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患女,60岁,汉族,因多关节肿痛8月于1994年9月来我院就诊。患者自1994年元月始无诱因出现双手小关节、腕、膝关节肿痛,活动受限,伴晨僵2h。查体:T36.9℃,P82次/min,R20次/min,BP16/9kPa,皮肤、淋巴结、心肺、腹均正常,双手近端指间关节、掌指关节、腕、膝关节肿胀,有压痛;双腕固定,双膝浮髌试验阳性。实验室检查:血沉80mm/h,C-反应蛋白0.03g/h,类风湿因子滴度1682IU/L,Pt320×10~9/L,肝、肾功能、尿、粪常规均正常。双手及腕关节X线显示:关节间隙变窄,有部分囊性变。诊断:类风湿关节炎。给口服布洛芬0.4g,3次/d,青霉胺0.25g,1次/d,治疗2月后关节肿痛明显减轻,晨僵时间缩短至半小时,停用布洛芬,继续青霉胺0.25g,1次/d治
Women, 60 years old, Han nationality, due to joint swelling and pain in August 1994 in September to our hospital. Patients from January 1994 no incentive to appear hands and small joints, wrist, knee swelling and pain, limited mobility, with morning stiffness 2h. Examination: T36.9 ℃, P82 times / min, R20 beats / min, BP16 / 9kPa, skin, lymph nodes, cardiopulmonary, abdominal average normal, both hands proximal interphalangeal joint, metacarpophalangeal, wrist, knee joint swelling Tenderness; double wrist fixed, knees floating patella test positive. Laboratory tests: erythrocyte sedimentation rate 80mm / h, C-reactive protein 0.03g / h, rheumatoid factor titer 1682IU / L, Pt320 × 10 ~ 9 / L, liver and kidney function, urine, normal feces were normal. Hands and wrist X-ray shows: joint space narrowing, some cystic change. Diagnosis: Rheumatoid arthritis. To oral ibuprofen 0.4g, 3 times / d, penicillamine 0.25g, 1 / d, 2 months after treatment, joint pain was significantly reduced, morning stiffness reduced to half an hour, disable ibuprofen, continue to green Mycophenolate 0.25g, 1 / d rule