以外周关节炎为首发的青少年强直陛脊柱炎的诊断特点

目的探讨以外周关节炎为首发的青少年强直性脊柱炎（AS）的诊断特点，避免误诊误治。方法回顾性分析我院2003年1月～2008年1月诊治的38例以外周大关节为首发症状的青少年强直性脊柱炎的临床特点。结果38例9～18岁的以外周关节炎为首发的青少年AS男性患者，外周关节炎首发部位分别为膝关节18例，踝关节8例，髋关节7例，肘关节3例，足跟末端跟腱2例。骶髂关节X线拍片或CT检查，单侧Ⅰ级者18例，双侧Ⅰ级者9例，单侧Ⅱ级者6例，双侧Ⅱ级者4例，Ⅲ级者1例，其中Ⅰ级和Ⅱ级单侧者共33例（86．8％），双侧Ⅱ级以上者共5例（13．2％）。所有患者HLA—B27阳性。结论青少年AS的临床特点是以外周关节炎／滑膜炎为首发主要症状，缺乏典型的影像学表现，早期诊断主要根据病史、体征和实验室检查，X线检查一般不作为主要依据。

The diagnosis features of juvenile ankylosing spondylitis with the leading symptom of peripheral monoarthritis

Objective To investigate the features of juvenile ankylosing spondylitis with the leading symptom of peripheral monoarthritis to avoid the miss diagnosis and mistreatment. Methods Thirty-eight patients, aged from 9 to 18, with this condition were involved in this retrospective study. Results The first onset was gonarthritis （n=18）, ankle arthritis （n=8）, eoxarthritis aneonitis （n=7）, Achilles tendinitis（n=2）. X-ray imaging or CT scan for the sacroiliac joint demonstrated unilateral grade Ⅰ （n=18）, bilateral grade Ⅰ（n=9）, unilateral grade Ⅱ（n=6）, bilateral grade Ⅱ （n=4）, and grade Ⅲ and above （n=1）. Patients with unilateral account for 86.8% （n=33） of all; patients with bilateral condition account for 13.2% （n=5）. Conclusions Juvenile ankylosing spondylitis is eharaeterised by the leading symptom of peripheral monoarthritis. Almost all patients are HLA-B27 positive, and lack typical imaging manifestations. Therefore, history, physical and lab examinations are major evidence for early diagnosis, instead X-ray imaging