| 类风湿关节炎累及肩关节的临床特征及药物治疗分析 |
| 投稿时间：2024-12-09 修订日期：2024-12-25 点此下载全文 |
| 引用本文：李丰源,郑建雄,翟蓉洁,康温佼,刘春花,沈海丽.类风湿关节炎累及肩关节的临床特征及药物治疗分析[J].医学研究杂志,2025,54(5):99-104, 72 |
| DOI：
10.11969/j.issn.1673-548X.2025.05.019 |
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| 基金项目:甘肃省科技计划项目(21JR7RA437)；兰州大学第二医院“萃英科技创新”计划(CY2021-BJ-A01)；兰州大学医学教育创新发展项目(lzuyxcx-2022-117) |
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| 中文摘要:目的 本研究旨在分析类风湿关节炎(rheumatoid arthritis,RA)患者在病程中肩关节受累的临床特征、超声影像学表现及药物治疗特点,探讨肩关节受累对RA病情整体的影响,进一步为临床诊疗提供依据。方法 选取2023年8月~2024年8月在笔者所在科室住院的140例RA患者,按是否合并肩痛或肩关节炎表现将其分为RA累及肩关节组与不累及组。分析比较两组临床资料,包括病情活动度、影像学特征及治疗方式。结果 RA累及肩关节组在疼痛视觉模拟评分、肿胀、压痛关节数、28个关节病活动评分-红细胞沉降率及C反应蛋白评分等指标上均显著高于不累及组,差异有统计学意义(P＜0.001)。两组在血常规、炎性指标、类风湿因子及抗CCP抗体等实验室检查项目上差异无统计学意义(P＞0.05),提示肩关节受累可能不会通过常规实验室检查轻易识别。RA累及肩关节超声下表现分为双侧和单侧病变,其中单侧病变多为肩锁关节滑膜炎,双侧病变则以肱骨头骨侵蚀为主。炎性改变的滑膜炎以肩锁关节为主,而结构性改变则集中于肱骨头的骨侵蚀。在结构性改变患者中,红细胞沉降率与C反应蛋白水平较炎性改变组更高,差异有统计学意义(P＜0.05),而类风湿因子和抗CCP抗体的差异无统计学意义(P＞0.05)。RA累及肩关节患者在使用传统合成抗风湿药(csDMARDs)的基础上,联合生物制剂(bDMARDs)或靶向合成抗风湿药(tsDMARDs)的比例显著较高,尤其是csDMARDs联合bDMARDs的比例最为突出。结论 RA患者在病程中若累及肩关节,通常表现为全身症状加重,疾病活动度较高,并且超声检查可发现肩关节滑膜炎及骨侵蚀的影像学表现。然而,常规实验室检查和影像学手段对肩关节受累的诊断缺乏特异性,因此临床中应高度关注RA肩关节受累的情况,以防疾病进展对整体预后造成不利影响。 |
| 中文关键词:类风湿关节炎 肩关节 肌骨超声 炎症 |
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| Analysis of Clinical Characteristics and Drug Treatment of Rheumatoid Arthritis Involving Shoulder Joints |
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| Abstract:Objective The aim of this study was to analyze the clinical features, ultrasonographic manifestations, and medication characteristics of shoulder joint involvement in patients with rheumatoid arthritis during the course of the disease, and to explore the impact of shoulder joint involvement on the overall condition of RA, to further provide a basis for clinical diagnosis and treatment. MethodsOne hundred and forty RA patients who were hospitalized in our department between August 2023 and August 2024 were selected, and they were divided into the RA involving shoulder joint group and the non-involving group according to whether they were combined with shoulder pain or shoulder arthritis manifestations. The clinical data of the two groups were analyzed and compared, including disease activity, imaging characteristics and treatment modalities. Results The RA-involved shoulder group was significantly higher than the non-involved group in pain visual analog scores, swelling, number of tender joints, 28 arthropathic activity scores-erythrocyte sedimentation rate and C reactive protein scores, and the differences were statistically significant (P<0.001). The two groups had significant differences in blood tests, inflammation indexes, Rheumatoid factor and anti-CCP antibody and other laboratory tests were significantly different in the morning (P>0.05), suggesting that shoulder joint involvement may not be readily recognized by routine laboratory tests. The ultrasonographic performance of RA involving the shoulder joint was classified into bilateral and unilateral lesions, in which the unilateral lesions were mostly acromioclavicular joint synovitis, and the bilateral lesions were predominantly humeral head bone erosions. Inflammatory changes of synovitis were predominantly in the acromioclavicular joint, while structural changes were focused on bone erosion of the humeral head. In patients with structural changes, the erythrocyte sedimentation rate and C-reactive protein level were higher than those of the group with inflammatory changes, and the difference was statistically significant (P<0.05), while the difference between the rheumatoid factor and the anti-CCP antibody was not statistically significant (P>0.05). The proportion of patients with RA involving the shoulder joint using traditional synthetic antirheumatic drugs (csDMARDs) in combination with biologics (bDMARDs) or targeted synthetic antirheumatic drugs (tsDMARDs) was significantly higher, especially the proportion of csDMARDs in combination with bDMARDs was the most prominent. Conclusion Patients with RA who have shoulder involvement during the course of the disease usually present with worsening systemic symptoms, high disease activity, and ultrasonographic findings of synovitis and bone erosion in the shoulder joint. However, conventional laboratory tests and imaging methods lack specificity in the diagnosis of shoulder joint involvement, and therefore, clinical attention should be paid to shoulder joint involvement in RA to prevent disease progression from adversely affecting the overall prognosis. |
| keywords:Rheumatoid arthritis Shoulder joint Musculoskeletal ultrasound Inflammation |
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