西部地区血清阴性类风湿关节炎临床特点及传统抗风湿药治疗1年的转归分析
Clinical features and outcomes of seronegative rheumatoid arthritis in western China after one-year treatment with traditional disease modifying anti-rheumatoid drugs

摘要：目的 通过系列分析西部地区血清阴性类风湿关节炎(RA)患者的临床特点及传统改善病情抗风湿药(DMARDs)治疗1年的转归，为进行有效治疗提供思路。方法 在2013年5月-2014年6月我科收治的240例RA患者资料中，选取随访资料完整的47例血清阳性RA及25例血清阴性RA，比较其临床表现及实验室检查结果的特点，并对传统DMARDs治疗1年的转归进行对比分析。结果 血清阴性RA比例为10.4%(25/240)，小关节肿胀数较血清阳性RA患者显著减少(P<0.01)，血红蛋白水平更低、血小板水平更高(P<0.05)，碱性磷酸酶水平更低(P<0.05)。接受传统DMARDs治疗1年，血清阴性RA组患者缓解率明显高于血清阳性RA组患者(P<0.05)。结论 血清阴性RA在临床上并不少见，虽然其小关节肿胀数较少，但从临床特征上不易与血清阳性RA区分，部分血清阴性RA患者的血液系统损害更重。仅采用传统DMARDs治疗1年，血清阴性RA患者临床缓解率更高。
ABSTRACT: Objective To investigate the clinical features of seronegative rheumatoid arthritis (RA) in western China and its outcomes after one-year treatment with disease modifying anti-rheumatoid drugs (DMARDs) so as to provide evidence for effective therapy. Methods We made a retrospective analysis of 240 RA patients treated in our department from May 2013 to June 2014. We compared the 47 seropositive and 25 seronegative RA patients in clinical features, laboratory parameters and outcomes after one-year DMARDs medication. Results The percentage of seronegative RA was 10.4% (25/240). The number of swollen small joints was significantly smaller in seronegative RA group (P<0.01). Compared with those in seropositive RA, the level of hemoglobin was lower, the level of platelets was higher, and the level of alkaline phosphatase was lower in seronegative RA (P<0.05). The remission rate was higher in seronegative RA group than in seropositive RA group after one-year DMARDs administration (P<0.05). Conclusion Seronegative RA is not rare in clinic. Even though seronegative RA patients often present fewer swollen small joints, it is difficult to distinguish between seronegative and seropositve RA just based on the clinical features. Besides, hematological damage is more severe in some patients with seronegative RA. Only after one-year treatment with DMARDs, the remission rate is higher in seronegative RA patients than in seropositve RA ones