脑血管炎可见于类风湿性关节炎患者

作者：Ozkul A 翻译： 研究生张璐

摘要：目的和意义：脑血管炎是类风湿关节炎的一种罕见并发症。类风湿关节炎最常见的神经系统受累表现为外周神经病变和由于颈椎半脱位压缩导致的脊髓型颈椎病，脑血管炎可见于类风湿性关节炎患者，尤其是长期血清学阳性的类风湿性关节炎患者。

临床表现：我们报道了两例类风湿相关的脑血管炎。两位患者都没有关节外表现并且类风湿关节炎临床病情得到控制。第一例是一位30岁的女性，血清阳性类风湿性关节炎病史15年，突发左侧面部及上肢无力，磁共振检查提示急性脑缺血导致的额颞区高信号。在控制磁共振成像中，检测出新急性缺血病灶在右侧中央前回、双侧额叶和胼胝体区。脑磁共振血管造影和经颅超声检查结果与脑血管炎情况一致。大剂量甲基强的松龙及口服硫唑嘌呤治疗效果很好。另一位男性患者52岁，类风湿关节炎病史29年。他被神经内科诊断出言语困难和右上肢少许乏力。磁共振成像显示左顶枕区的急性缺血，在一个星期内出现进展并且新增了右顶枕部缺血。脑血管增强MR和脑血管造影结果一至。使用甲基强的松龙冲击治疗期间，出现进展性脑缺血，而后开始进行环磷酰胺治疗，患者治疗反应很好。

结论：类风湿关节炎导致的脑血管炎是一种罕见并发症，可危及生命。因此，对类风湿关节炎导致的脑血管炎，特别是类风湿关节炎合并进展性中风，临床医生应引起关注。

附原文：Abstract：OBJECTIVE AND IMPORTANCE: Cerebral vasculitis (CV) is a rare described complication of rheumatoid arthritis (RA). Although the most frequent neurological manifestations of RA are peripheral neuropathy and cervical spinal cord compression due to subluxation of the cervical vertebrae, CV can be seen especially in patients with seropositive and long-standing RA.CLINICAL PRESENTATION: We report two cases of CV associated with RA. Both patients had no extraarticular manifestations and RA clinics were under control. Our first case is a 30-years-old woman with seropositive RA for 15?years who had suddenly onset left facial and upper extremity weakness. In magnetic resonance imaging (MRI) DWI, hyperintensity in frontotemporal region due to acute ischaemia was detected. The new lacuner acute ischaemic lesions in right precentral gyrus, bilateral frontoparietal and corpus callosal region were detected in the control MRI. The cerebral MR angiography and transcranial doppler findings were consistent with CV. The patient responded favourably to pulse methylprednisolone and oral azathiopurine treatments. The second patient is a 52-year-old man who had been RA for 29?years. He admitted to our neurology clinic with speech difficulty and right upper extremity minimal weakness. Magnetic resonance imaging DWI showed left parietooccipital acute ischaemia which was progressed within a week and a new right parietooccipital ischaemia was added. His cerebral MR angiography and cerebral angiography were concordant with CV. The cyclophosphamide therapy was started since the cerebral ischaemia was progressed during pulse methylprednisolone and he responded well to this therapy.CONCLUSION: CV due to RA is an uncommon serious complication which can be life-threatening. Therefore clinicians should be aware of the possibility of CV especially in progressive strokes in RA.

引自：Ozkul A, Y?lmaz A, Akyol A, et al,Cerebral vasculitis as a major manifestation of rheumatoid arthritis.[J].Acta Clin Belg. 2015 Oct;70(5):359-63. doi: 10.1080