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目的提高对恶性肿瘤的风湿症样表现识别能力。方法对以骨骼关节肌肉疼痛为首发表现的32例患者的临床资料进行分析。结果32例中14例属癌性风湿症,疼痛性质为隐痛、胀痛,呈慢性易反复,且逐渐加重,非甾类抗炎药和激素疗效不佳,切除癌肿后疼痛缓解。18例为恶性肿瘤骨转移,开始为隐痛,后发展为锥痛,呈剧烈持续性疼痛,部分病例碱性磷酸酶和血沉显著升高,非甾类抗炎药和激素无效,需麻醉性镇痛药才能短期缓解。两种情况下,肿瘤的类型及分布部位均较广,并无哪一种肿瘤占绝对优势。临床误诊率高。结论因临床医生对骨骼关节肌肉疼痛与肿瘤的相关性认识不够,常忽视肿瘤的存在。因此对出现骨骼关节肌肉疼痛的患者,若排除了弥漫性结缔组织病,对一般的镇痛药、激素疗效差、年龄≥60岁者,应注意排查恶性肿瘤的可能。
Aims To improve the ability to recognize rheumatic symptoms of malignant tumors. Methods The clinical data of 32 patients with skeletal-joint muscle pain as the first manifestation were analyzed. Results Of 32 cases, 14 cases were cancerous rheumatism. The pain was painful, painful, chronic and repetitive, and gradually aggravated. The non-steroidal anti-inflammatory drugs and hormones had poor curative effect. Pain was relieved after resection of the cancer. 18 cases of malignant tumor bone metastasis, began to pain, after the development of concussion, showed severe persistent pain, in some cases significantly increased alkaline phosphatase and ESR, non-steroidal anti-inflammatory drugs and hormones ineffective, need to be narcotic town Pain medicine can short-term relief. In both cases, the types and distribution of tumors were relatively wide, and no tumor accounted for an absolute advantage. High rate of clinical misdiagnosis. Conclusion Clinicians do not know enough about the correlation between muscular pain and tumor in bone and joint, and often ignore the existence of tumor. Therefore, patients with skeletal and joint muscle pain, if ruled out diffuse connective tissue disease, the general analgesics, hormones poor efficacy, age ≥ 60 years of age, should pay attention to the possibility of troubleshooting of malignant tumors.