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关节炎患者及滑膜中B19细小病毒DNA的结局

Outcome of patients with arthritis and parvovirus B19 DNA in synovial membranes.

作者信息

Schmid Simone, Bossart Walter, Michel Beat A, Brühlmann Pius

机构信息

Department of Rheumatology and Physical Medicine, University Hospital of Zurich, Gloria-strasse 25, 8091 Zurich, Switzerland.

出版信息

Rheumatol Int. 2007 Jun;27(8):747-51. doi: 10.1007/s00296-007-0337-2. Epub 2007 Mar 31.

Abstract

To investigate the follow-up of the 17 patients during the period of 1995-2001 of the outpatient Clinic for Rheumatology at the University Hospital of Zurich with arthritis and the presence of parvovirus B19 DNA demonstrated by PCR in synovial biopsies. Seventeen patients of 163 with arthritis, which were routinely examined by needle arthroscopy during 1995-2001 with a positive parvovirus B19 DNA by PCR of synovial biopsy were reevaluated. Investigations included medical history, clinical examination and blood tests. Joint fluid was taken on patients with joint effusion. The observation period of the 17 patients (F:M = 11:6) was 2-8 years (Ø = 6.5 years). In 8 of 17 patients the arthritis could not be classified neither at entry nor during the follow up of the study. The arthritis could be diagnosed in six patients early in the onset of the disease and included three cases of lyme arthritis of the knee joint, two cases with arthritis following a gastrointestinal infection (one with Salmonella typhimurium--positive faecal test--and the other one with a culture negative agent), one patient probably had an infection-associated arthritis after a gastrointestinal infection with Entamöeba histolytica (Schirmer et al. in Rheumatol Int 18:37-38, 1998; Kasliwal in Am J Proctol Gastroenterol Colon Rectal Surg 32:12, 16, 28, 1981; Haslock and Wright in J R Coll Phys Lond 8:1554-162, 1974; Than-Saw et al. in Trop Geogr Med 44:355-358, 1992) with remission after antibiotic therapy. After a disease course of 9 months one patient could be classified as rheumatoid arthritis in the presence of anti-cyclic citrullinated antibodies but lack of rheumatoid factor. One patient with polyarthritis developed psoriasis of the skin 22 months later. From the nine patients with unclassified arthritis 4 (45%) got into complete remission with no symptoms or signs of joint inflammation after a disease course of 9-45 months, whereas 5 (55%) still demonstrate active non erosive arthritis (disease duration between 3 and 10 years). The presence of parvovirus B19 DNA in synovial tissue of patients with joint inflammation does not allow the diagnosis of parvovirus induced arthritis. If the arthritis remains unclassified and without erosions over time a virus associated aetiology may be assumed. However, no definitive diagnosis is possible even in the presence of parvovirus B19 DNA in synovial tissue.

摘要

为了对苏黎世大学医院风湿病门诊1995 - 2001年期间的17例关节炎患者进行随访,这些患者的滑膜活检经聚合酶链反应(PCR)证实存在细小病毒B19 DNA。对1995 - 2001年期间163例关节炎患者中17例经滑膜活检PCR检测细小病毒B19 DNA呈阳性且接受常规针式关节镜检查的患者进行了重新评估。调查内容包括病史、临床检查和血液检查。对有关节积液的患者采集关节液。17例患者(女性∶男性 = 11∶6)的观察期为2 - 8年(平均 = 6.5年)。17例患者中有8例在研究开始时及随访期间关节炎均无法分类。6例患者在疾病早期可诊断出关节炎,其中包括3例膝关节莱姆关节炎、2例胃肠道感染后关节炎(1例粪便检测鼠伤寒沙门氏菌阳性,另1例病原体培养阴性),1例患者可能在溶组织内阿米巴胃肠道感染后发生了感染相关性关节炎(Schirmer等人,《Rheumatol Int》18:37 - 38,1998;Kasliwal,《Am J Proctol Gastroenterol Colon Rectal Surg》32:12,16,28,1981;Haslock和Wright,《J R Coll Phys Lond》8:1554 - 162,1974;Than - Saw等人,《Trop Geogr Med》44:355 - 358,1992),抗生素治疗后病情缓解。1例患者在病程9个月后,尽管缺乏类风湿因子,但存在抗环瓜氨酸化抗体,可被分类为类风湿关节炎。1例多关节炎患者在22个月后出现皮肤银屑病。9例未分类关节炎患者中,4例(45%)在病程9 - 45个月后完全缓解,无关节炎症症状或体征,而5例(55%)仍表现为活动性非侵蚀性关节炎(病程3至10年)。关节炎症患者滑膜组织中存在细小病毒B19 DNA并不能诊断为细小病毒所致关节炎。如果关节炎一直未分类且未出现侵蚀,可能推测其病因与病毒有关。然而,即使滑膜组织中存在细小病毒B19 DNA,也无法做出明确诊断。

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