[惠普尔病，一种血清阴性关节炎的非类风湿性病因]
[Whipple's disease, a non-rheumatoid cause of seronegative arthritis].
作者信息
Kramer Sjoerd, Dekkema Gerjan J, De Boer Rommy S, Vrolijk Loes B, Wink Freke R
机构信息
Medisch spectrum Twente, afd. Maag-darm-leverziekten, Enschede.
Medisch centrum Leeuwarden, afd. Interne Geneeskunde,Leeuwarden.
出版信息
Ned Tijdschr Geneeskd. 2023 Mar 16;166:D6697.
BACKGROUND
In 15-25% of patients with rheumatoid arthritis, the presence of pathognomonic autoantibodies (anti-citrullinated protein (aCCP) or rheumafactor (RF) is lacking. In these cases of seronegative rheumatoid arthritis, diagnosis is based on clinical presentation. However, some of the patients with seronegative rheumatoid arthritis are misdiagnosed.
CASE DESCRIPTION
Here we discuss a case of a 64 year old female, with a diagnoses of seronegative rheumatoid arthritis for 18 years. Although extensively treated with immunosuppressive medication, she did not reach remission. After second opinion in our hospital we diagnosed Whipple's disease.
CONCLUSION
This case report illustrates the importance of a broad differential diagnosis of seronegative arthritis as well as the importance of re-assessment of patients diagnosed with seronegative rheumatoid arthritis, who do not reach remission upon immunosuppressive treatment.
背景
在15%至25%的类风湿性关节炎患者中，缺乏特征性自身抗体（抗瓜氨酸化蛋白抗体（aCCP）或类风湿因子（RF））。在这些血清阴性类风湿性关节炎病例中，诊断基于临床表现。然而，一些血清阴性类风湿性关节炎患者被误诊。
病例描述
在此我们讨论一例64岁女性患者，她被诊断为血清阴性类风湿性关节炎18年。尽管接受了广泛的免疫抑制药物治疗，但她并未达到缓解状态。在我院接受二次诊断后，我们诊断为惠普尔病。
结论
本病例报告说明了血清阴性关节炎进行广泛鉴别诊断的重要性，以及对诊断为血清阴性类风湿性关节炎且免疫抑制治疗后未达到缓解的患者进行重新评估的重要性。
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