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Abstract：
BACKGROUND: Rheumatoid arthritis (RA) is an autoimmune disease.However, there are few cases of Charcot Neuro-osteoarthropathy (CN) caused by rheumatoid diseases in clinical reports. It is not easy to pay attention to the diagnosis of CN in the complications of rheumatoid disease, which greatly increases the probability of misdiagnosis and missed diagnosis. This case reported a rare complication of rheumatoid arthritis, Charcot arthritis, and the molecular mechanism and diagnosis and treatment of CN caused by RA were systematically discussed.
METHODS: The patient, a 79-year-old woman, was hospitalized due to bilateral shoulder pain, limited activity for half a year, aggravated for 4 months to the hospital. During this period, the symptoms did not improve after treatment with acupuncture and Chinese medicine. The patient was previously diagnosed with rheumatoid arthritis for more than 3 years and intermittent irregular use of methylprednisolone and methotrexate for 2 years. She had a history of osteoporosis.
METHODS: symmetrical malformed swelling of the finger joints of both hands; Bilateral supraspinatus and deltoid muscle atrophy, tenderness at the acromion, and attachment of the long head tendon of the biceps brachii were observed. The left Dugas test and the right Dugas test were positive.Blood test: anti-cyclic citrullinated peptide antibody (A-CCP) 33.10U/ml (normal range: 0-5RU/ml); antinuclear antibody quantification (ANA) 47.40AU/ml (normal range: Negative or < 32); anti-double stranded DNA IgG antibody quantification (dsDNA) 31.00 IU/ml (normal range: 0-100 IU/ml); D-Dimer 6.43 µg/ml (normal range: 0-0.5 mg/L); erythrocyte sedimentation rate (ESR) was 27 mm/h (normal range: < 20 mm/60 min). C-reactive protein (CRP) 39.06 mg/L(0.068-8 mg/L).MRI 3.0 T enhancement of bilateral shoulder joints, cervical spine and thoracic spine showed: 1.Large bone destruction, cartilage injury, multiple effusion, synovitis, obvious on the right side. 2.Intervertebral disc degeneration, cervical 3/4, 4/5, 5/6, 6/7 disc herniation, with cervical 3/4 obvious, posterior central herniation; CONCLUSIONS: Rheumatoid arthritis complicated with Charcot\'s joint is rare. Clinically, patients with rheumatoid diseases should not ignore Charcot\'s joint complications because of rareness. Early blood inflammatory markers, neuro electrophysiology, and imaging MRI of rheumatoid CN are of great significance for the diagnosis of this mild or early neurovascular inflammation. Early diagnosis and treatment are helpful to prevent further joint injury. The clinical diagnosis, treatment, and molecular mechanism of osteolysis in RA and peripheral sensory nerve injury remain to be further revealed.
METHODS: The patient, a 79-year-old woman, was hospitalized due to bilateral shoulder pain, limited activity for half a year, aggravated for 4 months to the hospital. During this period, the symptoms did not improve after treatment with acupuncture and Chinese medicine. The patient was previously diagnosed with rheumatoid arthritis for more than 3 years and intermittent irregular use of methylprednisolone and methotrexate for 2 years. She had a history of osteoporosis.
METHODS: symmetrical malformed swelling of the finger joints of both hands; Bilateral supraspinatus and deltoid muscle atrophy, tenderness at the acromion, and attachment of the long head tendon of the biceps brachii were observed. The left Dugas test and the right Dugas test were positive.Blood test: anti-cyclic citrullinated peptide antibody (A-CCP) 33.10U/ml (normal range: 0-5RU/ml); antinuclear antibody quantification (ANA) 47.40AU/ml (normal range: Negative or < 32); anti-double stranded DNA IgG antibody quantification (dsDNA) 31.00 IU/ml (normal range: 0-100 IU/ml); D-Dimer 6.43 µg/ml (normal range: 0-0.5 mg/L); erythrocyte sedimentation rate (ESR) was 27 mm/h (normal range: < 20 mm/60 min). C-reactive protein (CRP) 39.06 mg/L(0.068-8 mg/L).MRI 3.0 T enhancement of bilateral shoulder joints, cervical spine and thoracic spine showed: 1.Large bone destruction, cartilage injury, multiple effusion, synovitis, obvious on the right side. 2.Intervertebral disc degeneration, cervical 3/4, 4/5, 5/6, 6/7 disc herniation, with cervical 3/4 obvious, posterior central herniation; CONCLUSIONS: Rheumatoid arthritis complicated with Charcot\'s joint is rare. Clinically, patients with rheumatoid diseases should not ignore Charcot\'s joint complications because of rareness. Early blood inflammatory markers, neuro electrophysiology, and imaging MRI of rheumatoid CN are of great significance for the diagnosis of this mild or early neurovascular inflammation. Early diagnosis and treatment are helpful to prevent further joint injury. The clinical diagnosis, treatment, and molecular mechanism of osteolysis in RA and peripheral sensory nerve injury remain to be further revealed.
