类风湿关节炎的影像学诊断

类风湿关节炎 (RA)的影像学检查近年来发展非常迅速 ,检查手段也不断增多。1　 X线检查常规 X线在 RA诊断中仍起非常重要的作用。小关节周围的梭形软组织肿胀 ,关节间隙的改变及手、足小关节边缘部局限性骨吸收、破坏为较有价值的早期 X线征像。腕关节 RA的最早 X线表现为尺骨茎突内侧软组织肿胀 ,脂肪间隔可模糊或消失。进展期表现为关节软骨破坏 ,关节间隙常呈一致性变窄 ,关节面骨皮质侵蚀性破坏 ,关节囊附着的关节边缘部位出现小囊状的骨缺损 ,膝关节 RA常在胫骨平台内缘形成骨缺损。髋关节受累可出现股骨头软骨下囊变。晚期表现为…     

己酮可可碱对大鼠炎性关节炎的治疗作用

目的 探讨己酮可可碱(PTX)对大鼠Ⅱ型胶原诱导的炎性关节炎(CIA)的疗效和安全性.方法 利用牛Ⅱ型胶原建立Wishar大鼠CIA模型,造模成功后随机分为正常对照组、牛理盐水CIA模型对照组、吲哚美辛阳性药物对照组和PTX治疗组.观察各组大鼠的体质量变化、后足容积变化,并对关节炎的肿胀程度进行评分;对各组大鼠的踝关节拍摄X线片,评价CIA大鼠的软骨和骨的破坏程度;用踝关节的滑膜组织病理学评分分析PTX对CIA大鼠炎症的治疗作用.结果 实验第11～13天成功建立大鼠炎性父节炎模型,P11X治疗组大鼠于第3周开始体质量增长明显高于CIA模型组(P<0.01),踝关节肿胀程度于第17天开始下降;第5周时PTX组和吲哚美辛组的后足容积与正常对照组差异无统计学意义(P＞0.05);FIX组和吲哚美辛组关节滑膜组织充血水肿较CIA组明显减轻,滑膜细胞轻度增生,炎性细胞浸润较少,血管增生和血管翳形成大大减少,未见关节软骨变形、坏死或剥脱,病理损伤计分显著降低(P＜0.01).两治疗组大鼠的x线显示关节周围软组织肿胀、无骨质疏松和骨质破坏.结论 PTX对Ⅱ型胶原诱导的大鼠炎性关节炎具有缓解症状、抑制炎症肿胀的作用,与CIA模型组相比,疗效显著,而且安全性良好.     

糖尿病神经性骨关节病X线、CT诊断

回顾性分析11例15个部位关节经临床确诊的糖尿病神经性骨关节病X线、CT影像学表现.结果膝关节1个、跖跗关节3个、趾跖关节6个、趾间关节5个.X线、CT征象为关节周围软组织肿胀及其内多发钙化斑,关节半脱位,关节腔积液,腔内游离体;关节囊线样钙化,关节间隙狭窄且宽窄不均;邻近关节面不规则骨质破坏、碎裂、溶解;骨质硬化、骨刺形成及骨刺断裂.结论DNOAP多发生在足踝部,以跖跗关节、趾间关节、趾跖关节常见,X线是诊断的最基本手段.     

阿魏酸钠对佐剂关节炎大鼠血清瘦素和白介素-1的影响

目的研究通过阿魏酸钠对佐剂关节炎(AA)大鼠血清中的瘦素(Leptin)、白介素(IL)-1表达水平的影响。方法通过注射完全弗氏佐剂(CFA)0.1 ml/只于大鼠右后足跖部皮内而复制AA动物模型。在建模后的第11天,大鼠继发性关节炎出现。治疗组AA大鼠腹腔内注射阿魏酸钠40 mg.kg-1.d-1,连续注射14 d。直至第26天对大鼠足爪肿胀度的抑制有显著性时,用ELISA法检测各组AA大鼠血清中Leptin、IL-1的表达水平。结果治疗组AA大鼠血清中Leptin水平低于模型组,IL-1水平低于模型组,且血清中Leptin的表达水平与IL-1呈显著正相关。结论阿魏酸钠明显抑制了AA大鼠血清中Leptin、IL-1的表达水平。     

糖尿病神经性骨关节病X线、CT诊断

回顾性分析11例15个部位关节经临床确诊的糖尿病神经性骨关节病X线、CT影像学表现。结果：膝关节1个、跖跗关节3个、趾跖关节6个、趾间关节5个。X线、CT征象为关节周围软组织肿胀及其内多发钙化斑，关节半脱位，关节腔积液，腔内游离体；关节囊线样钙化，关节间隙狭窄且宽窄不均；邻近关节面不规则骨质破坏、碎裂、溶解；骨质硬化、骨刺形成及骨刺断裂。结论：DNOAP多发生在足踝部，以跖跗关节、趾间关节、趾跖关节常见，X线是诊断的最基本手段。     

