Rhupus综合征的临床特点

doi:10.19723/j.issn.1671-167X.2021.05.020

摘要/Abstract

摘要：

目的: 探讨类风湿关节炎(rheumatoid arthritis,RA)和系统性红斑狼疮(systemic lupus erythematosus,SLE)重叠综合征(Rhupus综合征)的临床和血清学特征。方法: 回顾性分析2010年1月至2018年1月于新疆维吾尔自治区人民医院风湿免疫科就诊的21例Rhupus综合征患者的临床资料,另选取同期81例单纯RA及51例单纯SLE作为对照,比较Rhupus综合征与单纯RA组、单纯SLE组关节受累、自身抗体及临床特点。结果: 21例Rhupus综合征患者中男性3例,女性18例,平均年龄(49.43±11.66)岁,高于单纯SLE组患者的(40.59±12.73)岁(P=0.008)。以RA起病的Rhupus综合征患者的发病年龄小于单纯RA组[(32.58±11.14)岁 vs. (43.11±11.83),P=0.010], 差异有统计学意义。21例Rhupus综合征患者中,以RA起病者12例,除2例为男性外,其余10例女性患者在出现SLE表现时均处于围绝经期或已绝经,平均闭经或绝经年龄(44.30±5.33)岁(36~50岁);出现SLE表现与RA起病的间隔时间为10.83年。以SLE起病者2例。就诊时同时存在RA与SLE表现者7例,除1例为男性外,其余6例为女性(3例处于围绝经期)。Rhupus综合征组特异性抗体的阳性率与单纯RA组相似,SLE相关表现中肾损害相对少见,但间质性肺病的发生率较高。Rhupus综合征和单纯SLE患者补体C3、补体C4、抗核抗体、抗双链DNA抗体、抗SSA抗体和抗SSB抗体的阳性率差异无统计学意义。结论: Rhupus综合征是一种RA与SLE表现共存的重叠综合征,多以RA起病且RA表现较SLE表现严重。Rhupus综合征的发病可能与性激素水平的变化有关。

关键词: 关节炎, 类风湿, 红斑狼疮, 系统性, Rhupus综合征

Abstract:

Objective: To investigate the clinical and serological features of rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) overlap syndrome (Rhupus syndrome). Methods: We retrospectively reviewed the medical records of 21 patients with Rhupus syndrome who were hospitalized at Department of Rheumatology and Immunology, People’s Hospital of Xinjiang Uygur Autonomous Region between January 2010 and January 2018. We compared the joint involvement, autoantibodies and clinical manifestations of Rhupus syndrome with 81 cases of RA-alone and 51 cases of SLE-alone. Results: In 21 patients with Rhupus syndrome, there are 3 males and 18 females. Compared with the SLE-alone group, the patients with Rhupus syndrome were older [(49.43±11.66) vs. (40.59±12.73), P=0.008]. The median age of the patients with Rhupus syndrome at RA onset was significantly younger than that of the RA-alone patients [(32.58±11.14) vs. (43.11±11.83), P=0.010]. Of the 21 patients with Rhupus syndrome, the initial diagnosis was RA in 57% (12/21), except 2 male patients, the other 10 patients with SLE manifestations were menopause, the mean age of amenorrhea or menopause was (44.30±5.33) (36-50) years. The mean interval between the onset of SLE and RA was 10.83 years. Two patients started with SLE manifestations. Moreover, both diseases simultaneously developed in 33.3% of the patients. Except one male patient, 3 patients were in menopause stage when RA and SLE appeared. The positive rate of specific antibody Rhupus syndrome was similar to that of RA. Renal damage was relatively rare in SLE related manifestations, but the incidence of interstitial lung disease was higher. There were no significant differences in the prevalence of complements C3 and C4, antinuclear antibody (ANA), anti-double-stranded DNA (anti-dsDNA), anti-SSA or anti-SSB antibody between the Rhupus syndrome and SLE-alone group. Conclusion: Rhupus syndrome is an overlapping syndrome in which RA and SLE coexist. Most of the diseases occur in RA and the related manifestations of RA are more serious than those of SLE. The incidence of Rhupus syndrome may be related to the change of sex hormone levels.

Key words: Arthritis, rheumatoid, Lupus Erythematosus, systemic, Rhupus syndrome

中图分类号:

R593.2

李正芳,吴雪,武丽君,罗采南,石亚妹,钟岩,陈晓梅,孟新艳. Rhupus综合征的临床特点[J]. 北京大学学报（医学版）, 2021, 53(5): 933-937.

Zheng-fang LI,Xue WU,Li-jun WU,Cai-nan LUO,Ya-mei SHI,Yan ZHONG,Xiao-mei CHEN,Xin-yan MENG. Clinical features of patients with Rhupus syndrome[J]. Journal of Peking University (Health Sciences), 2021, 53(5): 933-937.

图/表 3

表1

三组患者的人口学特征"

Items	Rhupus syndrome (n=21)	RA-alone (n=81)	SLE-alone (n=51)
Age/years, $x ?$ ±s	49.43±11.66	52.21±10.96	40.59±12.73^*
Female/%	85.7	84.0	96.1
Age at SLE onset/years, $x ?$ ±s	25.56±6.36		33.71±12.94
Age at RA onset/years, $x ?$ ±s	32.58±11.14	43.11±11.83^*
Duration of SLE/years, $x ?$ ±s	4.00±1.41		6.92±6.15
Duration of RA/years, $x ?$ ±s	10.83±8.44	8.94±7.47

表1

表2

表3

参考文献 19

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Items	Rhupus syndrome (n=21)	RA-alone (n=81)
Clinical features, n(%)
Morning stiffness	18 (85.7)	56 (69.1)
Polyarthritis	20 (95.2)	77 (95.1)
Rheumatoid nodule	1 (4.7)	8 (9.9)
Laboratory features, n(%)
RF	19 (90.5)	68 (84.0)
Anti-CCP	14 (66.7)	75 (92.6)^*
AKA	7 (33.3)	27 (33.3)
APF	8 (38.1)	11 (13.6)^*
Erosions on radiography, n(%)	20 (95.2)	65 (80.2)

Items	Rhupus syndrome (n=21)	SLE-alone (n=51)
Clinical features, n(%)
Malar or discoid lupus	5 (23.8)	28 (54.9)^*
Oral ulcers	3 (14.2)	11 (21.6)
Raynaud’s phenomena	5 (23.8)	8 (15.6)
Renal disorder (proteinuria)	5 (23.8)	26 (50.9)^*
Interstitial pulmonary diseases	10 (47.6)	5 (9.8)^△
Haematological disorder	12 (57.1)	25 (49.0)
Laboratory features, n(%)
ESR	21 (100.0)	39 (76.4)^*
CRP	16 (76.2)	20 (39.2)^#
Decreased complement C3	16 (76.2)	37 (72.5)
Decreased complement C4	16 (76.2)	43 (84.3)
Anti-dsDNA	9 (42.8)	34 (66.7)
SSA	12 (57.1)	34 (66.7)
SSB	2 (9.5)	11 (21.6)
RF	19 (90.5)	8 (15.6)^△
Anti-CCP	14 (66.7)	0^△