摘要：
背景：类风湿性关节炎（RA）是一种自身免疫性疾病。然而,在临床报道中，由类风湿疾病引起的Charcot神经骨关节病（CN）的病例很少。在类风湿并发症中注意CN的诊断并不容易，这大大增加了误诊和漏诊的概率。该病例报告了一种罕见的类风湿性关节炎并发症，Charcot关节炎,系统讨论了RA引起CN的分子机制和诊断治疗。
方法：患者，一个79岁的女人,因双侧肩痛住院,活动有限半年，恶化4个月到医院。在此期间,经针灸和中药治疗后，症状没有改善。该患者先前被诊断为类风湿性关节炎超过3年，间歇性不规则使用甲泼尼龙和甲氨蝶呤2年。她有骨质疏松症的病史。
方法：双手指关节对称畸形肿胀；双侧冈上肌和三角肌萎缩，肩峰处的压痛,观察到肱二头肌长头肌腱的附着。左Dugas测试和右Dugas测试均为阳性。血液检查:抗环瓜氨酸肽抗体(A-CCP)33.10U/ml(正常范围:0-5RU/ml);抗核抗体定量(ANA)47.40AU/ml(正常范围:阴性或<32);抗双链DNAIgG抗体定量(dsDNA)31.00IU/ml(正常范围:0-100IU/ml);D-D-D-D-D-D-D-D-C反应蛋白（CRP）39.06mg/L（0.068-8mg/L）。双侧肩关节MRI3.0T增强,颈椎和胸椎显示：1.大骨破坏,软骨损伤,多发性积液,滑膜炎,在右边很明显。2.椎间盘退变,颈3/4,4/5,5/6,6/7椎间盘突出症,宫颈3/4明显，中央后疝；结论：类风湿性关节炎合并Charcot关节少见。临床上,类风湿疾病患者不应因为罕见而忽视Charcot关节并发症。早期血液炎症标志物，神经电生理学，类风湿CN的MRI和影像学检查对这种轻度或早期神经血管炎症的诊断具有重要意义。早期诊断和治疗有助于防止关节进一步损伤。临床诊断,治疗,骨溶解在RA和周围感觉神经损伤中的分子机制仍有待进一步揭示。
方法：患者，一个79岁的女人,因双侧肩痛住院,活动有限半年，恶化4个月到医院。在此期间,经针灸和中药治疗后，症状没有改善。该患者先前被诊断为类风湿性关节炎超过3年，间歇性不规则使用甲泼尼龙和甲氨蝶呤2年。她有骨质疏松症的病史。
方法：双手指关节对称畸形肿胀；双侧冈上肌和三角肌萎缩，肩峰处的压痛,观察到肱二头肌长头肌腱的附着。左Dugas测试和右Dugas测试均为阳性。血液检查:抗环瓜氨酸肽抗体(A-CCP)33.10U/ml(正常范围:0-5RU/ml);抗核抗体定量(ANA)47.40AU/ml(正常范围:阴性或<32);抗双链DNAIgG抗体定量(dsDNA)31.00IU/ml(正常范围:0-100IU/ml);D-D-D-D-D-D-D-D-C反应蛋白（CRP）39.06mg/L（0.068-8mg/L）。双侧肩关节MRI3.0T增强,颈椎和胸椎显示：1.大骨破坏,软骨损伤,多发性积液,滑膜炎,在右边很明显。2.椎间盘退变,颈3/4,4/5,5/6,6/7椎间盘突出症,宫颈3/4明显，中央后疝；结论：类风湿性关节炎合并Charcot关节少见。临床上,类风湿疾病患者不应因为罕见而忽视Charcot关节并发症。早期血液炎症标志物，神经电生理学，类风湿CN的MRI和影像学检查对这种轻度或早期神经血管炎症的诊断具有重要意义。早期诊断和治疗有助于防止关节进一步损伤。临床诊断,治疗,骨溶解在RA和周围感觉神经损伤中的分子机制仍有待进一步揭示。
