Division of Rheumatology, Department of Internal Medicine, Hospital of the University of Pennsylvania and Arthritis-Immunology Center, Veterans Affairs Medical Center, Philadelphia, Pennsylvania.
J Clin Rheumatol. 1995 Feb;1(1):46-53. doi: 10.1097/00124743-199502000-00010.
Joint manifestations in patients with rheumatoid arthritis (RA) are usually caused by the rheumatoid disease or, less often, by secondary osteoarthritis or an infection. Effusions related to crystal deposits have been reported but are uncommon. We report on seven patients with quiescent RA who presented with incompletely explained, acute, mostly monoarticular, joint or bursal exacerbations that may have been caused by apatite or lipid crystals or by reactions to tissue and cell debris. In one of these patients, the joint symptoms were related to the development of pigmented villonodular synovitis. Whether or not our hypothesized mechanisms are correct, it is important to be aware that exacerbations in a single or a few sites out of proportion to the rest of the RA need not be because of activity of the RA or infection. This awareness can prevent inappropriate aggressive treatment of the rheumatoid disease or extensive antibiotic therapy. In our cases, careful analysis of the synovial fluid was helpful in ascertaining that active RA was less likely and in identifying some possible causes of the effusions.
类风湿关节炎 (RA) 患者的关节表现通常是由类风湿病引起的，较少见的是由继发性骨关节炎或感染引起的。已经报道了与晶体沉积有关的积液，但并不常见。我们报告了 7 例处于静止期的 RA 患者，他们出现了无法完全解释的急性、主要是单关节的关节或滑囊加重，可能是由磷灰石或脂质晶体或对组织和细胞碎片的反应引起的。在其中 1 例患者中，关节症状与色素绒毛结节性滑膜炎的发展有关。无论我们假设的机制是否正确，重要的是要意识到，与 RA 的其余部分不成比例的单个或少数部位的加重不一定是由于 RA 的活动或感染。这种认识可以防止对类风湿病进行不适当的强化治疗或广泛的抗生素治疗。在我们的病例中，对滑液进行仔细分析有助于确定活动性 RA 的可能性较小，并确定积液的一些可能原因。
