银屑病性关节炎的临床特点及影像表现

Clinical and Radiological Features of Psoriasis Arthropathica

目的探讨银屑病性关节炎(PsA)的临床特点及影像表现。方法对35例银屑病性关节炎的临床资料进行分析。结果21例皮损先于关节炎出现,5例皮损和关节症状同时发生,关节炎先发者9例。27例伴指、趾甲损害。不对称少关节炎型16例;脊椎炎型4例;远端指(趾)关节炎型2例;对称多关节炎型12例;掌跖脓疱病伴胸锁骨关节炎型1例。共32例患者接受X线检查,25例有PsA的X线征象。其中远端小关节受累13例(40.6%),膝关节受累8例(25%),踝关节受累7例(21.9%),骶髂关节受累3例(9.4%),其中6例为多关节同时受累(包括脊柱及髋关节受累)。11例患者接受CT检查,7例有PsA的CT改变。结论远端指(趾)关节受累是PsA的特征性表现。若传统的X线检查所见仍不足以为临床高度怀疑PsA患者提供诊断依据时或需监测早期PsA疗效时,可根据实际情况选择CT或磁共振成像作进一步检查。

Objective To assess the clinical and radiological features of psoriasis arthro pathica （PsA）. Me,otis An analysis on clinical data of 35 patients with CA was made. Results Among 35 patients, the manifestation of skin lesions was prior to arthritis in 21 cases, the occurrence of arthritis was prior to skin lesions in 9cases, and both two kinds of symptoms appeared simultaneously in 5 cases. Finger nail and toenail involvement was found in 27 cases. As for the type of PsA,16 cases belonged to asymmet- rical oligoarthritis,12 to symmetrical polyarthritis,4 to spinal form of PsA,2 to distal interphalangeal arthritis and 1 to eases to pustulosis palmopala-ntaris with osteoarthritis stemoclavieulatis. All 32 cases＇ roentgenograms suggested typical radio-logical changes of PsA 25 cases. The involvement of various joints in the proees of disease as shown on X-ray film in order of frequency was：the small joints of distalend and foot in B cases（40.6% ） , Knee joints in 8 eases （25%）and ankle joints in 7 cases （21.9%）, Sacroiliac joints in 3 cases（9.4% ）. Many joints in 6 cases of them were involved simuhaniouly（ ineluds backbone and hip joint）. All 11 eases＇ roentgenogr-ams suggested CT changes of PsA 7 cases. Conclusion Multipe distal inerphalangeal involv-ement was characteristic of PsA. For patient suspected of PsA and who have nor- real or questi-onable results on hand（ including wrist）radiography,or for monitoring the treatment of PsA, further wrist MR or CT examination should be advisable in PsA patient for early diagnosis or treatment.