患者女,41岁。24年前头皮、胸背部出现散在的丘疹,上有银白色鳞屑,刮除后可见光亮的薄膜及点状出血。18年前两侧手足及腕、踝关节发生疼痛、肿胀、活动受限,逐渐手足僵硬,生活不能自理,曾多次就诊,均诊断为“类风湿性关节炎”。化验血沉正常,类风湿因子阴性。口服消炎痛、保太松、强的松效果欠佳。近6～7年随 Female patient, 41 years old. 24 years ago, the scalp, chest and back appear scattered pimples, there are silver-white scales, after curettage can see the bright film and punctate bleeding. 18 years ago, both hands and feet and wrist, ankle pain, swelling, limited mobility, gradually hand and foot stiffness, life can not take care of themselves, had multiple visits, were diagnosed as “rheumatoid arthritis.” Normal erythrocyte sedimentation rate, rheumatoid factor negative. Oral indomethacin, Paul too loose, prednisone ineffective. Nearly 6 to 7 years with