
doi: 10.1016/s0049-0172(05)80031-9 pmid: 8342046
[12] Minari C, Cecconami L, Fioravanti A, et al. Lymphoedema of the limbs in rheumatoid arthritis[J]. Clin Rheumatol, 1994,13(3):464-469.
pmid: 7835011
[13] Sant SM, Tormey VJ, Freyne P, et al. Lymphatic obstruction in rheumatoid arthritis[J]. Clin Rheumatol, 1995,14(4):445-450.
doi: 10.1007/BF02207680 pmid: 7586983
[14] Ostrov BE. Beneficial effect of etanercept on rheumatoid lymphe-dema[J]. Arthritis Rheum, 2001,44(1):240-241.
doi: 10.1002/1529-0131(200101)44:1<240::AID-ANR32>3.0.CO;2-# pmid: 11212167
[15] Kogure T, Hoshino A, Ito K, et al. Beneficial effect of complementary alternative medicine on lymphedema with rheumatoid arthritis[J]. Mod Rheumatol, 2005,15(6):445-449.
doi: 10.1007/s10165-005-0438-2
[16] Eyigor S, Karapolat H, Kirazli Y. Efficacy of etanercept and complete decongestive physical therapy in bilateral lower-limb lym-phoedema associated with rheumatoid arthritis: A case report[J]. Adv Ther, 2008,25(1):23-28.
doi: 10.1007/s12325-008-0006-1
[17] Tily HI, Perl A. Lymphoedema: a paradoxical effect of tumour necrosis factor inhibitors: case report and review of literature[J]. BMJ Case Rep, 2009, bcr07. 2008. 0520. doi: 10.1136/bcr.07.2008.0520.
[18] Kuroyanagi G, Yamada K, Imaizumi T, et al. Leg lymphedema caused by iliopectineal bursitis associated with destruction of a rheumatoid hip joint: A case report[J]. Exp Ther Med, 2013,6(4):887-890.
doi: 10.3892/etm.2013.1243
[19] Béji M, Bouomrani S, Bouassida N, et al. Unilateral upper limb lymphedema in elderly rheumatoid arthritis[J]. Eur Geriatr Med, 2013,4(Suppl 1):S135.
[20] Breznik V, Dai K, Marovt M. Chronic peripheral edema in a patient with rheumatoid arthritis[J]. Acta Dermatovenerol Alp Pannonica Adriat, 2018,27(1):37-39.
pmid: 29589645
[21] 左晓霞, 鲍春德, 陈顺乐. 类风湿关节炎伴肢体淋巴性水肿的诊治二例报告[J]. 湖南医学, 1995,12(4):228-229.
[22] 戴冽, 汤美安. 强直性脊柱炎并类风湿性关节炎伴肢体淋巴性水肿1例[J]. 中国实用内科杂志, 1999,19(4):251.
[23] Mortimer PS, Levick JR. Chronic peripheral oedema: the critical role of the lymphatic system[J]. Clin Med, 2004,4(5):448-453.
doi: 10.7861/clinmedicine.4-5-448
[24] Grada AA, Phillips TJ. Lymphedema: Pathophysiology and clinical manifestations[J]. J Am Acad Dermatol, 2017,77(6):1009-1020.
pmid: 29132848
[25] Mcrorie ER, Reid DM, Dunn NA, et al. Lymphoedema associated with active inflammatory arthritis in a patient with congenital lymphatic hypoplasia[J]. Br J Rheumatol, 1995,34(7):689-691.
doi: 10.1093/rheumatology/34.7.689 pmid: 7670794
[26] Jayson MI, Barks JS. Oedema in rheumatoid arthritis: Changes in the coefficient of capillary filtration[J]. BMJ, 1971,2(5761):555-557.
pmid: 5579191
[27] Schmit P, Prieur AM, Brunelle F. Juvenile rheumatoid arthritis and lymphoedema: lymphangiographic aspects[J]. Pediatr Radiol, 1999,29(5):364-366.
doi: 10.1007/s002470050608 pmid: 10382216
[28] Bardare M, Falcini F, Cate HT, et al. Idiopathic limb edema in children with chronic arthritis: A multicenter report of 12 cases[J]. J Rheumatol, 1997,24(2):384-388.
pmid: 9035001
[29] Maclellan RA, Greene AK. Lymphedema[J]. Semin Pediatr Surg, 2014,23(4):191-197.
doi: 10.1053/j.sempedsurg.2014.07.004 pmid: 25241097
[30] Grada AA, Phillips TJ. Lymphedema: Diagnostic workup and management[J]. J Am Acad Dermatol, 2017,77(6):995-1006.
doi: 10.1016/j.jaad.2017.03.021 pmid: 29132859
[31] Liu N. MR lymphangiography [M]// Lee BB, Rockson S, Bergan J. Lymphedema. Berlin, Germany: Springer, Cham: 2018. https://doi.org/10.1007/978-3-319-52423-8_27.
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