高迁移率族蛋白-1在大鼠佐剂性关节炎发病中的作用研究

目的探讨高迁移率族蛋白-1(HMGB1)在佐剂性关节炎(AA)滑膜炎和关节破坏中的作用。方法30只雄性SD大鼠分为正常对照组(15只)和AA组(15只)。AA组采用完全弗氏佐剂(CFA)造模。第18天处死所有大鼠,心脏采血,采用Western blot检测血清中HMGB1的表达,对滑膜、关节进行病理组织学检查和免疫组织化学检测HMGB1的表达。结果正常大鼠滑膜细胞胞核呈阳性．胞质多为阴性。AA大鼠滑膜细胞、部分炎性细胞胞质多呈阳性,AA大鼠滑膜HMGB1在胞质表达强度显著增高(P＜0．05)。正常大鼠软骨细胞胞核和胞质均为阳性。骨质区骨细胞胞核和胞质较少呈阳性。AA大鼠软骨区和骨质区HMGB1在胞质的表达显著增高(P＜0．01)。AA组大鼠血清中HMGB1水平显著增高(P＜0．01)。结论HMGB1在AA大鼠滑膜、软骨区、骨质破坏区的胞质中表达明显增强,血清中HMGB1水平升高,这提示HMGB1可能参与AA软骨和骨质破坏病理过程。     

酸敏感离子通道在大鼠佐剂性关节炎关节软骨中的表达

目的 检测酸敏感离子通道(ASICs)在大鼠佐剂性关节炎关节软骨中的表达情况.方法 大鼠右侧后足跖皮内注射弗氏完全佐剂(CFA)诱导佐剂性关节炎(AA)大鼠模型,用半定量反转录-聚合酶链反应(RT-PCR)和Western blot方法检测ASICs在AA大鼠关节软骨的表达.结果 经半定量RT-PCR分析,ASIC1a、ASIC2a和ASIC3在AA大鼠关节软骨中的表达量明显高于正常组,差异有统计学意义(P＜0.01);Western blot进一步检测显示蛋白表达的变化与mRNA变化一致.结论 AA大鼠关节软骨中ASICs的表达增多,可能与关节软骨破坏有关.     

类风湿关节炎的核磁共振成像研究

类风湿关节炎 (ｒｈｅｕｍａｔｏｉｄａｒｔｈｒｉｔｉｓ,ＲＡ)是一个累及周围关节为主的多系统性炎症性的自身免疫病。临床表现为受累关节疼痛、肿胀、畸形、功能下降 ,病变呈持续、反复发作过程。它以纤维样滑膜细胞过度增生、形成血管翳为特征。血管翳由关节边缘部无软骨覆盖区开始逐渐破坏关节软骨及软骨下骨质 ,以及周围肌腱、韧带 ,造成关节的进行性破坏畸形和功能丧失。1　ＲＡ的传统诊断标准临床上 ,常用症状结合Ｘ线平片表现进行诊断 ,即符合1987年美国风湿病协会 (ＡＲＡ)诊断标准。Ｘ线改变包括关节周围软组织肿胀、关节邻近骨质…     

