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一、英译汉A30-year-oldwomanpresentedtotheofficewithacomplaintofintermittentepisodesofpain,stiffness,andswellinginbothhandsandwristsforapproximately1year.Theepisodeslastedforseveralweeksandthenresolved.Morerecently,shenoticedsimilarsymptomsinherkneesandankles.Jointspainandstiffnessweremakingitharderforhertogetoutofbedinthemorningandwereinterferingwithherabilitytoperformherdutiesatwork.Thejointstiffnessusuallylastedforseveralhoursbeforeimproving.Shealsoreportedmalaiseandeasyfatigabilityforthepastfewmonths,butshedeniedhavingfever,chills,skinrashes,andweightloss.Physicalexaminationrevealedawell-developedwoman,withbloodpressure120/70mmHg,heartrate82bpm,andrespiratoryrate14breathsperminute.Herskindidnotrevealanyrashes.Herhead,neck,cardiovascular,chest,andabdominalexaminationswerenegative.Therewasnohepatosplenomegaly.Thejointexaminationrevealedthepresenceofbilateralswelling,rednessandtendernessofmostproximalinterphalangeal(PIP)joints,thewrists,andknees.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。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-onsetStill’sdisease(AOSD)isanuncommonsystemicinflammatorydiseaseofunknownaetiology.Althoughitsclinicalpicturetendstobeveryheteroge-neous,ittypicallypresentswithspikingfever,arthritisorarthralgia,anevanescentrashandleukocytosis.Upto80%ofAOSDcasescanbecontrolledwithcorticosteroids;however,reportsoncasesunresponsivetocortico-steroids,conventionaldiseasemodifyingdrugsandbiolog-icalagents,includinganti-IL1inhibitors,areemerging.WepresentacaseofAOSDwithseverepoylarthritisunrespon-sivetocorticosteroids,methotrexate,anakinraandetaner-cept,butsuccessfullystabilisedwithahumanizedmonoclonalanti-IL-6receptorantibody,tocilizumab.A35-yearoldmanpresentedwithafeverofupto40°C,severearthralgiaandmyalgia,andapalpablehepatomeg-aly.Laboratorytestsshowedleukocytosis(upto23×109/l;normal,4–10×109/l;16.5×109/lgranulocytes),elevatedliverenzymes(AST3.40μkat/l;normal,0.5μkat/l;ALT,2.61μkat/l;normal,0.42μkat/l;CRP237mg/l;normal,5mg/l)andferitin(13,871μg/l;normal20–300μg/l),whileRF,ACPA,ANA,ENA,ANCA,anti-DNAandACEwereallnegative.Anabdominalultrasoundconfirmedhepatosplenomegaly,andtherewerebilateralpleuraleffusionandenlargedmediastinalandhilarlymphnodesvisibleonthechestCTscan.AllmicrobiologictestsincludingaQuantiferon-TBgoldtestwerenegative,whileamediastinallymphnodebiopsyrevealedreactivechanges.HewasdiagnosedwithAOSDbyfulfillingthreemajorandthreeminorcriteriadescribedbyYamaguchietal.whileotherinflammatory,infectiveorneoplasticcauseswereexcluded.Initialparenteralmethylprednisolone(80mgdaily)hadfailedtoproduceasignificantclinicalresponse.Sixweekslater,anakinra(100mgdailysubcu-taneously)wasintroduced.Anexcellentclinicalandlaboratoryimprovementfollowed;however,2monthslaterthediseaseflared-upagainwithafeverofupto38°C,elevatedCRP(98mg/l)andforthefirsttimepolyarthritis.Methotrexate(25mgweekly)wasaddedtotheanakinra(100mgsubcutaneouslydaily),andmethylprednisolone(8mgdaily)withoutsuccess.Thereafter,wediscontinuedanakinraandintroducedanantiTNF-alphaagent(etaner-cept,50mgsubcutaneouslyweekly).Theadministrationofmethotrexate(25mgweekly)andmethylprednisolone(8mgdaily)wascontinued.After3monthsoftreatment,thepolyarthritisaffectingsmalljoints,wristsandleftkneeandtenosynovitisoftheextensorcarpiradialismusclespersisted.Laboratorytestsshowedanincreasedsedimentationrate(SR,67mm/h;normal15mm/h),elevatedCRP(100mg/l),leukocytosis(12.3×109/l,10.1×109/lgranulocytes)andelevatedIL-6(33pg/ml,normal8pg/ml).Wediscontinuedetanerceptandafterobtainingawrittenpatientinformedconsent,westartedtoadministertocilizumab8mg/kgintravenouslyevery4weeks,withmethotrexate(15mgweekly)andmethyl-prednisolone(8mgdaily)asconcomitanttherapy.Theclinicalstatusimprovedremarkablywithindaysandhislaboratorytestsnormalisedcompletelybythefifthtocilizumabadministration.After7monthsoftocilizumabtreatment,heisdoingwell,currentlymaintainedontocilizumab8mg/kgevery4weeks,methotrexate7.5mgweeklyandmethylprednisolone3mgdaily.DiscussionVariouscytokines,IL-1bandIL-6amongthem,arebelievedtoplayamajorroleinAOSD[1].AlthoughcorticosteroidscurrentlyremainthefirstlinetherapyforAOSDpatients,followedbytraditionalDMARDs,refractorycasespresentanincentivefordevelopingneweffectivetherapeuticoptions.FourcasesofsuccessfultocilizumabtreatmentinrefractiveAOSDpatientshavebeendescribeduptonow(Table1).Inoneofthem,otherbiologicalagents,includinganakinraasinourpatient,weretriedbeforetocilizumab.Theinitialtocilizumabdosingrangedfrom4mg/kgweeklyto8mg/kgfortnightly,andweexpandedthisintervalto8mg/kgmonthly,whichistheapprovedtocilizumabdosinginRApatients.Asfarasweknow,thisisthefirstreportedcaseofarefractiveAOSDpatient,whorespondedwelltotocilizumabtreatmentadministeredoncemonthlyfromtheverybeginning.Weobservedarapidandstableclinicalandlaboratoryimprove-ment.Ourpatientreceivedtocilizumabprimarilyforrefractivepolyarthritiswhichemergedwhilebeingtreatedwithanakinra.Pascualandco-
本文标题:风湿免疫科专业英语
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