Burgos-Vargas Rubén
Rheumatology Department, Hospital General de México, Universidad Nacional Autónoma de México, Mexico City, Mexico.
Nat Clin Pract Rheumatol. 2009 Jan;5(1):52-7. doi: 10.1038/ncprheum0971.
A 14-year-old boy with a 6-year history of recurrent arthritis and enthesitis, which had not responded to previous treatment with NSAIDs, sulfasalazine and methotrexate, presented with a severe flare of these symptoms as well as spinal and sacroiliac joint pain. The patient's father had mild psoriasis.
Counts of tender and swollen joints and tender entheses; assessment of spinal mobility; assessments using the Childhood Health Assessment Questionnaire and the Bath Ankylosing Spondylitis Disease Activity and Functional Indices; measurement of erythrocyte sedimentation rate, serum C-reactive protein level and human leukocyte antigen B27 positivity; radiographs of the sacroiliac joints, hips and feet.
Juvenile-onset ankylosing spondylitis according to the modified New York criteria for ankylosing spondylitis, on the basis of the presence of inflammatory back pain, reduced mobility of the spine and grade 3 bilateral radiographic sacroiliitis.
Treatment with NSAIDs, sulfasalazine and methotrexate did not improve the patient's symptoms. Administration of infliximab 5 mg/kg induced a substantial and rapid improvement in all parameters of disease activity.
一名14岁男孩，有6年复发性关节炎和附着点炎病史，之前使用非甾体抗炎药、柳氮磺胺吡啶和甲氨蝶呤治疗均无反应，此次出现这些症状的严重发作以及脊柱和骶髂关节疼痛。患者的父亲有轻度银屑病。
压痛和肿胀关节计数、压痛附着点评估；脊柱活动度评估；使用儿童健康评估问卷以及巴斯强直性脊柱炎疾病活动度和功能指数进行评估；红细胞沉降率、血清C反应蛋白水平测定以及人类白细胞抗原B27阳性检测；骶髂关节、髋部和足部的X线片。
根据强直性脊柱炎的改良纽约标准诊断为青少年型强直性脊柱炎，依据为存在炎性背痛、脊柱活动度降低以及双侧3级骶髂关节放射学改变。
使用非甾体抗炎药、柳氮磺胺吡啶和甲氨蝶呤治疗未能改善患者症状。给予英夫利昔单抗5 mg/kg后，疾病活动的所有参数均迅速得到显著改善。
