合并膝关节急性疼痛的强直性脊柱炎早期临床特点分析

【摘要】目的了解以膝关节急性肿痛为首发症状的强直性脊柱炎（ankylosingspondylitis，AS）早期病情特征，以提高诊治水平。方法对2009年12月至2012年12月，我院经治的21例合并膝关节急性肿痛强直性脊柱炎患者的早期临床特点、影像学及实验室检查结果进行回顾性分析。结果年龄17—45岁。21例首发症状以患侧膝关节肿痛为主。膝关节腔积液黄白色、浑浊，涂片镜检白细胞4＋，膝关节滑膜组织为炎性肉芽组织。血沉、C反应蛋白、纤维蛋白原均高于正常，18例HLA—B27阳性。磁共振提示膝关节滑膜增生、关节腔内大量积液。16例骶髂关节及脊柱x线片显示，均无明显异常改变。结论强直性脊柱炎发病隐匿，往往以膝关节急性肿痛为首发症状，误诊率及漏诊率高。加强年轻患者早期筛查、需仔细询问病史、详细查体、密切观察病情变化，对强直性脊柱炎早期诊治有价值。

An analysis on the early clinical features of ankylosing spondylitis combined with the pain of knee

objective To explore the early clinical featrures of ankylosing spondylitis （ AS ） combined with the knee acute pain as the first symptom to improve the treatment. Methods From December 2009 to December 2012, there were 21 cases of ankylosing spondylitis combined with the first symptom of acute pain of the knee joint. The early clinical features, imaging and laboratory parameters were recorded and retrospectively analyzed. Results The age of the patients was ranging from 17 to 45 years. The first symptom of 21 patients was mainly knee acute pain. Knee joint effusion was yellow and turbid. Smear leucocyte under microscope was 4 ＋. Synovial tissue of the knee joint was inflammatory granulation tissue. The erythrocyte sedimentation rate （ ESR ）, C-reactive protein amount, and fibrinogen amount were higher than the normal. 18 cases of HLA-B27 were positive. MR/of the knee joint showed that there were synovial proliferation and joint effusion. X-ray of sacroiliac joint and spine in 16 cases revealed that there were no obvious abnormal changes. Conclusions With unconspicuous onset, acute pain of the knee joint is always regarded as the first symptom of ankylosing spondylitis. Missed and delayed diagnosis rate are high. Early screening for the knee symptoms of young patients, better understanding of history, careful examination and close observation of the disease are necessary to provide valuable information for the early disagnosis and prevention of ankylosing spondylitis.