| Object: Discuss the differences of clinical features between patients with rheumatoid diseases whose initial manifestation was iritis and simple iritis patients. In order to improve the understanding of clinical manifestations, laboratory examinations,diagnosis, treatment and prognosis of patients with iritis as the initial manifestation in the Department of Rheumatology.Methods:We collected the clinical data of the patients whose initial manifestation were iritis in the Department of Rheumatology in the Second Affiliated Hospital of Dalian Medical University from January 2013 to December 2013. The clinical data including the patients’ gender, age,the average duration of iritis,clinical manifestations, laboratory tests, radiological findings, diagnosis, treatment and prognosis.Results: There were 70 patients in total, 46(65.7%) were rheumatoid disease, among which 42(91.3%) were AS, 2(4.3%) were BD, 1(2.2%) was SS, and 1(2.2%) was ReA; the remaining 24 patients(34.3%) were simple iritis. According to the result of diagnosis,70 patients were divided into rheumatoid disease which included 46 patients(65.7%) and simple iritis group which included 24 patients(34.3%). There were 31males(67.4%) and 15 females(32.6%) in rheumatoid disease group, and in this group the patients’ mean age was(38.1±11.0) years, mean duration of iritis was(76.8±86.8)months. In simple iritis group(24 cases), there were 14(58.3%) males and 10(41.7%)females,the patients’ mean age was(43.3±17.9) years, mean duration of iritis was(83.4± 48.0) months. Differences between the two groups in gender, age and the average duration of iritis were not statistically significant(P>0.05).In clinical manifestations,patients with rheumatoid disease may appear a variety of clinical manifestations, ofwhich arthritis or enthesitis was the most prominent(42 cases, 91.3%), and the merger of recurrent oral ulcers, genital ulcers, skin rashes and other manifestations was possible,while patients with simple iritis had no arthritis or enthesitis manifestation. In laboratory test, 39 cases(84.8%) were HLA-B27-positive, mean level of ESR was(28.3±29.1)mm/h, mean level of CRP was(11.9±15.4) mg/l in rheumatoid disease group; while in simple iritis group, only six cases(25.0%) were HLA-B27-positive,mean level of ESR was(19.6 ±16.5) mm/h, mean level of CRP was(2.8 ±2.4) mg/l.The differences in HLA-B27 positive rate and the mean level of CRP of two groups were statistically significant(P<0.05),while the mean level of ESR of two groups makes no differences.The immunological parameters including RF, ANA, ENA, ANCA,immunoglobulins(IgG, IgA, IgM)and other serological tests including hemoglobin,platelets, albumin and radiological findings of two groups showed no significant difference(P>0.05).In treatment,the main therapy were systematic application of non-steroidal anti-inflammatory drugs, immunosuppressive agents and biological agents in rheumatoid disease group;the main therapy were topical therapy in simple iritis patients. In rheumatoid patients,30 patients were followed up for an average time of(11.50±8.81) months. In these 30 patients, mean level of ESR before treatment was(31.58±31.24) mm/h, mean level of CRP was(15.66±16.74) mg/L; the last time mean level of ESR was(17.50±14.14) mm/h, mean level of CRP was( 6.79±7.34) mg/L;there were differences(P<0.05) between the mean level of CRP or ESR before and after treatment. There were no patients followed up in simple iritis group.Conclusion: Those iritis patients with HLA-B27 positive, high level of CRP and arthritis need to protect themselves from systemic inflammatory diseases, especially AS.Of patients with iritis as the initial manifestation of rheumatoid disease, men were more common, and the most common disease was AS. HLA-B27 testing may be helpful for the diagnose of iritis. While iritis patients were young men, HLA-B27 test and sacroiliac joint CT may be helpful for the diagnose of AS.Iritis patients with rheumatoid disease generally need systemic therapy and the prognosis is usually good. |
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