背景:类风湿性关节炎(RA)是一种以关节炎症和各种关节外表现为特征的全身性炎症性疾病,包括类风湿结节(RNs)。本案例研究旨在探讨替代治疗RNs的有效性,特别强调柳氮磺吡啶的治疗潜力。
方法:一名52岁男性,患有类风湿关节炎,表现为关节疼痛恶化,肘部结节坚硬,脚,和手指。
方法:患者符合RA的诊断标准,并根据其与甲氨蝶呤起始的时间相关性被诊断为甲氨蝶呤诱导的RNs。
方法:停用甲氨蝶呤,开始联合使用来氟米特和柳氮磺胺吡啶。柳氮磺吡啶可改善关节痛和结节大小。然而,由于成本问题,病人停用了柳氮磺胺吡啶,导致症状和结节扩大的死灰复燃。甲氨蝶呤的重新引入导致关节炎症的显着改善,尤其是,随访6个月时未出现新结节.
结果:柳氮磺胺吡啶在治疗RA结节方面显示出疗效,建议一种潜在的替代疗法.
结论:该病例突出了RA结节的复杂病因,并强调了个体化治疗方法和密切监测以实现最佳管理的重要性。
BACKGROUND: 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.
METHODS: A 52-year-old male with established RA presented with worsening joint pain and firm nodules on his elbows, feet, and fingers.
METHODS: The patient fulfilled the diagnostic criteria for RA and was diagnosed with methotrexate-induced RNs based on their temporal association with methotrexate initiation.
METHODS: 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.
RESULTS: Sulfasalazine demonstrated efficacy in managing RA nodules, suggesting a potential alternative therapy.
CONCLUSIONS: The
case highlights the complex etiology of nodules in RA and emphasizes the importance of individualized treatment approaches and close monitoring for optimal management.