丙酮酸乙酯对胶原诱导性关节炎大鼠的治疗作用

目的探讨丙酮酸乙酯（EP）在胶原诱导关节炎（CIA）大鼠模型中的治疗作用和安全性。方法利用牛Ⅱ型胶原建立Wistar大鼠CIA模型,随机分为CIA对照组和EP干预组,并设立正常对照组。每周观察各组大鼠的一般情况变化,并对双后足进行关节炎指数（AI）评分及测量后足容积;在实验第42、63天分别对各组大鼠的右后足进行放射学及病理学观察。结果 CIA对照组大鼠与正常对照组大鼠比较,有脱毛、精神萎靡,摄食及其他活动减少;EP干预组大鼠精神食欲尚可。体重变化,与正常对照组大鼠比较,CIA对照组大鼠从造模第28天开始,体重增加缓慢;EP干预组从造模第35天开始体重增加程度也有所下降,差异均有统计学意义（P〈0.05）;从造模第56天开始EP干预组体重增加明显,与正常组比较差异无统计学意义（P〉0.05）。关节炎症,EP干预组大鼠造模第28、42、63天AI值分别为3.83±0.71、3.42±0.79、1.50±0.54,明显低于同期CIA对照组AI值4.58±1.08、5.17±1.19、3.67±0.81,差异均有统计学意义（P〈0.05）。足肿胀度,EP干预组大鼠足肿胀度在造模第42、63天分别为（1.58±0.11）、（1.51±0.09）ml,低于CIA对照组足肿胀度（1.97±0.10）、（1.81±0.10）ml,差异均有统计学意义（P〈0.05）。影象学表现,CIA对照组X线示关节间隙消失,严重的可出现骨质破坏、融合;与CIA对照组相比,EP干预组仅可见部分关节有关节间隙模糊、骨质疏松,很少见关节破坏融合。病理学表现,CIA对照组滑膜肥厚,大量炎性细胞浸润,并有骨结构破坏;与CIA对照组相比,EP干预组滑膜细胞增生不明显,有少量炎性细胞浸润,关节软骨和骨组织破坏不明显。EP干预过程中未见明显不良反应。结论 EP能改善CIA大鼠关节炎症状、放射学及滑膜组织病理变化,起到抑制炎症的作用,且安全性好。     

X线、64排能谱CT及3.0T磁共振诊断老年糖尿病患者早期糖尿病足的应用分析

目的探讨分析使用X线、CT、3.0TMRI诊断早期糖尿病足的方法,分析其影响。方法选取该院2016年12月—2017年12月收治的2型糖尿病并发足部症状患者35例,对患者分别行X线、CT、3.0TMRI检查,对结果进行分析。结果 35例患者X线检查结果示27例患者患足有骨质疏松,其中包含10例患足有骨端骨质破坏并周围软组织不同程度肿胀及8例软组织内检钙化影,8例阴性患者;CT检查结果显示29例患者患足有不同程度骨质疏松,其中包含17例骨质破坏并周围软组织不同程度肿胀及15例可见血管壁不规则钙化,6例阴性患者;MRI检查结果显示35例患者患足均有不同程度的骨质信号异常,软组织肿胀、溃疡,关节积液。结论 MRI检查对于早期糖尿病足的诊断明确于CT及X线平片检查,但检查费用高于CT及X线平片,差异有统计学意义(P0.05)。     

Juvenile psoriatic arthritis

Summary Among 664 juvenile chronic arthritis patients cared for in the Out-patient Clinic of the Pediatric Rheumatology Unit of the National Institute of Rheumatology and Physiotherapy 11 were found with juvenile psoriatic arthritis, and their data regarding skin, joint, ophthalmological, laboratory and radiological manifestations were analysed. These patients were categorised according to the four subgroups suggested by Truckenbrodt et al. Considering that the occurrence of the disease is rare, the small number of patients investigated in this study can provide additional data to the study of Truckenbrodt. The higher number of patients with JPA thus studied can give more information for a multicentric evaluation.     

Histologic documentation of gonococcal infection in the absence of a culturable organism

Summary The high incidence of negative routine cultures, in the presence of suppurative involvement of a joint suggested a possible role for alternative diagnostic techniques. Bedside cultures with hypertonic and anaerobic media were utilized to evaluate synovium and synovial membrane in gonococcal arthritis. This is the first histologic documentation of the diagnosis of gonococcal arthritis in the absence of a culturable organism.     

Joint sepsis as a complication of sero-negative arthritis

Summary Septic arthritis is a recognised complication of rheumatoid arthritis but has not been well described in sero-negative spondarthritis. We report 3 patients with sero-negative inflammatory joint disease who developed joint sepsis early in the course of the disease. In none was there a recognisable source of infection. Two cases were complicated by osteomyelitis and in one the sepsis has been recurrent over thirty years.     

Arthritis associated with salmonella infection

Summary Six cases of arthritis caused by or associated with Salmonella infection are reported. It is stated that an arthritis associated with a Salmonella infection cannot be excluded on the negative results of the Widaltest. Consequent upon Salmonella infection two different types of arthritis might develop: a) monoarticular infectious arthritis or b) a subacute reactive oligo-articular arthritis. In this study a patient with a chronic destructive reactive oligoarthritis is described, resembling experimental Salmonella-associated arthritis in rats. This form of arthritis might be regarded as an immune complex mediated disease associated with a chronic infection.     

