Aman S, Risteli J, Luukkainen R, Risteli L, Kauppi M, Nieminen P, Hakala M
Division of Rheumatology, Department of Internal Medicine, University of Oulu, Finland.
Ann Rheum Dis. 1999 Sep;58(9):559-62. doi: 10.1136/ard.58.9.559.
To assess the predictive significance of synovial fluid (SF) analysis for progressive radiological knee joint destruction in arthritis.
Altogether 55 patients with arthritis and knee joint effusion were included in the study. The diagnosis was rheumatoid arthritis (RA) for 44 of them, chronic seronegative spondylarthropathy for seven and juvenile rheumatoid arthritis for four. The mean age of the patients was 51.8 (SD 14.9, range 19-82) years, and the mean duration of disease 10.9 (SD 9.2, range 0.5-37) years. In addition to the routine laboratory tests, different markers of collagen synthesis and breakdown in serum and SF were assessed. The radiological grade of the knee joint was assessed by Larsen's method at the baseline and after a three year follow up.
During the follow up, Larsen's grade deteriorated in 22 (40%) patients. These patients had a significantly higher median level of cross linked carboxyterminal telopeptide of type I collagen (ICTP) in SF at entry than those who had a stable index (p = 0.035). Serum ICTP did not have any predictive value for a specific joint. The median levels of total SF leucocytes (p = 0.012) and the subgroup of polymorphonuclear leucocytes (p = 0.018) were higher in the patients with a stable Larsen's index. However, the relation of SF leucocyte level to radiological progression could not be confirmed in the RA group.
It is concluded that SF analysis may help in the identification of patients with inflammatory arthritis who are at risk for progressive destruction in a particular joint. A high total SF leucocyte level is not necessarily associated with a poor prognosis. Instead, a high SF ICTP level seems to reflect accelerated bone degradation.
评估关节液（SF）分析对关节炎患者膝关节影像学进展性破坏的预测意义。
本研究共纳入55例患有关节炎且伴有膝关节积液的患者。其中44例诊断为类风湿关节炎（RA），7例为慢性血清阴性脊柱关节病，4例为幼年类风湿关节炎。患者的平均年龄为51.8岁（标准差14.9，范围19 - 82岁），平均病程为10.9年（标准差9.2，范围0.5 - 37年）。除常规实验室检查外，还评估了血清和关节液中胶原蛋白合成与分解的不同标志物。膝关节的影像学分级采用Larsen方法在基线期及三年随访后进行评估。
随访期间，22例（40%）患者的Larsen分级恶化。这些患者在入组时关节液中I型胶原交联羧基末端肽（ICTP）的中位数水平显著高于指数稳定的患者（p = 0.035）。血清ICTP对特定关节没有任何预测价值。Larsen指数稳定的患者关节液中总白细胞（p = 0.012）和多形核白细胞亚组（p = 0.018）的中位数水平较高。然而，在RA组中，关节液白细胞水平与影像学进展的关系未能得到证实。
得出结论，关节液分析可能有助于识别炎性关节炎患者中特定关节有进展性破坏风险的患者。关节液白细胞总水平高不一定与预后不良相关相反，关节液ICTP水平高似乎反映了骨降解加速。
