儿童反应性关节炎的诊治进展

Progress in the diagnosis and treatment of reactive arthritis in children

反应性关节炎(ReA)泛指远离关节部位的微生物感染后发生的无菌性、非化脓性关节炎。本病的疾病谱很广,依据临床发病特点,可分为人类白细胞抗原B27(HLA-B27)相关性ReA、急性风湿热(ARF)、链球菌感染后反应性关节炎(PSRA)三类。除关节炎外,可伴有胃肠道、皮肤、眼、心脏病变等关节外表现。与成人不同,儿童ReA的发病过程更加复杂。HLA-B27相关性ReA更多见于胃肠道及呼吸系统感染后发生,中轴和骶髂关节累及少见,髋关节及外周关节受累和附着点炎更为常见。ARF最常见于5~15岁的儿童及青少年,以游走性、多发性关节炎为主要特点。儿童PSRA的发病持续时间较成人短,现就儿童ReA的流行病学特点、临床表现、诊治进展及预后进行综述,以提高临床医师对儿童ReA的认识。

Reactive arthritis(ReA)is a kind of sterile,non-purulent arthritis that occurs after microbial infections far from the joints.The disease has a broad spectrum,and it can be classified into three categories based on clinical characteristics:human leukocyte antigen B27(HLA-B27)-associated ReA,acute rheumatic fever(ARF),and post-streptococcal reactive arthritis(PSRA).In addition to joints,it may also involve the gastrointestinal tract,skin,eyes,and heart.Unlike adults,the pathogenesis of ReA in children is more complex.HLA-B27-associated ReA is more common after gastrointestinal and respiratory infections,with less involvement of the central axis and sacroiliac joints and more involvement of the hip and peripheral joints and attachment point inflammation.ARF is most common in children aged 5 to 15 years,characterized by migratory and multiple arthritis.The duration of onset of PSRA in children is shorter than that in adults.This article reviews the epidemiology,clinical manifestations,diagnosis and treatment of ReA in children to improve clinicians′understanding of ReA in children.