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目的:提高以风湿病症状为突出表现的恶性肿瘤的早期的识别,有利于提高临床医生对此类疾病早期诊断,避免误诊,提高诊断的正确率。方法:对22例患者以骨骼、关节及肌肉疼痛为突出表现,拟诊风湿性疾病,最终确定诊断为恶性肿瘤患者的临床资料进行分析。结果:22例患者中18例属癌性风湿症,疼痛性质为隐痛,呈慢性反复渐进性加重,非甾体抗炎药和激素治疗的效果不佳,手术切除癌肿后,疼痛明显减轻;4例患者属恶性肿瘤骨转移,最初为隐痛,逐渐发展为剧烈持续性疼痛,血沉有明显升高,抗核抗体(ANA)阳性,非甾体抗炎药和激素治疗效果为无效。结论:对骨骼、关节及肌肉疼痛的患者出现于风湿病难以解释的临床表现,常规治疗效果不佳,应注意排查恶性肿瘤的可能。
OBJECTIVE: To improve the early identification of malignant tumors with prominent symptoms of rheumatism, and to improve clinicians’ early diagnosis of such diseases, avoid misdiagnosis and improve the accuracy of diagnosis. Methods: 22 cases of patients with bone, joint and muscle pain as a prominent manifestation of rheumatic diseases to be diagnosed, the final diagnosis of patients with malignant tumors were analyzed. Results: Twenty - eight of 22 patients had cancerous rheumatism. The pain nature was dull pain, chronic progressive increase, non - steroidal anti - inflammatory drugs and hormone therapy were not effective. The pain was relieved after surgical removal of cancer. Four patients with malignant tumor bone metastasis initially developed painful pain and gradually developed severe persistent pain. Erythrocyte sedimentation rate was significantly elevated. Antinuclear antibodies (ANA) were positive. Non-steroidal anti-inflammatory drugs and steroid therapy were ineffective. CONCLUSIONS: Patients with skeletal, joint, and muscular pain are refractory to rheumatism and have poor general-purpose outcomes. Malignant neoplasms should be investigated.