Lehtinen J T, Kaarela K, Belt E A, Kauppi M J, Skyttä E, Kuusela P P, Kautiainen H J, Lehto M U
Rheumatism Foundation Hospital, Heinola, Finland.
Rheumatology (Oxford). 2001 Oct;40(10):1141-5. doi: 10.1093/rheumatology/40.10.1141.
To evaluate radiographically the humeroulnar (HU) and humeroradial (HR) joint spaces in patients with long-term rheumatoid arthritis (RA).
An inception cohort of 74 patients with RA were followed for 15 yr. At the end-point, 148 elbows were radiographed by a standard method. The HU and HR joint spaces were examined from the anteroposterior radiographs by measuring the shortest tangential distance in the middle of the joints. Destruction of the elbow joints, assessed with the Larsen method on a scale of 0-5, was studied in relation to the joint-space measurements.
Mean (s.d.) HU joint space (n=148) in RA patients was 2.5 (1.1) mm, range 0-4 mm [2.9 (0.8) mm in men and 2.4 (1.1) mm in women]. Mean (s.d.) HR joint space (n=140) was 2.3 (0.9) mm, range 0-4 mm [2.5 (0.8) mm in men and 2.3 (1.0) mm in women]. HU and HR spaces of the affected joints (Larsen grades 2-5) [1.9 (s.d. 1.1) and 1.8 (0.9) mm respectively] were notably narrower than those of the unaffected (Larsen grades 0-1) joints [3.1 (0.7) and 2.9 (0.6) mm]. All the joints graded as Larsen 4 or 5 (n=13) had a value of 0 mm for both joint spaces. Both the HU and the HR joint-space narrowing was associated with increasing destruction (Larsen grading) of the joint. [r= -0.69 (95% CI -0.77 to -0.60) and r= -0.70 (-0.78 to -0.60)]. The monotonic narrowing was significantly increasing from unaffected (Larsen 0, 1), slightly (2), moderately (3) to severely (4, 5) affected joints (P<0.001). A step in this process occurred between Larsen grades 3 and 4, when the mean joint space diminished from 1.4 and 1.5 respectively to 0 mm.
Joint-space narrowing is a frequent consequence of rheumatoid affection of the elbow joint. HR joint space decreases together with HU joint space; however, the HR joint space is already slightly narrower at the start. The narrowing is a rather late phenomenon, occurring only after erosive destruction. This should be borne in mind when using the Larsen method to evaluate changes in the elbow joint.
通过影像学评估长期类风湿关节炎（RA）患者的肱尺（HU）和肱桡（HR）关节间隙。
对74例RA患者的起始队列进行了15年的随访。在终点时，采用标准方法对148个肘部进行了X线摄影。通过测量关节中部的最短切线距离，从前后位X线片上检查HU和HR关节间隙。采用Larsen方法在0 - 5级量表上评估肘关节破坏情况，并与关节间隙测量结果相关联进行研究。
RA患者的平均（标准差）HU关节间隙（n = 148）为2.5（1.1）mm，范围为0 - 4 mm[男性为2.9（0.8）mm，女性为2.4（1.1）mm]。平均（标准差）HR关节间隙（n = 140）为2.3（0.9）mm，范围为0 - 4 mm[男性为2.5（0.8）mm，女性为2.3（1.0）mm]。受累关节（Larsen分级2 - 5级）的HU和HR间隙[分别为1.9（标准差1.1）和1.8（0.9）mm]明显窄于未受累关节（Larsen分级0 - 1级）[分别为3.1（0.7）和2.9（0.6）mm]。所有评为Larsen 4级或5级（n = 13）的关节，其两个关节间隙值均为0 mm。HU和HR关节间隙变窄均与关节破坏增加（Larsen分级）相关[r = -0.69（95%可信区间-0.77至-0.60）和r = -0.70（-0.78至-0.60）]。从未受累（Larsen 0、1级）、轻度（2级）、中度（3级）到重度（4、5级）受累关节，关节间隙单调变窄显著增加（P < 0.001）。在Larsen分级3级和4级之间出现了这一过程中的一个台阶，此时平均关节间隙分别从1.4和1.5减小到0 mm。
关节间隙变窄是肘关节类风湿病变的常见后果。HR关节间隙与HU关节间隙一起减小；然而，HR关节间隙在开始时就已略窄。关节间隙变窄是一个相当晚出现的现象，仅在侵蚀性破坏后发生。在使用Larsen方法评估肘关节变化时应牢记这一点。
