关节镜检结合滑膜病检对单膝关节类风湿性关节炎早期诊断价值——附41例随访观察

The early diagnosis value of arthroscopy and synovial biopsy for rheumatoid arthritis with solitary knee synovitis

目的:探讨关节镜检结合滑膜病理检查对单膝关节类风湿性关节炎(rheum atoid arthritis,RA)早期诊断价值。方法:选择本院于1998年9月～2006年5月期间,关节镜检结合病理检查诊断为RA的单膝关节滑膜炎41例,男,19例,女22例,年龄40.5岁。跟踪随访3～11年,平均6.9年,以ARA修订的RA诊断标准作为RA最终诊断依据,统计随访中发展为多关节RA的病例数。结果:41例患者中,13例发展为多关节RA,占总病例数的31.70%(13/41)。回顾分析13例确诊病例,血RF(+)9例,关节滑液RF(+)12例,关节镜下滑膜呈结节样增生13例,血管翳形成6例,滑膜中夹杂坏死纤维素6例。结论:关节镜检查结合滑膜组织学检查对单关节RA早期诊断具有一定价值,还需结合其验室检查,以提高单关节RA早期确诊率。

Objective：The early diagnosis value of arthroscopy and synovial biopsy for rheumatoid arthritis with solitary knee joint was evaluated.Methods：A total of 41 cases were selected from September 1998 to May 2006 in our hosptial,including 19 male and 22 female patients with an average age of 40.5 years who suffered from solitary knee synovitis. All of patients were diagnosed as rheumatoid arthritis confirmed by arthroscopy and synovial biopsy and were followed for 3～11 years （mean 6.9 years）. The RA cases were determined by the criteria of RA diagnosis of American rheumatoid association. Results：For all patients,13 cases（31.70%,13/41）were diagnosed as RA. In those 13 cases,9 cases had positive rheumatoid factor in blood and 12 cases had positive rheumatoid factor in synovial fluid. The synovium of 13 cases had proliferated and enlarged. The creeping pannus were observed in 6 cases and the necrosis fibrin deposition in 6 cases. Conclusion：Arthroscopy and synovial biopsy were helpful for the early diagnosis of RA. However,more evidences were need for RA with solitary knee joint to make a definite diagnosis.