肠病性关节炎30例临床特征分析并文献复习

目的 通过分析炎性肠病伴发关节炎的临床特征,提高对其的认识,以及探讨其与HLA-B_(27)的相关性.方法 分析30例炎性肠病(溃疡性结肠炎、克罗恩病)伴发脊柱关节病变的临床表现、实验室检查及x线表现.结果 肠病性关节炎患者30例,男14例,女16例.出现肠道表现的年龄16～48(32.2 ±11.0)岁,病程1个月～20(5.9±3.4)年,出现关节炎的年龄15～52(43.4±6.8)岁,出现肠道表现与关节炎或发生腰背痛的时间间隔为0～13(4.2±4.0)年.26例患者外周关节受累,其中14例的表现极似类风湿关节炎;22例患者腰背痛,其中7例HLA-B_(27)阳性,且13例患者有影像学骶髂关节病变.关节外的表现包括:24例发热,6例肌腱端炎,4例眼炎,l例腊肠趾.9例患者HLA-B_(27)阳性.结论 炎性肠病相关的关节炎表现复杂多样,可表现为多关节对称性受累、单或寡关节和(或)中轴关节受累,肠病性关节炎骶髂关节受累与HLA-B_(27)相关.

The clinical characters of 30 patients with enteropathic arthritis and literature review

Objective To better understand the clinical characters of enteropathic arthritis patients. Methods The clinical, laboratory and X-rays data of 30 enteropathic arthritis in-patients were analyzed. Results Among the 30 patients, 14 were male, 16 were female. Average age at onset of gastroenteric manifestations was 16-48 (32.2 ±11.0) years old. The course of disease was 1 month-20 (5.9 ±3.4) years. Average age at onset of arthritis was 15-52 (43.4±6.8) years old. The average interval between onset of diarrhea and arthritis was 0-13 (4.2±4.0) years. Peripheral arthritis was founded in 26 (87%) patients, and only 4 felt low back pain at onset. During the disease course, peripheral arthritis in 14 (54%) patients was similar to rheumatoid arthritis. The history of low back pain or buttock pain Wag recorded in 22 (73%) patients. Extra-articular features including fever occurred in 24 patients, enthesitis in 6, iritis or conjunctivitis in 4, dactulifts in l were observed. HLA-B_(27) was positive in 36% (9/25) patients. Sacroiliitis in X-ray or CT was observed in 59% patients. Conclusion The clinical manifestations of enteropathic arthritis are characterized by pauciarticular arthritis or symmetric polyarthritis or (and) sacroiliitis, a wide spectrum of extra-articular features, presence of HLA-B_(27) and familial history of spondyloarthropathies. As other spondylearthropathies, the sacroiliitis in enteropathic arthritis was also associated with HLA-B_(27).