双语病例SAPHO综合征引发胸锁关节
CaseReport
病例报告
A55-year-oldmalehadbeenexperiencingpainovertheleftshouldertotheanteriorpartofthechestsincetwodays.Physicalexaminationindicatedabodytemperatureof37.8°C,aswellasswelling,elevatedtemperature,andtendernessontheleftsideofthesternum(Figure1).Thepainworsenedwithelevationoftheleftshoulder,rightrotationandretroflexionoftheneck,anddeepinspiration.Bloodtestsshowedaninflammatoryresponse(C-reactiveprotein,13.1mg/dL,erythrocytesedimentationrate,48mm/h).Rheumatoidfactorandanti-cycliccitrullinatedpeptide(anti-CCP)antibodywerenegative.Jointaspirationwasnotperformedbecauseultrasonographydidnotdetecttheeffusionofsternoclavicularjoints.Computedtomography(CT)scanofthesternoclavicularjointsrevealedanerosivechangeintheleftsternoclavicularjoint.Magneticresonancewiththeshort-T1inversion-recovery(MR-STIR)sequenceshowedanabnormalsignalintheleftsternoclavicularjoint(Figure2).Anon-steroidalanti-inflammatorydrugwasorallyadministered,andthesymptomsdisappearedafteronemonth.Althoughnoskineruptiondevelopedduringthefollow-up,sternoclavicularjointarthritisduetoSAPHOsyndromewasdiagnosed.
患者，男，55岁。左肩至胸前疼痛，持续2天。体检发现体温37.8°C；肿胀，发烧，胸骨左侧有压痛（图1）；左肩抬高、颈部右旋和翻转以及深呼吸时疼痛加剧。血液检查结果显示炎症，C反应蛋白13.1mg/dL；红细胞沉降率48mm/h。类风湿因子和抗环瓜氨酸肽（anti-CCP）抗体呈阴性。由于超声波检查未发现胸骨关节积液，所以未进行关节抽吸。胸骨关节CT扫描显示糜烂性病变。磁共振成像短时间反转恢复（MR-STIR）序列显示左侧胸骨关节异常信号（图2）。给药口服非甾体类抗炎药，1个月后症状消失。随访未发现皮肤病变，诊断为SAPHO综合征引发的胸骨关节炎。
图1：
图2：
Discussion
讨论
Conditionsofthesternoclavicularjointsaresometimesmisdiagnosedasshoulderdiseasesbecausesternoclavicularjointsareinvolvedduringshoulderjointelevation.Wheninflammationrelatedtosternoclavicularjointarthritisspreadstothesternocleidomastoidmuscles,retroflexionoftheneckorrotationtotheunaffectedsidecausespain.Sternoclavicularjointarthritismaybecausedbysepticarthritis,osteoarthritis,rheumatoidarthritis,SAPHOsyndrome,ankylosingspondylitis,psoriasis,gout,orpseudogout.Amongthose,erosivechangesofinsternoclavicularjointshavebeenobservedinrheumatoidarthritis,ankylosingspondylitis,psoriasisandSAPHOsyndrome.Anti-CCPantibodywasnegativeinthispatient,makingrheumatoidarthritisunlikely.Ankylosingspondylitistypicallydevelopsinyoungadultsandoccursinsidiously.Naillesionsanddactylitiswerenotobserved,makingpsoriaticarthritisunlikely.
胸骨关节炎肩部抬高时累及胸骨，有时被误诊为肩部疾病。当胸骨关节炎症扩散至胸锁乳突肌时，颈部翻转或者向未感染一侧旋转时会引起疼痛。化脓性关节炎、骨关节炎、类风湿性关节炎、SAPHO综合征、强直性脊柱炎、银屑病、痛风或者假性痛风等都可能引起胸骨关节炎。其中，类风湿性关节炎、强直性脊柱炎、银屑病和SAPHO综合征中可能出现糜烂性病变。该患者抗环瓜氨酸肽（anti-CCP）抗体检查呈阴性，说明不可能是类风湿性关节炎。强直性脊柱炎一般发生于年轻人，且具有潜伏期。未观察到指甲病变和指炎，说明不可能是银屑病。
AmongpatientswithSAPHOsyndrome,65–90%experiencedamageinthebonesandjointsoftheanteriorchest.SkinsymptomssuchassevereacneandpalmoplantarpustulosisaidthediagnosisofSAPHOsyndrome.However,32–60%ofpatientsdevelopboneandjointsymptomsseveralyearsbeforeskinsymptoms,and15%ofpatientsdonotdevelopskinsymptoms.Osteolyticchangesareoftennotedatanearlierstagewithorwithoutosteoscleroticfindings.A白癜风北京白癜风专治医院
