Division of Rheumatology, Faculdade de Medicina da Universidade de São Paulo, Hospital das Clínicas da, São Paulo, Brazil.
J Clin Rheumatol. 2010 Aug;16(5):205-8. doi: 10.1097/RHU.0b013e3181e928e6.
Connective tissue diseases (CTD) may be associated with idiopathic trigeminal neuralgia (TN). The prevalence and diagnostic implications of this association are, however, not well established.
The objective of this study was to evaluate, in TN patients, if rheumatologic clinical and laboratory findings could contribute to the early diagnosis of rheumatic diseases.
Forty-six consecutive TN patients, 67% female, mean disease duration 8.78 +/- 7.25 years, and 47 controls were initially interviewed using a standard questionnaire based on common signs/symptoms of systemic lupus erythematosus, Sjögren syndrome, mixed CTD, and systemic sclerosis. Autoantibodies were detected by standard techniques. Those with rheumatologic complaints or positive autoantibodies were referred to the Rheumatology Outpatient Clinic for a more detailed evaluation. Secondary causes of TN were excluded.
The frequency of Raynaud phenomenon (P = 0.026) and ANA reactivity (P = 0.04) were significantly higher in TN patients compared with controls. Fourteen TN patients were ANA positive. Seven of them reported concomitant rheumatic complaints, and interestingly, diffuse CTD was diagnosed in 4 (57%) of these patients: 1 systemic lupus erythematosus; 2 Sjögren syndrome; and 1 undifferentiated disease with scleritis and positive parotid scintigraphy. In all cases, TN preceded by at least 10 months the rheumatologic signs/symptoms. Moreover, these 4 TN patients with CTD had a higher frequency of sicca symptoms (P = 0.001) and higher titers of ANA (>or=1:320) (P = 0.006) than the remaining 42 TN patients without CTD diagnoses. Sixteen patients had isolated laboratory or clinical abnormalities, and none of them had CTD diagnoses.
The concomitant presence of sicca symptoms and high titer ANA are clues for the early investigation of rheumatic diseases in TN patients.
结缔组织病（CTD）可能与特发性三叉神经痛（TN）有关。然而，这种关联的患病率和诊断意义尚不清楚。
本研究旨在评估 TN 患者的风湿临床和实验室检查结果是否有助于早期诊断风湿性疾病。
46 例连续 TN 患者，女性占 67%，平均病程 8.78±7.25 年，47 例对照者最初接受了基于系统性红斑狼疮、干燥综合征、混合 CTD 和系统性硬化症常见体征/症状的标准问卷访谈。采用标准技术检测自身抗体。对有风湿学投诉或阳性自身抗体的患者转至风湿科门诊进行更详细的评估。排除 TN 的继发性病因。
与对照组相比，TN 患者出现雷诺现象（P=0.026）和抗核抗体（ANA）反应性（P=0.04）的频率明显更高。14 例 TN 患者 ANA 阳性。其中 7 例报告同时存在风湿学投诉，有趣的是，4 例（57%）患者被诊断为弥漫性 CTD：1 例系统性红斑狼疮；2 例干燥综合征；1 例未分化疾病伴巩膜炎和阳性腮腺闪烁扫描。在所有情况下，TN 均至少早于风湿学表现/症状 10 个月。此外，这 4 例伴有 CTD 的 TN 患者出现干燥症状的频率更高（P=0.001），且 ANA 滴度更高（≥1:320）（P=0.006），而其余 42 例无 CTD 诊断的 TN 患者则无此情况。16 例患者存在孤立的实验室或临床异常，且均无 CTD 诊断。
干燥症状和高滴度 ANA 的同时存在是提示 TN 患者早期进行风湿性疾病检查的线索。
