谭婕 许砚秋 吴斌

    [摘要] 重庆市中医院风湿病科收治1例以风湿病表现起病的腺癌病例，该病例为中年女性，起病隐匿，起病前有明显外感诱因，病程中主要表现为反复发热(以低热为主)及对称性多关节肿痛，辅助检查提示关节滑膜炎存在伴炎症指标升高，故考虑诊断为反应性关节炎，经规律抗风湿药物治疗后患者未见明显缓解。其肿瘤疾病相关表现不典型，筛查肿瘤指标未见明显异常，直至体表肿块形成，完善病理检查得以明确诊断。对该例病例临床资料进行回顾性分析，提示副肿瘤风湿综合征以多种方式产生风湿样症状或风湿疾病，临床与肿瘤特征性表现差异较大，早期诊断困难，易误诊误治，在治疗上对抗风湿免疫疾病治疗有效率不高，故而风湿病的诊疗规范十分重要，当发现难治性风湿疾病时，应积极排除肿瘤可能。

    [关键词] 副肿瘤风湿综合征;腺癌;风湿病;首发表现

    [中图分类号] R259? ? ? ? ? [文献标识码] C? ? ? ? ? [文章编号] 1673-9701(2022)04-0169-03

    [Abstract] A patient with adenocarcinoma presenting as rheumatic disease was admitted to Department of Rheumatology， Chongqing Hospital of Traditional Chinese Medicine. The patient was a middle-aged female with insidious onset and obvious external inducements before onset. The main clinical manifestations in the course of the disease were recurrent fever (mainly low fever) and symmetrical multiple joint swelling and pain. Auxiliary examination indicated synovitis of the joint with increased inflammatory indicators， so it was considered to be diagnosed as reactive arthritis. The patient did not get significant relief after regular anti-rheumatic drug treatment. The tumor disease related manifestations were not typical ......