Kelly C A
Department of Rheumatology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
Int J Clin Lab Res. 1992;21(4):288-91. doi: 10.1007/BF02591663.
There is evidence that the prevalence of monoclonal parparoteinaemia is slightly increased in patients with rheumatoid arthritis. The possibility that this may be a marker of the development of later malignancy in such patients is explored. Mortality rates in rheumatoid arthritis are increased although the development of lymphoreticular malignancy contributes only a small percentage of this increase. However, it does seem likely that patients with longstanding severe rheumatoid arthritis are more at risk of developing myeloma or lymphoma if they have a monoclonal paraprotein band in their serum. IgA paraprotein seems to carry a higher risk than IgG whilst other factors such as urinary free light chains and the presence of secondary Sjögren's syndrome are of less prognostic significance. Similarly a monoclonal paraprotein may identify patients with primary Sjögren's syndrome who have a particular risk of later lymphoma whilst this risk does not appear to extend to patients with systemic lupus erythematosus. Patients with an overlap syndrome do not appear to be at greater risk than those with "pure disease". The association of other rheumatological disease and paraproteinaemia is briefly discussed.
有证据表明，类风湿关节炎患者单克隆副蛋白血症的患病率略有增加。本文探讨了这一情况可能作为此类患者日后发生恶性肿瘤标志的可能性。类风湿关节炎患者的死亡率有所上升，尽管淋巴网状系统恶性肿瘤的发生仅占死亡率上升的一小部分。然而，如果长期患有严重类风湿关节炎的患者血清中存在单克隆副蛋白带，那么他们罹患骨髓瘤或淋巴瘤的风险似乎更高。IgA副蛋白似乎比IgG携带更高的风险，而其他因素，如尿游离轻链和继发性干燥综合征的存在，其预后意义较小。同样，单克隆副蛋白可能会识别出原发性干燥综合征患者中具有日后发生淋巴瘤特定风险的人群，而这种风险似乎并未扩展至系统性红斑狼疮患者。重叠综合征患者的风险似乎并不比“单纯疾病”患者更高。本文还简要讨论了其他风湿性疾病与副蛋白血症的关联。
