中西医结合治疗难治性类风湿关节炎1例
A Case of Difficult-to-treat Rheumatoid Arthritis Treated with Combination of Chinese and Western Medicine
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1.天津中医药大学第一附属医院,天津 300000
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高晶月,刘维.中西医结合治疗难治性类风湿关节炎1例[DB/OL].(2023-11-13)[2023-11-13].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43867725&Fpath=home&index=0&lang=zh
GAO Jingyue,LIU Wei.A Case of Difficult-to-treat Rheumatoid Arthritis Treated with Combination of Chinese and Western Medicine[J].,
高晶月,刘维.中西医结合治疗难治性类风湿关节炎1例[DB/OL].(2023-11-13)[2023-11-13].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=43867725&Fpath=home&index=0&lang=zh DOI:
GAO Jingyue,LIU Wei.A Case of Difficult-to-treat Rheumatoid Arthritis Treated with Combination of Chinese and Western Medicine[J]., DOI:.
病史摘要,2,患者2年前无明显诱因出现左膝关节肿痛,于当地医院就诊,考虑滑膜炎,予手术清除滑膜治疗,治疗后患者关节肿痛症状时有反复。1年前出现右肘关节肿痛,于外院就诊,考虑类风湿关节炎(具体化验未见),予甲氨蝶呤、艾拉莫得、阿达木单抗治疗。用药后病情控制欠佳,5个月前改用乌帕替尼治疗,用药后病情控制仍不佳,逐渐出现右肘关节屈伸不利,2月前肘关节X线示关节融合,遂改用托珠单抗治疗。患者使用托珠单抗2次后,症状无明显改善,现左膝关节、右肘关节肿痛,为求进一步中西医结合诊疗,遂于我院就诊。入院症见:神清,精神可,左膝、右肘关节肿痛,屈伸不利,晨僵2-3小时,余关节肿痛不显著,无发热,无口腔溃疡、光过敏,口干口苦,无胸闷咳喘,无胃痛反酸,纳寐尚可,小便黄,大便粘滞。舌红,苔黄腻,脉弦滑。中医诊断 尪痹(湿热毒蕴证)。西医诊断 类风湿关节炎。干预措施 中药辨证论治,西药使用JAK抑制剂治疗。疗效转归 好转。
Summary of case history, Two years ago, the patient had left knee joint swelling and pain without any obvious cause, and was treated with synovitis in a local hospital, and was given surgery to remove the synovial membrane, after which the patient's symptoms of joint swelling and pain recurred from time to time. 1 year ago, the patient had right elbow joint swelling and pain, and was treated with rheumatoid arthritis in an outside hospital, and was given methotrexate, elavilamate, and adalimumab. The patient's condition was poorly controlled after using the medication, and he was switched to upatinib 5 months ago. The patient's condition was still poorly controlled after using the medication, and he gradually developed unfavorable flexion and extension of the right elbow joint, and his elbow joint fusion was shown on X-ray 2 months ago, and he was then switched to tolizumab treatment. After using tolizumab for 2 times, the patient's symptoms did not improve significantly, and now her left knee and right elbow joints were swollen and painful. In order to seek for further integrated diagnosis and treatment with traditional Chinese and western medicine, she was admitted to our hospital. Admission symptoms: clear, spirit can, left knee, right elbow joint swelling and pain, flexion and extension is not favorable, morning stiffness 2-3 hours, the rest of the joint swelling and pain is not significant, no fever, no mouth ulcers, photosensitivity, dry mouth, bitter mouth, no chest tightness, no coughing and wheezing, no gastric pain and acid reflux, sleep is still good, urine is yellow, stools are sticky. Tongue red, moss yellow and greasy, pulse slippery.,TCM diagnosis, Wang Bi (Damp-Heat-Toxicity).,Western medicine diagnosis, Rheumatoid Arthritis.,Therapeutic methods, Traditional Chinese medicine for evidence-based treatment and western medicine with JAK inhibitors.,Clinical outcomes, Take a turn for the better.
难治性类风湿关节炎中西医结合清热利湿、解毒通络法
Difficult-to-treat refractory rheumatoid arthritisCombination of traditional Chinese and western medicineClearing away heat and dampnessdetoxifying and clearing away collaterals
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