García-Porrúa C, González-Gay M A, Vázquez-Caruncho M, López-Lazaro L, Lueiro M, Fernández M L, Alvarez-Ferreira J, Pujol R M
Hospital Xeral-Calde, Lugo, Spain.
Arthritis Rheum. 2000 Mar;43(3):584-92. doi: 10.1002/1529-0131(200003)43:3<584::AID-ANR15>3.0.CO;2-6.
To examine the frequency and features of erythema nodosum (EN), establish disease associations, and identify the optimal set of predictors for the occurrence of secondary EN.
We performed a retrospective study of an unselected population of patients 14 years and older with biopsy-proven EN diagnosed at a referral hospital between 1988 and 1997. Patients were classified as having either idiopathic EN or EN secondary to other diseases if the skin nodules occurred in the context of a well-defined disease, or if there was a precipitating event in close temporal proximity to the onset of EN.
One hundred six patients (82 women) were diagnosed as having biopsy-proven EN. At the time of diagnosis, no precipitating events or underlying diseases were identified in 36.8% of patients. Sarcoidosis and nonstreptococcal upper respiratory tract infections (URI) were the most common conditions associated with secondary EN. Only 1 of 35 patients with an initial diagnosis of idiopathic EN and a followup of at least 1 year was finally diagnosed as having secondary EN. The best predictive model of secondary EN included an abnormal results on a chest radiograph, a previous history of nonstreptococcal URI, and a significant change in antistreptolysin O (ASO) titer in 2 consecutive determinations performed in a 2-4-week interval. Also, the presence of peripheral synovitis, a positive tuberculin skin test, and a history of diarrhea suggested the presence of secondary EN. This model showed high sensitivity and specificity.
Idiopathic EN is common. A basic procedure including careful medical history-taking, a physical examination for peripheral synovitis, 2 consecutive ASO determinations, a tuberculin skin test, and chest radiography may be sufficient to diagnose EN.
研究结节性红斑（EN）的发病频率及特征，确定其与疾病的关联，并找出预测继发性EN发生的最佳指标组合。
我们对1988年至1997年在一家转诊医院确诊为活检证实的EN且年龄在14岁及以上的非特定人群进行了一项回顾性研究。如果皮肤结节出现在明确的疾病背景下，或者在EN发病的紧密时间范围内有诱发事件，则将患者分类为特发性EN或继发于其他疾病的EN。
106例患者（82名女性）被诊断为活检证实的EN。在诊断时，36.8%的患者未发现诱发事件或潜在疾病。结节病和非链球菌性上呼吸道感染（URI）是与继发性EN相关的最常见疾病。35例最初诊断为特发性EN且随访至少1年的患者中，只有1例最终被诊断为继发性EN。继发性EN的最佳预测模型包括胸部X线片结果异常、既往非链球菌性URI病史以及在2 - 4周间隔内连续两次测定抗链球菌溶血素O（ASO）滴度有显著变化。此外，外周滑膜炎的存在、结核菌素皮肤试验阳性以及腹泻病史提示继发性EN的存在。该模型显示出高敏感性和特异性。
特发性EN很常见。包括仔细询问病史、检查外周滑膜炎、连续两次测定ASO、进行结核菌素皮肤试验和胸部X线检查在内的基本程序可能足以诊断EN。
