幼年银屑病关节炎

Juvenile psoriatic arthritis

患儿,男,12岁。主因双足跟肿痛1年半,加重伴右膝、踝关节肿痛及活动受限2月,右髋关节痛1周入院。否认银屑病家族史。双手指甲呈"顶针"样凹陷;双足掌跖皮肤有对称性红斑、鳞屑性斑块伴脓疱;指(趾)无"腊肠"样改变。双下肢"4字"试验阴性,右侧浮髌试验(+)。ESR增快,CRP升高类风湿因子(RF)阴性,人类白细胞抗原(HLA-B27)(+),抗核抗体(ANA)、抗可提取核抗原抗体(ENA)、抗双链DNA抗体(ds-DNA)抗体阴性。双骶髂关节核磁平扫及增强未见异常。双膝、踝关节超声示右膝、踝关节骨皮质侵蚀改变伴积液。皮肤活检病理结果符合银屑病。诊断幼年银屑病关节炎(juvenile psoriatic arthritis,JPsA)。经非甾体抗炎药、柳氮磺吡啶和关节腔注射长效皮质激素治疗后,症状无明显好转,ESR继续增快,故改用来氟米特(Leflunomide)加anti-TNF的生物制剂依那西普(Etanercept)治疗。2周后,患儿症状明显好转,ESR接近正常,CRP阴性,出院后继用来氟米特和依那西普治疗。

A case of juvenile psoriatic arthritis in a 12 year-old boy was repdrted. The patient had a history of one and half a year of bilateral heel pain, followed by pain in the right knee and ankle and right hip joint. He developed psoriatic lesions affecting his nails and skin. He had increased erythrocyte sedimentation rate （ESR） and C-reactive protein （CRP） contents. Human leukocyte antigen （HLA） B27 was detected but serum rheumatoid factor was not in the patient. A skin biopsy revealed psoriasis and ultrasonography demonstrated synovitis in right knee and ankle. Juvenile psoriatic arthritis was diagnosed based on his physical, laboratory and skin biopsy findings. A treatment with nonsteroidal antiinflammatory drugs and sulfasalazine produced no effect. Leflunomide in conjunction with anti-TNF biologic agents （Etanercept） was administered, followed by symptomatic improvement 2 weeks later.