幼年型类风湿关节炎的放射学结果及其与功能残疾的关系。

Radiologic outcome and its relationship to functional disability in juvenile rheumatoid arthritis.

作者信息

Oen Kiem, Reed Martin, Malleson Peter N, Cabral David A, Petty Ross E, Rosenberg Alan M, Cheang Mary

机构信息

Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada.

出版信息

J Rheumatol. 2003 Apr;30(4):832-40.

PMID:12672208

Abstract

OBJECTIVE

To determine the radiologic outcome in juvenile rheumatoid arthritis (JRA) and the relationship of radiologically detected joint damage to functional disability using multivariate analyses.

METHODS

Selection criteria included a diagnosis of JRA made by 1977 American College of Rheumatology criteria, onset of arthritis > or = 5 years prior to study, current age > or = 8 years, a minimum grade 3 reading ability, and the availability of radiographs. Disability was measured by the Childhood Health Assessment Questionnaire (CHAQ) and Steinbrocker classifications. Radiographs taken within 2 years after onset (early) and the most recent radiographs (late) were examined by a single pediatric radiologist blinded to patients' identities, diagnoses, and outcomes. Multiple regression analyses were performed.

RESULTS

On late radiographs the frequencies of joint space narrowing were 38, 14, 43, and 79%, respectively, among patients with systemic, pauciarticular, rheumatoid factor (RF) negative polyarticular, and RF positive polyarticular onset; erosions occurred in 63, 25, 39, and 75%, respectively. Early erosions were most frequent in patients with RF+ polyarticular onset, while both joint space narrowing and erosions occurred early in systemic onset. Radiologic signs of joint damage were most frequent at hips and wrists, while knees and ankles were relatively spared. Based on patients who had radiographs performed within one year of clinical study, 17.7% of the variation in CHAQ score was explained by joint space narrowing, 32.4% by pain, and 5% by a severe rating on physician's global estimate of disease activity. The odds of a Steinbrocker class > I were increased by joint space narrowing, pain, systemic onset, and active joint count.

CONCLUSION

Differences in the frequencies and patterns of joint damage occur both among JRA onset subtypes and among individual joints. Radiographic damage, especially joint space narrowing, correlates with functional disability. However, pain is the major contributor to variation in CHAQ scores.

摘要

目的

通过多变量分析确定青少年类风湿性关节炎（JRA）的放射学结果，以及放射学检测到的关节损伤与功能残疾之间的关系。

方法

选择标准包括根据1977年美国风湿病学会标准诊断为JRA，关节炎发病时间在研究前≥5年，当前年龄≥8岁，最低三年级阅读能力，以及有X光片。残疾程度通过儿童健康评估问卷（CHAQ）和斯坦布鲁克分类法进行测量。由一位对患者身份、诊断和结果不知情的儿科放射科医生检查发病后2年内拍摄的X光片（早期）和最近的X光片（晚期）。进行多元回归分析。

结果

在晚期X光片上，全身型、少关节型、类风湿因子（RF）阴性多关节型和RF阳性多关节型发病的患者中，关节间隙变窄的频率分别为38%、14%、43%和79%；侵蚀分别发生在63%、25%、39%和75%的患者中。早期侵蚀在RF阳性多关节型发病的患者中最常见，而关节间隙变窄和侵蚀在全身型发病中都较早出现。关节损伤的放射学征象在髋部和腕部最常见，而膝部和踝部相对较少。基于在临床研究1年内进行X光检查的患者，CHAQ评分变化的17.7%可由关节间隙变窄解释，32.4%由疼痛解释，5%由医生对疾病活动的整体评估中的重度评级解释。关节间隙变窄、疼痛、全身型发病和活跃关节计数增加了斯坦布鲁克分级>I的几率。