Classification of inflammatory arthritis by enthesitis
Classification of inflammatory arthritis by enthesitis
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DOI：
10.1016/s0140-6736(97)12004-9
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发表时间：
1998-10-03
期刊：
影响因子：
168.9
通讯作者：
Emery, P
中科院分区：
文献类型：
--
作者：
McGonagle, D;Gibbon, W;Emery, P
早期滑膜炎的影像学研究表明，与脊柱关节病相关的肿胀关节出现的第一个异常是附着点炎（韧带、肌腱或关节囊与骨连接部位的炎症）。我们认为脊椎关节病的滑膜炎是继发于附着点释放促炎介质，而类风湿性关节炎的滑膜炎是原发性的。这一建议允许将关节炎分类为原发性滑膜（类风湿性）或附着点（脊椎关节病样），并允许区分预后良好的多发性关节炎（脊椎关节病样）和预后不良的多发性关节炎（类风湿性关节炎）。脊椎关节病的发病机制，特别是HLA-B27和微生物所起的作用，应在附着点而不是滑膜中进行评估。
Imaging studies of early synovitis suggest that the first abnormality to appear in swollen joints associated with spondyloarthropathy is an enthesitis (inflammation at sites where ligaments, tendons, or joint capsules are attached to bone). We propose that the synovitis of spondyloarthropathy is secondary to liberation of proinflammatory mediators from the enthesis, whereas the synovitis of rheumatoid arthritis is primary. This suggestion allows a classification of arthritis as either primary synovial (rheumatoid-like) or entheseal (spondyloarthropathy-like) and allows differentiation of presentation of a polyarthritis with a good prognosis (spondyloarthropathy-like), from that with a bad prognosis (rheumatoid arthritis). Pathogenesis of spondyloarthropathy, in particular the part played by HLA-B27 and micro-organisms, should be assessed at the enthesis rather than in the synovium.