Lehtinen J T, Lehto M U, Kaarela K, Kautiainen H J, Belt E A, Kauppi M J
Department of Surgery, Tampere University Hospital and Rheumatism Foundation Hospital, Heinola, Finland.
Rheumatology (Oxford). 1999 Nov;38(11):1104-7. doi: 10.1093/rheumatology/38.11.1104.
To evaluate radiographically the acromioclavicular joint space in patients with long-term rheumatoid arthritis (RA).
A cohort of 74 patients with RA was followed prospectively for 15 yr. At the end point, 148 shoulders were radiographed with a standard method. The acromioclavicular (AC) joint space was examined from the radiographs with a method developed previously for population studies; the joint space was measured at its superior and inferior border, and the average of the two measurements, the integral space, calculated.
Mean AC joint space in RA patients was 4.9 (S.D. 3.7), range 0-20.5 mm; 6.2 mm (S.D. 5.1) in men and 4.5 mm (S.D. 3. 0) in women. An AC joint space wider than 7 mm in men was found in 11 (31%) out of 36 joints and wider than 6 mm in women in 17 (15%) out of 112 joints. Joint space widening was associated (r=0.87, 95% CI 0.82-0.90) with increasing destruction (Larsen grading) of the joint and it seems to be an inevitable consequence of AC joint affection in RA. Joint space widening is more progressive on the caudal side because of the nature of the erosive destruction. Degeneration with joint space narrowing was observed in 8 (11%) patients (11 joints, 7%; three bilateral).
The largest value of the joint space may be used when evaluating rheumatoid AC joint space. In RA patients, a joint space of >7 mm in men and >5 mm in women is a sign of destructive AC joint affection.
通过影像学评估长期类风湿关节炎（RA）患者的肩锁关节间隙。
对74例RA患者进行了为期15年的前瞻性随访。在随访终点，采用标准方法对148个肩部进行了X线摄影。使用先前为人群研究开发的方法从X线片上检查肩锁（AC）关节间隙；在关节间隙的上缘和下缘进行测量，并计算这两个测量值的平均值，即整体间隙。
RA患者的平均AC关节间隙为4.9（标准差3.7），范围为0 - 20.5毫米；男性为6.2毫米（标准差5.1），女性为4.5毫米（标准差3.0）。在36个男性关节中，有11个（31%）的AC关节间隙大于7毫米，在112个女性关节中，有17个（15%）的间隙大于6毫米。关节间隙增宽与关节破坏程度增加（Larsen分级）相关（r = 0.87，95%可信区间0.82 - 0.90），似乎是RA中AC关节受累的必然结果。由于侵蚀性破坏的性质，关节间隙增宽在尾侧更明显。在8例（11%）患者（11个关节，7%；3例双侧）中观察到有关节间隙变窄的退变。
评估类风湿性AC关节间隙时可采用关节间隙的最大值。在RA患者中，男性关节间隙>7毫米、女性关节间隙>5毫米是AC关节破坏性受累的征象。
