儿童赖特综合征22例临床分析

目的 分析总结儿童赖特综合征(RS)的临床特征.方法 2002年8月-2008年9月我院风湿科共收治RS患儿22例,对其临床特征进行回顾性分析.结果 22例患儿中,男19例,女3例.年龄4～14岁,平均10.7岁,其中8岁以上的20例.家族史中有强直性脊柱炎2例,炎性下腰痛和未分化脊柱关节病4例,银屑病2例.均发病于每年6至9月份,10例发病前1个月内有腹泻.21例有发热.20例发生结膜炎,1例合并色素膜炎.12例发生尿道炎,3例仅尿检异常.关节炎主要累及下肢大关节,多为非对称性少关节炎,9例出现附着点炎.19例男性中有10例出现旋涡状龟头炎.普遍有白细胞、中性粒细胞、血小板、血沉、C反应蛋白、免疫球蛋白及补体C3的增高.类风湿因子均阴性,HLA-B27阳性率72.7%.非甾体抗炎药和柳氮磺吡啶是基本治疗药物.14例使用了环磷酰胺(总量0.6～2.0 g),其中4例联用了甲氨蝶呤.4例加用了肾上腺皮质激素.1例合并色素膜炎的患儿使用了环孢素.多数患儿在6个月内完全缓解.结论 儿童RS是一种并不少见的反应性关节炎,临床特征与成人不尽相同,预后较好.

Reiter's syndrome in children:a clinical analysis of 22 cases

Objective To study the clinical features of Reiter's syndrome(RS)in children.Method Twenty-two patients with RS were referred to our department between August 2002 and September 2008.Their clinical features were analyzed retrospectively.Result Of the 22 patients,19 were male,only 3 were female.Age ranged from 4 to 14 years,and the average was 10.7 years,most patients(20/22)were older than eight. Among their relatives,2 had ankylosing spondylitis,4 had undifferentiated spondyloarthropathy or presented with a history of inflammatory low back pain,and 2 had psoriasis.The season of onset of all patients was summer months from June to September every year.Ten had a history of diarrhea within l month preceding the symptoms of arthritis.Twenty-one had fever at the onset.Conjunctivitis occurred in 20 patients,only one was complicated with uveitis.Urethral symptoms occurred in 12 patients,and another 3 patients had abnormal results of urine analysis only.Synovitis occurred in all cases,most of whom had oligoarthritis,predominantly affecting large joints of the lower limbs in an asymmetric pattern with enthesitis occurred in 9.Balanitis circinata was common in male patients(10/19).Elevated inflammatory indicators such as white blood cell,neutrophil,platelet,erythrocyte sedimentation rate,C-reactive protein,immunoglobulins and serum complement C3 were common during the acute illness.All of the 22 cases were negative for rheumatoid factor and 16(72.7%) were HLA-B27 positive.Nonsteroidal anti-inflammatory drugs and sulfagalazine were the mainstay of treatment.Cyclophosphamide was used in 14 patients(total doses 0.6-2.0 g),in 4 cases methotrexate was added.Corticosteroids were added in 4 patients and cyelosporine was given to the patient complicated with uveitis.Most patients achievod full remission within 6 months.Conclusion RS is common in children with clinical features different from those in adults and a relatively good prognosis.