银屑病关节炎临床特点及与HLA-B27的相关性研究  

The clinical characters of psoriatic arthritis and their relationship with HLAB27

作　　者：张江林[1] 黄烽[1] 刘湘源[1] 

机构地区：[1]解放军总医院

出　　处：《中华风湿病学杂志》1999年第2期87-89,共3页Chinese Journal of Rheumatology

摘　　要：目的分析银屑病关节炎（ＰＡ）的临床特点及与ＨＬＡＢ２７的相关性。方法选５５例住院患者，总结分析其皮疹和关节炎、关节外表现、Ｘ线特征及骶髂关节炎与ＨＬＡＢ２７的关系。结果３６例皮疹先于关节炎出现，１３例关节炎在先，６例同时发生。３８例有指甲改变。手足小关节最易受累，共计４５例，占８１８％，２８例（６２２％）伴远端指间关节（ＤＩＰ）受累。２８例有关节外表现。２０例有手足小关节Ｘ线破坏征，１９例出现骶髂关节炎或脊柱炎。３８例检测ＨＬＡＢ２７，１９例（５０％）为阳性，其中有骶髂关节炎者为８４２％（１６／１９）。结论伴ＤＩＰ受累的寡关节炎是ＰＡ的特征性表现，中轴关节受累常无症状，并与ＨＬＡＢ２７密切相关。治疗应选择对皮疹及关节炎均有效的甲氨蝶呤或环孢霉素Ａ，以及包括金制剂、柳氮磺胺吡啶等在内的联合方案。Objective To analyse the clinical characters of psoriatic arthritis (PA) and their relationship with HLAB27.THZMethods Fiftyfive PA inpatients were chosen and analysed for the relationship between psoriasis and arthritis,extraarticular features,radiographic findings and the association between sacroiliitis(spondylitis)and HLAB27. Results The male to female ratio was 151,but the ratio in patients with axial involvement was 851.Psoriasis antedated the arthritis in 36 patients and followed it in 13.An isochronous onset occurred in 6Nail involvement was found in 38 patients.The small joint of hand or foot involvement was noted in 45 patients,distal interphalangeal joint (DIP) involvement in 28.Various extraarticular features were observed in 28 patients.Erosions and destructions of the small joints on Xray were noted in 20 patients,sacroiliitis(spondylitis) in 19.HLAB27 was positive in 50% (19/38) of patients,but the positive rate of HLAB27 increased to 842% (16/19) in patients with sacroiliitis(spondylitis). Conclusion Oligoarthritis with DIP involvement is a characteristic manifestation of PA.The axial joint involvement is usually not the presenting symptoms and is associated with HLAB27.Combining scheme,including MTX,Gold or Cyclosporine,which have reproducible effects on both articular and cutaneous manifestations,should be chosen for treatment.

关 键 词：关节炎 银屑病 HLA-B27抗原 临床特点 相关性 

分 类 号：R758.630.6[医药卫生—皮肤病学与性病学] R684.3[医药卫生—临床医学]