附着点炎相关关节炎的临床特征  

Clinical characteristics of children with enthesitis related arthritis

作　　者：李崇巍[1] 胡坚[1] 皮士红[1] 

机构地区：[1]天津市儿童医院内科风湿免疫学组,300074

出　　处：《中华儿科杂志》2003年第11期835-838,共4页Chinese Journal of Pediatrics

摘　　要：目的　分析附着点炎相关关节炎 (ERA)的临床特征。方法　 2 0 0 2年 8～ 11月共收治12例ERA ,全部符合ILAR关于幼年特发性关节炎 (JIA)和ERA的分类标准。对性别、年龄、家族史、临床表现、影像学改变、实验室资料及用药选择进行回顾性分析。结果　 12例患儿中 ,男 11例 ,女 1例。年龄 4～ 16岁 ,中位数年龄 10 5岁 ,其中 8岁以上 10例 (83% )。一级亲属中强直性脊柱炎 (AS) 1例 ,炎性下腰痛 3例。 9例存在附着点炎。 11例出现滑膜炎 ,主要为下肢大关节的非对称性少关节炎。 7例对骶髂关节进行了CT扫描 ,1例发现侵蚀样改变而构成幼年AS诊断。 10例有发热 ,1例起病前有腹泻史。 3例因合并尿道炎和漩涡状龟头炎而同时满足赖特综合征的诊断 ,其中 2例出现结膜炎 ,1例合并角膜炎。急性期普遍有炎症指标如白细胞、中性粒细胞、血小板、血沉、C反应蛋白、免疫球蛋白及补体C3 的增高。 4例有轻度贫血。 4例骨髓中见到组织细胞吞噬血细胞现象。 2例血中检测到细小病毒B19DNA ,1例血柯萨奇病毒IgM(+)。本组类风湿因子均为阴性 ,HLA B2 7均为阳性。非甾体抗炎药和柳氮磺吡啶是基本治疗药物。 3例因全身炎症反应剧烈而加用了肾上腺皮质激素作为“桥”治疗。 4例难治性或有髋关节受累者加用了氨甲喋呤 ,其中Objective To study clinical characteristics of children with enthesitis related arthritis (ERA).Methods Twelve patients fulfilling the international league of associations for rheumatolgy (ILAR) criteria for classification of juvenile idiopathic arthritis (JIA) and ERA were referred to our department between August and November, 2002. Their gender, age, family history, clinical manifestations, imaging data, laboratory data and treatment regimens were analyzed retrospectively.Results Of the 12 patients, 11 were male, only one was female; their age ranged from 4 to 16 years, and the median age was 10.5 years. Ten (83%) of the patients were older than eight years. Among their first degree relatives, one had definite ankylosing spondylitis (AS), and 3 presented with a history of inflammatory low back pain. Enthesitis occurred in 9. Synovitis occurred in 11, most of which were oligoarthritis, predominantly affecting large joints of the lower limbs in an asymmetric pattern. Seven patients underwent CT scan, and only one had erosions of the sacroiliac joints to achieve a diagnosis of juvenile AS. Ten had fever at the onset, and one had a history of diarrhea preceding the symptoms of arthritis. Urethritis and balanitis circinata occurred in 3 cases fulfilling the classification criteria of Reiter's syndrome, with conjunctivitis in 2 and corneitis in one. Elevated inflammatory indicators such as white blood cell, neutrophil, platelet, erythrocyte sedimentation rate, C-reactive protein,immunoglobulins and serum complement C3 were common during the acute illness. Mild anemia was found in 4, and reactive hemophagocytosis in 4 bone marrow specimens. DNA of human parvovirus B19 was detected in sera of 2 cases. One had positive IgM antibody to coxsackie virus B. All 12 cases were rheumatoid factor negative and HLA-B27 positive. Nonsteroidal anti-inflammatory drugs and sulfasalazine were the mainstay of treatment. Corticosteroids were added in 3 cases as a “bridge” therapy due to the severe systemic inflammation. Methotr

关 键 词：附着点炎 关节炎 临床特征 回顾性分析 

分 类 号：R725.9[医药卫生—儿科]