风湿

胸锁关节肥厚性骨炎常被延误诊断

作者:van der Kloot WA 翻译:北医三院邓晓莉 来源:中国风湿病公众论坛 日期:2017-10-05
导读

         胸锁关节肥厚性骨炎常被延误诊断

        摘要

        目的:胸锁关节肥厚性骨炎是一种少见的前胸壁慢性无菌性骨髓炎,病因不清,常常与特征性的掌跖脓疱病相关。该病在确诊前常常被延误多年。本研究目的是追溯这类患者的诊断轨迹,以研究诊断延误的后果。

        方法:回顾性收集分析52例经临床、核医学以及放射科确诊的胸锁关节肥厚性骨炎患者的资料。

        结果:大多数患者表现为胸锁关节部位的肿痛或者肩带肌附近的活动受限。约30%的患者合并掌跖脓疱病。诊断延误的时间为3.5年左右。在确诊前患者往往就诊于3个科室以上。对该病临床表现认识的缺乏以及诊断的延误与患者身体、精神以及社会经济上的不良后果密切相关,显著影响患者生活质量。

        结论:胸锁关节肥厚性骨炎尽管特点鲜明,仍然极易被误诊。对该病认识不足导致延误诊断会对患者生活的多个方面造成显著的不利影响。提高对该病的认识,使得患者能够及时得到诊断和治疗,有助于减轻患者因诊断延误而不能得到治疗带来的身体和精神痛苦。

        附原文

        OBJECTIVE: Sternocostoclavicular hyperostosis (SCCH) is a rare, debilitating, chronic inflammatory disorder of the anterior chest wall due to a chronic sterile osteomyelitis of unknown origin, often associated with characteristic skin lesions of palms and soles: pustulosis palmoplantaris. SCCH goes often unrecognized for years before the diagnosis is established and treatment instituted. The objective of this study was to trace the diagnostic paths of patients with SCCH and to investigate the consequences associated with diagnostic delay.METHODS: Data were collected through structured interviews of 52 patients with a clinically, scintigraphically, and radiologically established diagnosis of SCCH.RESULTS: The majority of patients presented with swelling and/or pain in the sternocostoclavicular region and/or limited movement of the shoulder girdle. Pustulosis palmoplantaris was present in approximately 30% of patients. The disease went unrecognized for a median of 3.5 years. Patients were often seen by at least 3 members of the medical profession before the diagnosis was suspected and eventually established. Lack of recognition of the clinical manifestations of the disease and delay in diagnosis were associated with important physical, psychological, and socioeconomic consequences affecting quality of life.CONCLUSION: SCCH remains an ill-recognized disease despite its characteristic clinical features. A low level of awareness of the disorder leads to a delay in diagnosis, which has a significant impact on various aspects of quality of life. Awareness should be raised for this disorder, enabling timely diagnosis and initiation of treatment to prevent the irreversible physical and psychological sequelae associated with the protracted untreated state..

        引自

        van der Kloot WA, Chotkan SA, Kaptein AA, Hamdy NA. Diagnostic delay in sternocostoclavicular hyperostosis: impact on various aspects of quality of life.Arthritis Care Res (Hoboken). 2010 Feb;62(2):251-7.

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