关节病型银屑病37例临床分析

Clinical analysis of 37 cases with psoriasis arthropathica

目的:探讨关节病型银屑病的临床特点。方法:对37例关节病型银屑病患者的临床资料进行回顾性分析。结果:本组病例平均发病年龄32.2岁,男:女为2.4:1。非对称性少数关节炎型最为常见,占45.9%(17例);其次为对称性多数关节炎型,占21.6%(8例),远端指(趾)关节炎型,占16.2%(6例),脊椎关节病型,占10.8%(4例)及残毁性关节炎型,占5.4%(2例)。各型银屑病皮损均可发生关节炎病变。膝关节最为常见(56.8%),其次为指(趾)关节(54.1%)及踝关节(35.1%)。在21例伴有甲病的患者中,19例患有远端指(趾)关节炎,占90.5%。3例患者尿蛋白检查阳性。X线检查常见的改变有关节间隙变窄,骨质疏松和骨质吸收等,亦可见关节骨性融合、骨刺形成和关节残毁性损害等不常见的改变。结论:非对称性多发性关节炎和远端指(趾)易受累是本病的特点,甲病变是远端指(趾)关节炎型的特征。一部分病人可伴有肾脏损害。非甾体类抗炎药、小剂量糖皮质激素、雷公藤多甙、氨苯砜、甲氨蝶呤等和中药的合理联合应用可取得一定疗效。

Objective： To investigate the clinical features of psoriatic arthritis （PsA）. Methods： The clinical data of 37 patients with PsA were analysed retrospectively. Results： Among the 37 patients, the average age of onset was 32.2 years, and the ratio of male to female was 2.4： 1. As for the types of arthritis, asymmetric oligoartieular pattern was the most conunonly observed （45.9%, 17 cases）, followed by symmetric polyarticular （21.6%, 8 cases）, distal interphalangeal （16.2%, 6 eases）, sponyloarthropathy （10.8%, 4 cases） and mutilation （5.4%, 2 cases） patterns. Arthropathy can be observed in all the types of psoriasis. Arthritis of knee was the most conunonly seen （56.8 % ）, followed by interph＇,dangeal （ 54.1% ） and ankle （ 35.1% ）. Twenty - one cases had diseased nails, among which 19 cases had distal interphalangeal arthritis （90.5%）. Three cases had albuminuria. The common radiological findings were joint space narrowing, osteopomsis and erosive changes, but rare changes sueh as spur formation, bone coalescence and destructive changes were also noticed. Conclusion： Asymmetric oligoarthritis and distal interphalangeal joints involvement are characteristic of PsA. Patients with diseased nails are mostly those with distal interphalangeal arthritis . A part of patients with PsA may have renal abnormalities. NSAIDs, low dose of cortlcostemids, Tripterygium wilfordii, methotrexate, DDS, etretinate and Chinese medicine used in cormbination might have good results in the management of PsA.