类风湿性关节炎和血清阴性脊柱关节病患者血清急性时相反应蛋白的测定及其临床意义

目的：观察活动期类风湿性关节炎（RA）和血清阴性脊柱关节病患者血清4种急性时相反应蛋白α1－酸性糖蛋白（AAG）、α1－扶胰蛋白酶（AAT）、触珠蛋白（HPT）和铜蓝蛋白（CER）浓度的变化及其临床意义。方法采用ARRAY360蛋白质测定系统测定61例RA和血清阴性脊柱关节病患者及31例正常对照组血清AAG、AAT、HPT、CER浓度并进行比较,结果RA、血清阴性脊柱关节病及差了炎综合组患者该4项指标浓度均显著高于正常对照组（P＜0．001）,并与血沉、C－反应蛋白呈正相关。结论动态观察血清4种急性时相反应蛋白浓度的变化对照于关节炎患者病变活动的监测以及及药物疗效的判断等有一定的临床指导意义。     

Seronegative Spondyloarthropathy Initiated by Physical Trauma

We undertook this study to demonstrate the pattern of onset and the course of arthritis on the traumatised joint in spondyloarthropathy (SpA) initiated by physical trauma. Among 288 patients with SpA, 12 (4.2%) whose arthropathies were associated with trauma were reviewed retrospectively. There were seven patients with ankylosing spondylitis (AS), three with juvenile onset AS and two undifferentiated SpA. The type of trauma was direct injury to the joint and injuries at other sites, except in spinal surgery, for example. In eight cases the initial evidence of disease was peripheral arthritis. The disease first occurred in traumatised joints in five cases. Only three cases showed recurrent inflammatory episodes in the traumatised joints throughout the disease course. SpA initiated by trauma initially manifested as peripheral arthritis at the traumatised joints in about half of the cases. Inflammatory episodes preferentially involved other joints apart from the traumatised joints throughout the whole course of the disease. Received: 4 August 1999 / Accepted: 25 January 2000     

Histological analysis of the ligamentum flavum of patients with dialysis-related spondyloarthropathy

Dialysis-related spondyloarthropathy (DRS) is a severe complication of long-term hemodialysis that ultimately leads to functional disability of the upper and lower extremities. Although the cause of this disease is still unknown, it is thought that amyloid deposits are involved. 2-Microglobulin (2M) is a major component of amyloid fibrils, some of which are modified with the advanced glycation end-product (AGE). To clarify the pathophysiology of DRS we histologically examined the ligamentum flavum of the cervical spine in 15 patients with DRS. The mean duration of hemodialysis was 20 years (12–27 years). In addition to the congo red stain for amyloid, 2M and AGE were detected by immunohistochemical methods. Macrophages were stained with CD68 antibody. Amyloid deposits were found in tissues, although the extent of the stained area differed among the patients. Part of the amyloid deposit area was positively immunostained for 2M and AGE. In 10 cases macrophages positive for CD68 infiltrated around the amyloid deposits. Comparing these histological findings with the dialysis duration, more positive staining areas for 2M and AGE were found in the tissue from patients with long-term dialysis. These findings suggest that both 2M and AGE play roles in the pathogenesis of DRS.     

Imiquimod: potential risk of an immunostimulant

A 19-year-old woman with severe HLA B27 spondyloarthropathy whose disease was controlled on cyclosporin, methotrexate and prednisolone had human papillomavirus infection and developed cervical dysplasia and a large number of cutaneous and vulval warts. These were not responsive to cryotherapy, salicylic acid or cimetidine, so she was treated with topical imiquimod 5% cream. Two weeks after starting this treatment she had a significant flare of her spondyloarthropathy. She was so ill that she stopped using the imiquimod cream. She had full resolution of her warts after 3 weeks' treatment with imiquimod cream, but her spondyloarthropathy took more than 3 months to improve, despite significant augmentation of her immunosuppression. This case highlights the potential risk of using imiquimod cream (an immunostimulant) in a patient who has a condition requiring immunosuppression, such as autoimmune disease or an organ transplant.     

