Kobak Şenol, Karaarslan Ahmet Adnan, Yilmaz Hatice, Sever Fidan
Department of Rheumatology, Sifa University, Izmir, Turkey.
Sifa University, Izmir, Turkey.
BMJ Case Rep. 2015 Jul 6;2015:bcr2014208803. doi: 10.1136/bcr-2014-208803.
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterised by erosive arthritis. Sarcoidosis is a chronic disease characterised by formation of non-calcified granulomas. Our case, a 35-year-old woman, presented with metacarpophalangeal, proximal interphalangeal (PİP) joints and arthritis of both ankles, of 6-month duration. She had morning stiffness lasting 1 h, restriction of range of motion and erythaema nodosum. Laboratory tests showed elevated acute phase responses and serum ACE levels, and anti-cyclic citrullinated peptide antibody positivity. There was periarticular osteoporosis on her hand and wrist on direct X-rays and hilar lymphadenopathy on her thorax CT. The pathological result of endobronchial ultrasound biopsy showed non-calcified granuloma congruent with sarcoidosis. According to clinical, laboratory and histopathological evaluation, the patient was diagnosed with RA and sarcoidosis. Corticosteroids and methotrexate were started, and on her sixth month of follow-up, her clinical and laboratory findings and lymphadenopathies on CT had regressed. The clinical follow-up continues; the patient appears to be in clinical remission.
类风湿关节炎(RA)是一种以侵蚀性关节炎为特征的慢性炎症性疾病。结节病是一种以非钙化性肉芽肿形成为特征的慢性疾病。我们的病例是一名35岁女性,出现掌指关节、近端指间关节(PIP)以及双踝关节关节炎,病程6个月。她有持续1小时的晨僵、活动范围受限和结节性红斑。实验室检查显示急性期反应升高、血清ACE水平升高以及抗环瓜氨酸肽抗体阳性。手部和腕部的直接X线检查显示关节周围骨质疏松,胸部CT显示肺门淋巴结肿大。支气管内超声活检的病理结果显示与结节病一致的非钙化性肉芽肿。根据临床、实验室和组织病理学评估,该患者被诊断为RA和结节病。开始使用皮质类固醇和甲氨蝶呤治疗,在随访的第六个月,她的临床和实验室检查结果以及CT上的淋巴结肿大有所消退。临床随访仍在继续;患者似乎处于临床缓解状态。