Alarcón-Segovia D, Abud-Mendoza C, Diaz-Jouanen E, Iglesias A, De los Reyes V, Hernández-Ortiz J
Department of Immunology and Rheumatology, Institute Nacional de la Nutrición Salvador Zubirán, Mexico City, Mexico.
J Rheumatol. 1988 Jan;15(1):65-9.
Forty-one of 858 patients with systemic lupus erythematosus (SLE) developed clinical deformity of their hands. This deformity was clinically and radiologically different from that found in 40 patients with classical or definite rheumatoid arthritis (RA), and tended to appear early in the course of disease. Characteristics of this arthropathy included nonerosive carpal collapse; exceptional erosion of the styloid processes; Z deformity of the thumb; nonerosive ulnar deviation and subluxation of MCP joints; parametacarpophalangeal joint hook formation; scant and asymmetric joint erosions; and swan neck deformity of the fingers. Most of these changes seemed to be due to involvement of the ligaments rather than to the destructive effect of synovitis. Patients with SLE with deforming arthropathy had a higher frequency of rheumatoid factor positivity, sicca symptoms and antibodies to native DNA, whereas they had lower incidence of facial rash and photosensitivity than did those without. Other manifestations did not differ. We propose that most patients with SLE with deforming arthropathy belong to a subset of SLE rather than representing the coexistence of SLE and RA.
858例系统性红斑狼疮（SLE）患者中有41例出现手部临床畸形。这种畸形在临床和放射学上与40例典型或确诊类风湿关节炎（RA）患者的畸形不同，且往往在疾病进程早期出现。这种关节病的特征包括非侵蚀性腕骨塌陷；茎突异常侵蚀；拇指Z形畸形；非侵蚀性尺侧偏斜和掌指关节半脱位；掌指关节钩状形成；关节侵蚀少且不对称；以及手指天鹅颈畸形。这些变化大多似乎是由于韧带受累而非滑膜炎的破坏作用。患有畸形性关节病的SLE患者类风湿因子阳性、干燥症状和抗天然DNA抗体的频率较高，而与无畸形的患者相比，面部皮疹和光敏性的发生率较低。其他表现无差异。我们认为，大多数患有畸形性关节病的SLE患者属于SLE的一个亚组，而非代表SLE与RA并存。
