类风湿关节炎合并干燥综合征继发抗磷脂抗体综合征致神经功能损害一例报道并文献回顾

Neurological Impairment Caused by Rheumatoid Arthritis Complicated with Sjogren’s Syndrome Secondary to Antiphospholipid Antibody Syndrome: A Case Report and Literature Review

摘要: 类风湿关节炎是以侵蚀性关节炎为特征、滑膜炎为病理基础的一种慢性复杂性自身免疫性疾病，病灶对全身结缔组织均可造成损害，常与其他疾病伴发，以合并干燥综合征多见。当类风湿关节炎合并干燥综合征时，提示疾病活动度增加，预后不良。而部分伴发干燥综合征的类风湿关节炎患者可能因没有及早识别干燥综合征的发生，仅采用类风湿关节炎的治疗措施，导致其误诊或漏诊。文中报道一例女性，因“间断头晕2年，四肢乏力、活动笨拙1年，右上肢麻木3天”主诉入院，完善相关检验检查诊断为干燥综合征合并类风湿关节炎继发抗磷脂抗体综合征致多神经系统损害，其中包括累及周围神经系统、中枢神经系统及自主神经。目前关于类风湿关节炎伴发干燥综合征同时继发抗磷脂抗体综合征且引发多神经系统损害的病例报道较少，通过对该病例的报道，旨在强调在类风湿关节炎患者中定期筛查干燥综合征相关抗体及抗磷脂抗体的必要性，以便及时识别并防范严重并发症的发生。

Abstract: Rheumatoid arthritis is a chronic, complex autoimmune disease characterized by erosive arthritis with synovitis as the pathological basis, and the foci of the disease can cause damage to connective tissues, and it is often accompanied by other diseases, most commonly Sjögren’s syndrome. When rheumatoid arthritis is combined with Sjögren’s syndrome, it suggests increased disease activity level and a poor prognosis. Some patients with rheumatoid arthritis associated with Sjögren’s syndrome may be misdiagnosed or underdiagnosed due to failure to identify the occurrence of Sjögren’s syndrome early on, resulting in only receiving therapeutic measures for rheumatoid arthritis. In the article, a female was admitted to the hospital with the complaints of “intermittent dizziness for 2 years, weakness and clumsiness of the limbs for 1 year, and numbness of the right upper limb for 3 days”, which was diagnosed with Sjögren’s syndrome combined with rheumatoid arthritis secondary to antiphospholipid antibody syndrome resulting in neurological damage, which included the involvement of the peripheral nervous system, central nervous system and autonomic neuropathy. At present, few cases of rheumatoid arthritis associated with Sjögren’s syndrome and secondary antiphospholipid antibody syndrome with multiple neurological damage have been reported, and the purpose of this case is to emphasize the necessity of regular screening for antibodies related to Sjögren’s syndrome and antiphospholipid antibodies in patients with rheumatoid arthritis, so as to promptly identify and prevent the occurrence of serious complications.