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一名48岁双膝少关节炎患者,已排除脊柱关节炎和类风湿关节炎。

[A 48-year-old patient with oligoarthritis of the knees, having excluded spondyloarthritis and rheumathoid arthritis].

作者信息

Gehlen M, Janik S, Dudko P, Schwarz-Eywill M

机构信息

Rheumatologie und Immunologie, Medizinische Klinik, Evangelisches Krankenhaus Oldenburg, European Medical School Oldenburg/Groningen, Steinweg 13-17, 26122, Oldenburg, Deutschland,

出版信息

Internist (Berl). 2014 Apr;55(4):443-7. doi: 10.1007/s00108-014-3472-3.

Abstract

We report the case of a patient with amyloid light-chain (AL) amyloidosis, presenting for more than 1.5 years with oligoarthritis as the only clinical symptom of the underlying disease. Developing further organ symptoms (heart and gastrointestinal tract) led to the definitive diagnosis. Joint involvement due to AL amyloidosis is extremely rare and may mimic rheumatoid arthritis. Arthritis might be the first symptom of the AL amyloidosis. The combination of arthritis and other organ disorders (e.g., proteinuria, heart failure, or diarrhea) should initiate further diagnostic efforts considering AL amyloidosis as a differential diagnosis. The diagnosis will be confirmed by the typical histology of synovia or involved organs including immunohistochemistry for typing amyloid and performing immunoelectrophoresis.

摘要

我们报告了一例患有轻链(AL)淀粉样变性的患者,该患者以少关节炎作为基础疾病的唯一临床症状已出现超过1.5年。进一步出现其他器官症状(心脏和胃肠道)后才得以明确诊断。AL淀粉样变性导致的关节受累极为罕见,可能类似类风湿关节炎。关节炎可能是AL淀粉样变性的首发症状。关节炎与其他器官疾病(如蛋白尿、心力衰竭或腹泻)同时出现时,应考虑将AL淀粉样变性作为鉴别诊断,展开进一步的诊断工作。通过滑膜或受累器官的典型组织学检查,包括用于淀粉样蛋白分型的免疫组织化学检查和免疫电泳,可确诊该病。

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