Spondyloarthropathies: an overview

Abstract
Spondyloarthropathies are important and common inflammatory arthropathies that occur in approximately 2% of the population. They are often underrecognized. The diagnosis features the presence of asymmetrical, predominately lower limb arthritis and/or inflammatory back pain. The spondyloarthropathies can be subdivided into several disease subcategories, including ankylosing spondylitis, Reiter's/reactive arthritis, psoriatic arthritis, inflammatory bowel disease-associated arthritis and a large group of undifferentiated spondyloarthritis. The interactions between infectious agents and the individual's genetic background are important aetiological factors. Therapies for these conditions include physical therapy, non-steroidal anti-inflammatories and disease-modifying drugs. (Intern Med J 2002; 32: 40–46)     

Varied presentations of enthesopathy

BACKGROUND: The concept of "enthesis organ" allows a new look at the nature of enthesis involvement in some rheumatic and nonrheumatic systemic disorders. OBJECTIVES: To describe the various presentations of enthesopathy in the course of systemic medical disorders using the available literature data. METHODS: Review of relevant articles from 1996 to 2006 retrieved by a Medline search utilizing the index terms "enthesis," "enthesitis," and "tendonitis." The list of articles reviewed herein is not exhaustive, with preference given, where possible, to studies and surveys over case reports as well as the most recent literature reflecting new developments on the subject. RESULTS: Enthesis is defined as the site of insertion of a tendon, ligament, fascia, or articular capsule into bone. Pain originating in the free nerve endings enriched entheses (enthesalgia) may represent a potential cause of chronic musculoskeletal pain in some individuals. Enthesis involvement in the disease process is well appreciated in spondyloarthropathies and in rheumatoid arthritis, though overshadowed by synovitis in the latter. Calcium deposition diseases may constitute the most significant articular cause of enthesopathies in the general population. New data may shed light on the possible pathophysiologic role of enthesopathy in the development of osteoarthritis. Various metabolic and endocrine conditions may manifest with enthesopathy features. The pathogenic mechanisms of enthesis involvement are not uniform and differ in the diverse disorders. CONCLUSIONS: The concept of enthesopathy as a variety of syndromes in the course of many rheumatic, metabolic, and endocrine disorders should be appreciated. Exercise of a high level of suspicion toward enthesopathic involvement, and greater knowledge of enthesopathy's characteristic patterns and diagnostic possibilities, may allow better management of many patients in rheumatology practice.     

Trauma to the ankylotic spine: imaging spectrum of vertebral and soft tissue injuries

The objectives of the study were to review the clinical entities that can cause ankylosis of the spine and to illustrate the spectrum of traumatic injury patterns. Ankylosing spondylitis, diffuse idiopathic systemic hyperostosis, degenerative spondyloarthropathy, and spinal canal stenosis can render the spine susceptible to trivial trauma. Multidetector computed tomography and magnetic resonance imaging can accurately diagnose vertebral and soft tissue traumatic injury patterns in this patient population.     

下肢肌腱端病超声诊断

目的 探讨血清阴性脊柱关节病（SPA）和类风湿关节炎（RA）下肢肌腱端病的声像图特征。 方法 回顾性分析经临床确诊的43例SPA患者（SPA组）双下肢5处肌腱端声像图特征,并与40例RA患者（RA组）和30例健康志愿者（HC组）的检查结果进行比较。发现具有肌腱端增厚、肌腱端深部滑囊积液、肌腱端内钙化灶、肌腱端骨赘形成或骨侵蚀、肌腱端彩色血流信号阳性,即可判定为肌腱端异常。 结果 SPA组、RA组和HC组分别有93%、85%和23%的患者检测到至少一处肌腱端异常,SPA组与RA组肌腱端异常的超声检出率比较,差异无统计学意义（P>0.05）,但均高于HC组的检出率（P<0.05）。SPA组滑囊积液累及的肌腱端所占比例少于RA组（8.6％vs 14.0％,P<0.05）,且SPA组滑囊积液的程度轻于RA组[（3.92±1.79 ）mm vs（5.97±2.63）mm,P<0.05];而其他声像图异常所累及的肌腱端所占比例,SPA组与RA组比较差异无统计学意义（P>0.05）。HC组常见的异常是跟腱附着点远段腱内钙化灶以及骨赘形成,肌腱端均未发现血流信号和滑囊积液。 结论 超声检测下肢肌腱端病的敏感性较高,但声像图表现缺乏特异性;肌腱端深部滑囊积液的严重程度可为病因学诊断提供一定的参考价值。