附着点炎/脊柱关节炎相关幼年特发性关节炎诊治进展  

Advances in diagnosis and treatment of juvenile idiopathic arthritis related to enthesitis and spondyloarthropathies

作　　者：曹兰芳[1] 徐金苹 薛海燕[1] CAO Lan-fang;XU Jin-ping;XUE Hai-yan(Department of Pediatrics,Renji Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200001,China)

机构地区：[1]上海交通大学医学院附属仁济医院儿科,上海200001

出　　处：《中国实用儿科杂志》2021年第1期9-16,共8页Chinese Journal of Practical Pediatrics

基　　金：上海交通大学医学院中西医结合学科创新基金项目(18zxy003)。

摘　　要：幼年脊柱关节炎(JSpA)是儿童和青春期一组重要的关节风湿病,与HLA-B27相关,16岁以前起病,与成人脊柱关节炎相比,很少累及中轴骨骼,但更多影响髋部和外周关节及关节外脏器,表现多样,常被误诊。国际风湿病联盟(ILAR)于2004年发表了关于幼年特发性关节炎(JIA)的定义及分型标准,该标准几乎涵盖了儿童时期所有的慢性关节炎,其中第6型与附着点相关的幼年特发性关节炎(ERA)包含了部分形式的JSpA,因此出现了部分病例临床诊断混乱,把与附着点相关的外周关节炎和(或)肌腱端附着点炎诊断为ERA。由于存在上述问题,2018年儿童风湿病国际试验组织(PRINTO)制定了最新分类标准,提出了ERA/SpA的分型标准,目的是与其他类型的JIA区分开。本文阐述了ERA/SpA相关JIA的最新诊治进展,以加强临床医生认识,提高对该型JIA的诊疗水平,从而改善预后。Juvenile spondyloarthritis(JSpA)is an important group of articular rheumatism in children under 16 years old,which is associated with human leucocyte antigen B27.It is often misdiagnosed with its diverse clinical manifestations of less involvement of the axial skeletons but more hips and peripheral entheses in children than in adults.The rheumatism associations international(ILAR)published the definition and classification standard(ILAR standard)of juvenile idiopathic arthritis(JIA)in 2004,which covered almost all childhood chronic arthritis.Among them,the sixth category enthesitis-related arthritis(ERA)contains part of JSpA,resulting in some cases of clinical confusion between JSpA and ERA,of which peripheral arthritis associated with attachment points and/or aponeurotic attachment point inflammation were both diagnosed as ERA.Due to this confusion,the international organization for trials in childhood rheumatism(PRINTO)developed the latest classification criteria in 2018,and proposed the classification criteria of ERA/SpA,to distinguish it from other subtypes of JIA.This article describes the latest diagnosis and treatment progress in ERA/SpA-related JIA,which aims to enhance clinicians understanding,diagnosis and treatment level of ERA/SpA related JIA and thus improve the prognosis.

关 键 词：幼年脊柱关节炎 与附着点炎相关的关节炎 诊断 治疗 幼年特发性关节炎 

分 类 号：R72[医药卫生—儿科]