Thiele A, Störkel S, Stierle H E
Zentrum für Rheumatologie und Orthopädie St. Josef, Wuppertal.
Z Rheumatol. 1998 Oct;57(5):285-91. doi: 10.1007/s003930050111.
Retroperitoneal fibrosis is a disorder in which the retroperitoneal fat is the site of a subacute and chronic inflammatory reaction and is subsequently replaced by dense fibrotic tissue. Rheumatoid nodules are chronic granulomata occurring at sites of pressure and movement, both near the body surface and internally. A 55-year-old sales-manager was admitted to radiation synovectomy after a 5 year history of excessive right and left knee effusions. There were no other clinical or laboratory abnormalities. The patient did not respond to either radioisotope synoviorthesis using radioactive Yttrium (90 Y), or to open synovectomy and prostetic surgery of the right knee. One year later, surgery of left ureter was necessary. Histological findings revealed the diagnosis of Ormond's disease. Comparative histological studies of synovial membrane of knee and retroperitoneal tissues showed local necrosis, fibrin deposition, lining cell proliferation, and infiltration by lymphocytes. Diagnosis of arthritis complicated by retroperitoneal rheumatoid nodules and retroperitoneal fibrosis was made. Serum rheumatoid factor has been negative. For the last 3 years, the patient has been on successful therapy with azathioprine. Rheumatoid nodules of the retroperitoneum have vanished completely and frequency of knee effusions decreased.
腹膜后纤维化是一种疾病，其中腹膜后脂肪是亚急性和慢性炎症反应的部位，随后被致密的纤维组织取代。类风湿结节是发生在体表附近和体内压力及活动部位的慢性肉芽肿。一名55岁的销售经理在有5年左右双侧膝关节积液过多病史后接受放射性滑膜切除术。无其他临床或实验室异常。该患者对使用放射性钇（90Y）的放射性滑膜切除或右膝开放性滑膜切除及假体手术均无反应。一年后，有必要对左侧输尿管进行手术。组织学检查结果确诊为奥蒙德病。对膝关节滑膜和腹膜后组织进行的比较组织学研究显示局部坏死、纤维蛋白沉积、衬里细胞增殖以及淋巴细胞浸润。诊断为并发腹膜后类风湿结节和腹膜后纤维化的关节炎。血清类风湿因子一直为阴性。在过去3年里，该患者使用硫唑嘌呤治疗成功。腹膜后的类风湿结节已完全消失，膝关节积液频率降低。
