Dubost J J, Ristori J M, Zmantar C, Sauvezie B
Service de Rhumatologie, Hôpital Saint-Jacques, Clermont-Ferrand.
Rev Rhum Mal Osteoartic. 1991 Oct;58(9):577-84.
The authors reviewed the files of male patients who have been hospitalized over a 12 year period for a rheumatoid-factor negative arthritis beginning after age 50. Polymyalgia rheumatica, psoriasis or crystal-induced arthritis were excluded. The remaining 105 observations were classified according to published criteria in rheumatoid arthritis (RA), reactive arthritis or ankylosing spondylitis (AS). Twenty-nine patients had RA and 29 had AS with equal numbers of axial and peripheral types. Four patients had reactive arthritis, one of them had also AS. Forty-four patients had "unclassified arthritis". Among the latter, 14 were B27 positive, 21 were B27 negative, 9 were not typed. Some features were more frequent in B27+ patients: an assymetrical oligoarthritis of the lower limbs with minimal signs of inflammation at synovial analysis or at synovial biopsy; frequent unilateral edema; marked, constitutional signs; very high ESR. Nine patients, all B27+, met the diagnostic criteria of spondylarthropathy. B27 typing thus appears relevant to the classification of late-onset, seronegative rhumatisms.
作者回顾了50岁以后发病的类风湿因子阴性关节炎男性患者在12年期间的住院病历。排除了风湿性多肌痛、银屑病或晶体性关节炎。其余105例观察病例根据类风湿关节炎（RA）、反应性关节炎或强直性脊柱炎（AS）的已发表标准进行分类。29例患者患有RA，29例患有AS，轴向型和外周型数量相等。4例患者患有反应性关节炎，其中1例也患有AS。44例患者患有“未分类关节炎”。在后者中，14例B27阳性，21例B27阴性，9例未分型。一些特征在B27阳性患者中更为常见：下肢不对称性少关节炎，滑膜分析或滑膜活检时炎症迹象轻微；频繁单侧水肿；明显的全身症状；血沉非常高。9例患者均为B27阳性，符合脊柱关节病的诊断标准。因此，B27分型似乎与迟发性血清阴性风湿病的分类有关。
