风湿免疫科专业英语

1、一、英译汉A 30-year-old woman presented to the office with a complaint of intermittent episodes of pain, stiffness, and swelling in both hands and wrists for approximately 1 year. The episodes lasted for several weeks and then resolved. More recently, she noticed similar symptoms in her knees and ankles.

2、 Joints pain and stiffness were making it harder for her to get out of bed in the morning and were interfering with her ability to perform her duties at work. The joint stiffness usually lasted for several hours before improving. She also reported malaise and easy fatigability for the past few month

3、s, but she denied having fever, chills, skin rashes, and weight loss. Physical examination revealed a well-developed woman, with blood pressure 120/70 mmHg, heart rate 82 bpm , and respiratory rate 14 breaths per minute. Her skin did not reveal any rashes. Her head, neck, cardiovascular, chest, and

4、abdominal examinations were negative. There was no hepatosplenomegaly. The joint examination revealed the presence of bilateral swelling, redness and tenderness of most proximal interphalangeal(PIP) joints, the wrists , and knees.二、汉译英你可能会出现下列症状和体征:1、关节肿胀、疼痛、局部发热；2、晨僵，常超过1个小时；3、手臂包块(类风湿结节)；4、疲劳或体重减轻

5、。早期类风湿关节炎以影响手足的小关节常见，如掌指关节、近端指间关节。随病情发展，症状常蔓延至腕、肘、肩、膝和踝部。大多数情况下，类似的关节症状会在身体两侧出现，我们称之为“对称性”。类风湿关节炎的严重程度因患者不同有所差异，而同一患者的病情也常反复。最终可导致关节变形和功能受限。三、阅读写作Adult-onset Stills disease (AOSD) is an uncommon systemic inflammatory disease of unknown aetiology. Although its clinical picture tends to be very hetero

6、ge- neous, it typically presents with spiking fever, arthritis or arthralgia, an evanescent rash and leukocytosis. Up to 80% of AOSD cases can be controlled with corticosteroids ; however, reports on cases unresponsive to cortico- steroids, conventional disease modifying drugs and biolog- ical agent

7、s, including anti-IL1 inhibitors, are emerging. We present a case of AOSD with severe poylarthritis unrespon- sive to corticosteroids, methotrexate, anakinra and etaner- cept, but successfully stabilised with a humanized monoclonal anti-IL-6 receptor antibody, tocilizumab. A 35-year old man presente

8、d with a fever of up to 40C, severe arthralgia and myalgia, and a palpable hepatomeg- aly. Laboratory tests showed leukocytosis (up to 23 109/l; normal, 410 109/l; 16.5 109/l granulocytes), elevated liver enzymes (AST 3.40 kat/l; normal, 0.5 kat/l; ALT, 2.61 kat/l; normal, 0.42 kat/l; CRP 237 mg/l;

9、normal, 5 mg/l) and feritin (13,871 g/l; normal 20 300 g/l), while RF, ACPA, ANA, ENA, ANCA, anti- DNA and ACE were all negative. An abdominal ultrasound confirmed hepatosplenomegaly, and there were bilateral pleural effusion and enlarged mediastinal and hilar lymph nodes visible on the chest CT sca

10、n. All microbiologic tests including a Quantiferon-TB gold test were negative, while a mediastinal lymph node biopsy revealed reactive changes. He was diagnosed with AOSD by fulfilling three major and three minor criteria described by Yamaguchi et al. while other inflammatory, infective or neoplasti

11、c causes were excluded. Initial parenteral methylprednisolone (80 mg daily) had failed to produce a significant clinical response. Six weeks later, anakinra (100 mg daily subcu- taneously) was introduced. An excellent clinical and laboratory improvement followed; however, 2 months later the disease

12、flared-up again with a fever of up to 38C, elevated CRP (98 mg/l) and for the first time polyarthritis. Methotrexate (25 mg weekly) was added to the anakinra (100 mg subcutaneously daily), and methylprednisolone (8 mg daily) without success. Thereafter, we discontinued anakinra and introduced an ant

13、i TNF-alpha agent (etaner- cept, 50 mg subcutaneously weekly). The administration of methotrexate (25 mg weekly) and methylprednisolone (8 mg daily) was continued. After 3 months of treatment, the polyarthritis affecting small joints, wrists and left knee and tenosynovitis of the extensor carpi radi

14、alis muscles persisted. Laboratory tests showed an increased sedimentation rate (SR, 67 mm/h; normal 15 mm/h), elevated CRP (100 mg/l), leukocytosis (12.3109/l, 10.1 109/l granulocytes) and elevated IL-6 (33 pg/ml, normal 8 pg/ml). We discontinued etanercept and after obtaining a written patient inf

15、ormed consent, we started to administer tocilizumab 8 mg/kg intravenously every 4 weeks, with methotrexate (15 mg weekly) and methyl- prednisolone (8 mg daily) as concomitant therapy. The clinical status improved remarkably within days and his laboratory tests normalised completely by the fifth toci

16、lizumab administration. After 7 months of tocilizumab treatment, he is doing well, currently maintained on tocilizumab 8 mg/kg every 4 weeks, methotrexate 7.5 mg weekly and methylprednisolone 3 mg daily. Discussion Various cytokines, IL-1b and IL-6 among them, are believed to play a major role in AO

17、SD 1. Although corticosteroids currently remain the first line therapy for AOSD patients, followed by traditional DMARDs, refractory cases present an incentive for developing new effective therapeutic options. Four cases of successful tocilizumab treatment in refractive AOSD patients have been descr

18、ibed up to now (Table 1). In one of them, other biological agents, including anakinra as in our patient, were tried before tocilizumab. The initial tocilizumab dosing ranged from 4 mg/kg weekly to 8 mg/kg fortnightly， and we expanded this interval to 8 mg/kg monthly, which is the approved tocilizuma

19、b dosing in RA patients. As far as we know, this is the first reported case of a refractive AOSD patient, who responded well to tocilizumab treatment administered once monthly from the very beginning. We observed a rapid and stable clinical and laboratory improve- ment. Our patient received tocilizumab primarily for refractive poly