银屑病关节炎与强直性脊柱炎的对比研究

Comparison of the clinical characters of psoriatic arthritis with ankylosing spondylitis

目的 :提高对同属脊柱关节病的两种炎性关节病的认识。方法 :比较分析 60例银屑病关节炎 ( PA)和61例强直性脊柱炎 ( AS)患者的临床特征。结果 :5 3例 ( 88.3 % ) PA以外周关节炎起病 ;5 0例 ( 83 .3 % ) PA出现手足小关节受累 ,其中 3 2例 ( 5 3 .3 % )有 DIP受累 ,而近半数的 AS患者以腰背疼痛为首发表现 ,主要累及的外周关节是下肢大关节 ,尤其是髋关节病变明显多于 PA患者 ( P<0 .0 5 )。PA与 AS有很相似的关节外表现 ,但腊肠趾(指 )在 PA更多见 ( P<0 .0 5 )。 2 1例 PA出现骶髂关节炎 (脊柱炎 ) ,其 HL A - B2 7阳性率为 85 .0 % ( 17/ 2 0 )。结论 :PA与 AS不同在于多以外周关节炎发病 ,伴 DIP受累的多关节炎是 PA的特征性表现 ,而中轴关节受累常无症状 ,但与 HL A- B2

Objective:To better understand the clinical characters of psoriatic arthritis (PA) and ankylosing spondylitis (AS). Methods:Sixty inpatients with PA were chosen and compared with 61 AS depending on type of arthritis, extra articular features, radiographic findings, laboratory tests and the association between sacroiliitis and HLA B27. Results:Fifty three PA patients had peripheral arthritis and only 6 felt low back pain at the onset of the disease. Involvement of the small joints of hands or feet was observed in 50 PA patients and distal interphalangeal joints (DIP) involvement in 32. Back pain and stiffness were first symptoms in half of patients with AS. Similar extra articular features were found in PA and AS patients except dactylitis. sacroiliitis on X ray films was noted in 21 PA patients. HLA B27 was positive in 50% (20/40) of PA patients, but the positive rate of HLA B27 increased to 85 0% (17/20) in patients with sacroiliitis similar to that (86 9%) in AS. Conclusion:Peripheral arthritis is the common clinical feature of PA at the onest, especially the small joints of hands and feet. Polyarthritis with DIP involvement is a characteristic manifestation of PA. The axial joint involvement is not usually seen but it is often associated with HLA B27 if presenting.