A WIDER SPECTRUM OF SPONDYLOARTHROPATHIES
A WIDER SPECTRUM OF SPONDYLOARTHROPATHIES
复制标题
DOI：
10.1016/0049-0172(90)90023-9
复制
发表时间：
1990-10-01
影响因子：
5
通讯作者：
VANDERLINDEN, SM
中科院分区：
文献类型：
--
作者：
KHAN, MA;VANDERLINDEN, SM
与其他病因不明的疾病一样，强直性脊柱炎（AS）和相关脊柱关节病（SpA）的诊断基于临床和X线特征。目前对其中一些疾病的诊断标准过于局限，没有认识到存在更广泛的疾病谱。例如，放射学检查发现骶髂关节炎是非常常见的AS，但可能不是一个强制性的表现，特别是在早期或非典型形式的疾病。累及中轴骨骼（包括骶髂关节）的关节炎可出现在一些X线检查无糜烂性病变证据的患者中。赖特综合征的疾病谱也已大大拓宽，并且观察到“不完全”形式的赖特综合征比关节炎、结膜炎和尿道炎的经典三联症更常见。近年来，术语“B27相关反应性关节炎”被用于指肠道或泌尿生殖道感染后的SpA，疾病谱包括典型的Reiter综合征的临床表现。银屑病SpA的临床谱已得到更好的阐明。一些定义不太明确的B27相关临床综合征包括血清阴性的少关节炎、多关节炎或下肢趾炎（“香肠样”脚趾），以及由跟骨（和跗骨）骨膜炎引起的足跟痛。这些和其他未分化的SpA在以前的流行病学研究中被忽视，因为现有的分类标准的不足。欧洲脊柱关节病研究组（ESSG）已经完成了一项研究，旨在为整个SpA患者组制定初步分类标准，具体目的是包括未分化的SpA患者。
As in other diseases of undetermined etiology, the diagnosis of ankylosing spondylitis (AS) and related Spondyloarthropathies (SpA) is based on clinical and roentgenographic features. The current criteria for diagnosis of some of these diseases are too restricted, and do not recognize the existence of a much wider disease spectrum. For example, radiographically detected sacroiliitis is extremely frequent in AS, but may not be an obligate manifestation, especially in early or atypical forms of the disease. Arthritis involving the axial skeleton, including the sacroiliac joints, can be present in some patients without evidence of erosive disease roentgenographically. The disease spectrum of Reiter's syndrome has also been broadened considerably, and “incomplete” forms of Reiter's syndrome are observed much more commonly than the classical triad of arthritis, conjunctivitis, and urethritis. The term “B27-associated reactive arthritis” has been used in recent years to refer to SpA following enteric or urogenital infections, and the disease spectrum includes the clinical picture of typical Reiter's syndrome. The clinical spectrum of psoriatic SpA has been better clarified. Some of the less well defined B27-associated clinical syndromes include seronegative oligoarthritis, polyarthritis, or dactylitis (“sausagelike” toes) of the lower extremities, and heel pain caused by calcaneal (and tarsal) periostitis. These and other undifferentiated SpA have been ignored in previous epidemiological studies because of the inadequacy of the existing classification criteria. The European Spondylarthropathy Study Group (ESSG) has completed a study aimed at developing preliminary classification criteria for the whole group of SpA patients, with the specific intention of encompassing patients with undifferentiated SpA.