Goto Akiko, Mukai Masaya, Notoya Atsushi, Kohno Michifumi
Division of Clinical Immunology and Hematology, Department of Medicine, Sapporo City General Hospital, Kita 11-jo, Nishi 13-chome, Chuo-ku, Sapporo, 060-8604, Japan.
Mod Rheumatol. 2005;15(2):118-22. doi: 10.1007/pl00021709.
This article describes a patient with rheumatoid arthritis (RA) with crescentic glomerulonephritis (CrGN) associated with myeloperoxidase-antineutrophil cytoplasmic antibodies (MPO-ANCA), who responded well to methotrexate (MTX). A 48-year-old woman with a 4-year history of RA was admitted with fever and elevated C-reactive protein. On laboratory evaluation, her level of MPO-ANCA was 422 EU, and urinalysis revealed proteinuria and hematuria. Because she was also suffering from episcleritis, vasculitis was considered. A renal biopsy was performed, which revealed necrotizing CrGN. We diagnosed RA complicated with MPO-ANCA-associated vasculitis. We considered treatment with high-dose oral prednisolone for vasculitis, but the patient refused this treatment. We started MTX at a dose of 8 mg/week for RA from the time of admission, and the patient responded immediately. Biochemical parameters, including C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, and MPO-ANCA, improved. Seven months later, MPO-ANCA had decreased to 46 EU. In clinical studies, few patients have been reported with RA complicated with ANCA-associated CrGN. This case differs from previous cases in the treatment given. No high-dose steroid with intensive immunosuppression or plasma exchange was required.
本文描述了一名患有类风湿关节炎（RA）并伴有新月体性肾小球肾炎（CrGN）且与髓过氧化物酶抗中性粒细胞胞浆抗体（MPO-ANCA）相关的患者，该患者对甲氨蝶呤（MTX）反应良好。一名有4年RA病史的48岁女性因发热和C反应蛋白升高入院。实验室检查时，她的MPO-ANCA水平为422 EU，尿液分析显示蛋白尿和血尿。由于她还患有巩膜炎，考虑存在血管炎。进行了肾活检，结果显示为坏死性CrGN。我们诊断为RA合并MPO-ANCA相关性血管炎。我们考虑用大剂量口服泼尼松龙治疗血管炎，但患者拒绝了这种治疗。自入院起我们开始以每周8 mg的剂量给予MTX治疗RA，患者立即有反应。包括C反应蛋白、红细胞沉降率、类风湿因子和MPO-ANCA在内的生化指标均有所改善。7个月后，MPO-ANCA降至46 EU。在临床研究中，很少有RA合并ANCA相关性CrGN的患者被报道。该病例在治疗方面与先前病例不同。无需使用强化免疫抑制的大剂量类固醇或进行血浆置换。
