Faculty of Medicine, University of Hama, Hama, Syria.
Rheumatology Department, Faculty of Medicine, Damascus University, Damascus, Syria.
Medicine (Baltimore). 2024 Aug 2;103(31):e39209. doi: 10.1097/MD.0000000000039209.
Rheumatoid arthritis (RA) is a systemic inflammatory disease characterized by joint inflammation and various extra-articular manifestations, including rheumatoid nodules (RNs). This case study aims to explore the effectiveness of alternative treatments for RNs, particularly highlighting the therapeutic potential of sulfasalazine.
A 52-year-old male with established RA presented with worsening joint pain and firm nodules on his elbows, feet, and fingers.
The patient fulfilled the diagnostic criteria for RA and was diagnosed with methotrexate-induced RNs based on their temporal association with methotrexate initiation.
Methotrexate was discontinued and a combination of leflunomide and sulfasalazine was initiated. Sulfasalazine led to improvement in both joint pain and nodule size. However, due to cost concerns, the patient discontinued sulfasalazine, resulting in a resurgence of both symptoms and nodule enlargement. Reintroduction of methotrexate resulted in significant improvement in joint inflammation, and notably, no new nodules developed at 6 months follow-up.
Sulfasalazine demonstrated efficacy in managing RA nodules, suggesting a potential alternative therapy.
The case highlights the complex etiology of nodules in RA and emphasizes the importance of individualized treatment approaches and close monitoring for optimal management.
类风湿关节炎（RA）是一种全身性炎症性疾病，其特征为关节炎症和各种关节外表现，包括类风湿结节（RNs）。本病例研究旨在探讨 RNs 的替代治疗方法的有效性，特别强调柳氮磺胺吡啶的治疗潜力。
一名 52 岁男性，患有确诊的 RA，出现关节疼痛加剧和肘部、足部和手指出现硬结结节。
患者符合 RA 的诊断标准，并根据与甲氨蝶呤起始时间的关联，被诊断为甲氨蝶呤引起的 RNs。
停用甲氨蝶呤，并开始使用来氟米特和柳氮磺胺吡啶联合治疗。柳氮磺胺吡啶改善了关节疼痛和结节大小。然而，由于费用问题，患者停用了柳氮磺胺吡啶，导致症状和结节再次增大。重新使用甲氨蝶呤治疗后，关节炎症显著改善，且在 6 个月随访时未出现新的结节。
柳氮磺胺吡啶在治疗 RA 结节方面显示出疗效，提示其可能是一种替代治疗方法。
该病例强调了 RA 结节的复杂病因，并强调了个体化治疗方法和密切监测对于优化管理的重要性。
