背景:继发性免疫性血小板减少性紫癜(ITP)也称为获得性血小板减少性紫癜,自身免疫性疾病通常是其重要病因之一。关于类风湿关节炎(RA)难治性血小板减少性紫癜的治疗报道很少。我们报告了一例难治性ITP,其中血小板相关标志物与治疗剂的变化值得临床医生关注。
方法:一名69岁女性因颈部和手臂瘀斑入院15天。她5年前被诊断为RA。
方法:诊断符合美国风湿病学会/欧洲抗风湿病联盟2010分类标准。疾病活动性评分28(DAS-28)为4.6,表明疾病活动性中等。
方法:一线治疗和二线治疗——艾曲波帕(EPAG)治疗无效。因此,我们进行了利妥昔单抗联合低剂量EPAG治疗.
结果:患者接受2个周期的利妥昔单抗联合EPAG,在随访期间,她的颊粘膜和四肢没有新的瘀斑。
结论:本病例提示利妥昔单抗联合EPAG早期治疗对RA难治性ITP患者有益。在疾病动态监测方面,未成熟血小板分数(IPF)可能是预测疗效的辅助指标,但其意义有待进一步研究。
BACKGROUND: Secondary immune thrombocytopenic purpura (ITP) is also known as acquired thrombocytopenic purpura, autoimmune disease is usually one of the important causes. There are few
reports about treatment of refractory thrombocytopenic purpura in rheumatoid arthritis (RA). We report a
case of refractory ITP in which changes in platelet-related markers with therapeutic agents are worthy of the attention of clinicians.
METHODS: A 69-year-old woman admitted for ecchymosis on the neck and arms for 15 days presented to our hospital. She was diagnosed with RA 5 years ago.
METHODS: The diagnosis met the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria. The disease activity score 28 (DAS-28) was 4.6, indicating that the disease activity was moderate.
METHODS: Treatment with first-line therapies and second-line treatment--eltrombopag (EPAG) were ineffective. Therefore, we performed rituximab combined with a low dose of EPAG.
RESULTS: The patient received 2 cycles of rituximab combined with EPAG, and reported no new petechiae on her buccal mucosa and limbs during follow-up.
CONCLUSIONS: This
case suggests that early treatment of rituximab combined with EPAG is beneficial to patients with refractory ITP in RA. In terms of disease dynamic monitoring, immature platelet fraction (IPF) may be an auxiliary indicator for predicting efficacy, but its significance needs further study.