Experimental animal models resembling rheumatoid arthritis

Summary The experimental animal models of arthritis which in certain aspects share similarities to human rheumatoid arthritis are reviewed. Various methods have been applied to induce in animals experimental models of arthritis which would provide important insights into the aetiopathogenetic mechanisms of human RA. Immunological methods and infectious agents induced the most interesting models. The histology of the synovial tissue, regardless of the inducing mechanisms, is similar to the lesions of RA. Yet, none of these experimental models of arthritis reflects all the articular and systemic features, the immunological profile and the genetic factors which characterize the human disease. The animal models of arthritis reported here and the development of new ones may ultimately offer the information necessary for the understanding of the mechanisms involved in the aetiopathogenesis of human rheumatoid disease.     

Magnetic resonance imaging in patients with inflammatory arthritis of the knee

Summary Magnetic resonance imaging (MRI) permits visualization of anatomic structures not appreciated by conventional radiographic imaging and may quantify inflammatory disease and its progression with greater sensitivity than available techniques. We therefore compared MRIwith clinical evaluation and with radiographic examination of 17 patients with inflammatory arthritis of the knee. We sought to determine anatomic integrity of bone, cartilage, menisci, and ligaments, and to quantify joint effusion and synovial proliferation. Patients studied had rheumatoid arthritis (10patients), juvenile rheumatoid arthritis (4patients), ankylosing spondylitis (1 patient), and monoarticular arthritis (2 patients). In all patients MRI revealed clinically important abnormalities not detected by physical or conventional radiographic exams. These included proliferative synovitis (13 patients), cartilage thinning (2 patients), cartilage erosion (8 patients), bone infarction (1 patient), meniscal injury (1 patient), and synovial invagination into bone (1 patient). Also MRI indicated inflammatory disease to be quantitatively greater than had been appreciated on clinical examination or routine X-ray studies-proliferative synovitis (12 patients), erosion (7 patients), effusion (8 patients), cartilage thinning (11 patients), and ligamentous/meniscal damage (1 patient). These findings led to reassessment of anatomic staging and influenced therapeutic decision for these patients. Thus MRI provides clinically important information about joint integrity and inflammatory disease, with a sensitivity and resolution considerably beyond conventional techniques.     

Multilating rheumatoid arthritis associated with sarcoidosis: A case report

Summary We describe a case of sarcoidosis with opera-glass fingers and outstanding flexion deformity of both knees. Histological examination of skin eruptions and transbronchial lung biopsy revealed the existence of noncaseating epithelioid granuloma. However, the synovial tissue showed chronic inflammation consistent with rheumatoid arthritis without any epithelioid lesions.     

白细胞介素-33促进胶原诱导性关节炎的实验研究

目的 探讨新型细胞因子自细胞介素(IL)-33在胶原诱导性关节炎(CIA)发病中的作用.方法 建它DBA/1小鼠的CIA模型.以牛Ⅱ型胶原(CⅡ)/完全福氏佐剂(CFA)免疫,从免疫后第21天开始每天注射IL-33或磷酸盐缓冲液(PBS)共5 d.免疫后第28天取小鼠淋巴结细胞体外培养,培养上清的细胞因子浓度以酶联免疫吸附试验(ELISA)法检测或Luminex检测.同时检测血清中抗Ⅱ型胶原抗体和血清中的细胞因子浓度.鼠爪脱钙后行病理检查.采用两样本均数的t检验、χ~2检验进行统计学处理.结果 IL-33可使小鼠实验性的关节炎发病加重,致炎性细胞因子和抗Ⅱ型胶原抗体产生增多(P<0.05).PBS组与IL-33组的IgG2a型Ⅱ型胶原抗体为[(1.24±0.33)mg/L和(1.96±0.16)mg/L,P<0.05],而IgG1型抗Ⅱ型胶原抗体为[(1.1±0.4)ms/L和(1.7±0.4)mg/L,P<0.05).结论 IL-33是炎性关节病中的重要致炎因子.这一IL-1家族新成员是潜在的类风湿关节炎(RA)治疗靶点.     

Protrusio acetabuli in juvenile rheumatoid arthritis

Summary Acetabular protrusion (PA) as measured by a line crossing method was studied in 73 patients with juvenile rheumatoid arthritis (JRA) and its frequency found to be 12% (9/73), presenting bilaterally in 5 cases and unilaterally in 4. All patients had some other forms of radiological damage and the presence of PA was predominantly observed in the JRA group with greater age at onset (8 vs 4.2 years; p<0.001) and lower frequency of extraarticular manifestations (22% vs 72%; p<0.01). There was no correlation with type of JRA onset, course of disease, sex, disease duration, seropositivity for rheumatoid factor, and prior steroid intake.     

Lyme arthritis in Belgium. Report of three cases

Summary Three cases of lyme arthritis are reported. The clinical manifestations of lyme disease and the literature are discussed.