目的 分析类风湿因子(rheumatoid factor,RF)或抗环瓜氨酸化多肽(cyclic-citrullinated peptide,CCP)抗体阳性银屑病关节炎(psoriatic arthritis,PsA)患者的临床和实验室检查特点。方法 共纳入2007年1月至2019年6月于北京大学第三医院风湿免疫科住院的PsA患者77例,所有患者均符合2006年美国风湿病学会修订的《银屑病关节炎的分类诊断标准》或《Moll和Wright标准》,并进行了RF及抗CCP抗体检测,根据血清中是否检测到抗CCP抗体或RF将所有患者分为抗CCP抗体或RF阳性组15例、抗CCP抗体或RF阴性组62例;根据血清中是否检测到抗CCP抗体将所有患者分为抗CCP抗体阳性组7例、抗CCP抗体阴性组70例,收集患者的临床及实验室资料,比较RF或抗CCP抗体阳性和阴性PsA患者的临床及实验室指标的差异,并单独比较了抗CCP抗体阳性和阴性PsA患者的临床及实验室指标的差异。结果 在77例患者中,RF或抗CCP抗体阳性者15例,其中仅RF阳性者8例,仅抗CCP抗体阳性者2例,两者均为阳性者5例。RF或抗CCP抗体阳性组PsA患者年龄较阴性组大[(58.2±14.8)岁 vs.(46.69±12.27)岁,P=0.002],更易出现掌指关节、肘关节、肩关节受累。抗CCP抗体阳性组PsA患者较阴性组年龄大[(62.43±14.34)岁vs.(47.59±12.75)岁,P=0.005],RF阳性率高,血纤维蛋白原水平高。抗CCP抗体阳性组PsA患者均为多关节炎,阴性组患者中有68.6%的患者为多关节炎,但两组间差异无统计学意义。RF或抗CCP抗体阳性和阴性以及抗CCP抗体阳性和阴性组PsA患者在腊肠指/趾表现、关节骨质破坏、指/趾甲改变、附着点炎方面差异无统计学意义。结论 部分PsA患者血清中可检测到RF或抗CCP抗体;RF或抗CCP抗体阳性PsA患者更易出现掌指关节、肘关节、肩关节受累,年龄更大;抗CCP抗体阳性PsA患者年龄更大,RF阳性率、纤维蛋白原水平高。

Objective: To analyze the clinical and laboratory features of psoriatic arthritis (PsA) patients with positive rheumatoid factor(RF)or anti-cyclic citrullinated peptide(CCP)antibody.Methods: In the study, 77 PsA patients who were hospitalized in the Department of Rheumatology and Immunology of Peking University Third Hospital from January 2007 to June 2019 were enrolled. All the patients met Classification Criteria for Psoriatic Arthritis or Moll or Wright Criteria. Rheumatoid factor (RF) and anti-cyclic-citrullinated peptide (CCP) antibody were tested in these patients. According to whether anti-CCP antibody or RF was detected in serum, all the patients were divided into anti-CCP antibody or RF positive group (15 cases), anti-CCP antibody or RF negative group (62 cases). According to the detection of anti-CCP antibody in serum, all the patients were divided into anti-CCP antibody positive group (7 cases) and anti-CCP antibody negative group (70 cases). Clinical and laboratory data were collected. The differences of clinical and laboratory indicators between the RF or anti-CCP antibody positive and negative PsA patients were compared. Clinical and laboratory indicators between the anti-CCP antibody positive and negative patients were also compared.Results: Among the 77 patients, 15 were RF or anti-CCP antibody positive, of whom 8 were only RF positive and 2 were only anti-CCP antibody positive, and both of RF and anti-CCP antibody were positive in 5 cases. The RF or anti-CCP antibody positive PsA patients were older than those in the negative group [(58.2±14.8) years vs.(46.69±12.27)years, P=0.002]. And metacarpophalangeal joints, elbow joints and shoulder joints were more likely to be involved in RF or anti-CCP antibody positive PsA patients. PsA patients in the anti-CCP antibody positive group were older than those in the negative group [(62.43±14.34) years vs.(47.59±12.75)years old, P=0.005]. The positive rate of RF and serum level of fibrinogen in the anti-CCP antibody positive group were higher than those in the negative group. The PsA patients in the anti-CCP antibody positive group were all polyarthritis, while 68.6% patients in the negative group were polyarthritis, but there was no statistical difference between the two groups. There was no statistical difference in sausage fingers/toes, changes in nails and enthesitis, and bone erosion on radiographs between the RF or anti-CCP antibody positive and negative PsA patients. There was also no statistical difference in sausage fingers/toes,bone erosion on radiographs,and changes in nails and enthesitis between the anti-CCP antibody positive and negative patients.Conclusion: RF and anti-CCP antibodies can be detected in the serum of some PsA patients. RF or anti-CCP antibody positive PsA patients were older than those in negative PsA patients. Metacarpophalangeal joints, elbow joints and shoulder joints were more likely to be involved in RF or anti-CCP antibody positive PsA patients. Anti-CCP antibody positive PsA patients were older and had higher levels of RF positive rate and fibrinogen level.