以外周关节炎为首发症状的青少年强直性脊柱炎的早期诊治特点  

The features of the diagnosis and treatment in juvenile ankylosing spondylitis with the leader symptom of peripheral monoarthritis

作　　者：钟建庭[1] 方玲[1] 王璇[1] 许瑞元[1] 王春雨[1] 陆伟[1] 

机构地区：[1]兰州军区兰州总医院内分泌科,甘肃兰州730050

出　　处：《中国现代医学杂志》2011年第7期865-867,871,共4页China Journal of Modern Medicine

摘　　要：目的探讨68例以外周关节炎为首发青少年强直性脊柱炎的早期诊治特点,避免青少年强直性脊柱炎的误诊误治。方法回顾性分析该院2003年1月~2008年1月诊治的68例以外周关节炎为首发的青少年强直性脊柱炎的早期临床特点。结果在68例9~18岁的青少年AS男性患者中,以外周关节炎为首发症状的48例(占70.6%),首发部位分别为膝关节炎22例,足跟末端跟腱炎10例,踝关节炎7例,髋关节炎6例,肘关节炎3例;其中23例曾经误诊为化脓性关节炎8例、滑膜炎5例、风湿性关节炎4例、结核性关节炎3例、骨质增生2例,致密性骨炎1例,并行关节腔穿刺术、关节腔内封闭术等不适治疗,最终经确诊后行规范性治疗后患者的症状才得到控制。结论青少年强直性脊柱炎的临床特点是以外周关节炎/滑膜炎为首发主要症状,HLA^B27为阳性,缺乏典型的影像学表现,因此对于青少年AS的早期诊断主要根据病史、体征和实验室检查,X线检查一般不作为主要依据。治疗上采用非特异性抗炎药、柳氮磺吡啶片、甲氨喋呤和TNF-α抑制剂。早期诊断和治疗才能减少致残率。【Objective】 To approach the feature of the diagnosis and treatment of 68 patients with ankylosing spondylitis in juvenile avoiding of its misdiagnosed and mistreatment.【Methods】 68 patients with ankylosing spondylitis in juvenile in our department form January 2003 to January 2008,were included in this retrospective study.【Results】 There are 48 patients who the leader symptom was peripheral monoarthritis among 68 patients with ankylosing spondylitis in juvenile.The leader symptom among 48 patients were gonarthritis（22case）,achilles tendinitis（10case）,ankle arthritis（7case）,coxarthritis anconitis（6case） or anconitis（3case） respectively.23 cases were misdiagnosed as pyogenic arthritis（8case）,synonitis（5case）,rheumarthritis（4case）,tuberculous arthritis（3case）,hyperosteogeny（2case） or sclerosing osteitis（1case）,they were mistreated with arthrocentesis and cavum articulare blockade.At last,all of patients were diagnosed ankylosing spondylitis and treated with regular antirheumatic therapy resulted in significantly improved following 12 months averagely.【Conclusions】 Ankylosing spondylitis in juvenile is characterized by the leader symptom of peripheral monoarthritis,HLA-B27 positive and lack of typical imaging manifestation.Therefore,the history and physical examination are the major diagnostic tools,although radiographic evidence of sacroiliitis is helpful.Therapeutic options include nonsteroidal anti-inflammatory drugs,sulfasalazine,methotrexate,and tumor necrosis factor-alpha inhibitors.Early recognition and appropriate treatment can help to limit disability.

关 键 词：强直性脊柱炎 青少年 外周关节炎 诊断 治疗 

分 类 号：R681.51[医药卫生—骨科学]