Wielosz Ewa, Majdan Maria
Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Poland.
Reumatologia. 2020;58(3):162-166. doi: 10.5114/reum.2020.96655. Epub 2020 Jun 29.
Systemic sclerosis (SSc) is a connective tissue disease characterised by extremely high heterogeneity. This heterogeneity concerns the organ involvement, course of disease and prognosis. Unlike in some other systemic connective tissue diseases, especially systemic lupus erythematosus, in SSc haematological disorders occur rarely. When they develop, they affect erythrocytes, leucocytes and platelets. The most common cause of this pathology of erythrocyte abnormalities is microcytic anaemia resulting from micro-haemorrhages with telangiectasias within the digestive mucosa in patients with SSc. In SSc patients with severe haematological disturbances, the differential diagnosis should include overlapping with another systemic connective tissue disease or a haemato-oncological disease (lympho/myeloproliferative syndrome). In SSc patients with monoclonal proteins or cryoglobulins, it is essential to consider a haemato-oncological disease. In such cases, the differential diagnosis should be focused on a paraneoplastic syndrome, especially when the haematological symptoms develop shortly after the diagnosis of SSc and in the elderly.
系统性硬化症(SSc)是一种具有极高异质性的结缔组织病。这种异质性涉及器官受累情况、疾病进程和预后。与其他一些系统性结缔组织病不同,尤其是系统性红斑狼疮,SSc很少发生血液系统疾病。当血液系统疾病发生时,会影响红细胞、白细胞和血小板。红细胞异常这种病理状况最常见的原因是SSc患者消化黏膜内出现微出血伴毛细血管扩张导致的小细胞性贫血。对于有严重血液系统紊乱的SSc患者,鉴别诊断应包括与另一种系统性结缔组织病或血液肿瘤性疾病(淋巴/骨髓增殖综合征)的重叠情况。对于有单克隆蛋白或冷球蛋白的SSc患者,必须考虑血液肿瘤性疾病。在这种情况下,鉴别诊断应集中在副肿瘤综合征上,尤其是当血液系统症状在SSc诊断后不久且在老年患者中出现时。