Doury P, Wendling D, Pattin S, Eulry F, Delmaire P, Aboukrat P, Rolland Y, Leloire O
Service de Rhumatologie, HIA Bégin, Saint-Mandé.
Rev Rhum Mal Osteoartic. 1987 Oct;54(10):621-6.
The authors report on 4 cases of particularly severe and extensive reflex neurovascular dystrophy, whose clinical course was marked by the onset of a malignant tumor, without any sign of improvement in the reflex neurovascular dystrophy, despite various therapeutic regimens, until the patient's death from malignancy. At this time, the authors compiled a total of 63 case reports (4 of which were reported) and have proposed a classification to differentiate 4 types of disorders in combination according to whether there is a very probable, probable, or possible link or whether the combination is strictly a coincidence. The pathogenic mechanism remains a mystery, when a link is observed; but it never corresponds to criteria to describe a paraneoplastic disorder. Finally, the authors insist on the practical value of detecting this combination, even if due to chance: in order to systematically detect cancer in the presence of any reflex neurovascular dystrophy, and especially to be conscious of a possible reflex neurovascular dystrophy, besides possible metastatic lesions, in the presence of osteoarticular pain present in a patient with cancer. Such a diagnosis, although difficult to realize, has great prognostic and therapeutic interest.
作者报告了4例特别严重且广泛的反射性交感神经营养不良病例，其临床病程以恶性肿瘤的发生为特征，尽管采用了各种治疗方案，但反射性交感神经营养不良没有任何改善迹象，直至患者死于恶性肿瘤。此时，作者共收集了63例病例报告（其中4例为本报告内容），并提出了一种分类方法，根据是否存在极可能、可能或有可能的关联，或者这种组合是否纯属巧合，将4种类型的病症组合进行区分。当观察到关联时，其致病机制仍是个谜；但它从未符合描述副肿瘤性疾病的标准。最后，作者强调了检测到这种组合的实际价值，即使是偶然情况：以便在存在任何反射性交感神经营养不良时系统地检测癌症，尤其是要意识到在癌症患者出现骨关节疼痛时，除了可能的转移病变外，还可能存在反射性交感神经营养不良。这样的诊断虽然难以实现，但具有重大的预后和治疗意义。
