Steere A C
Department of Rheumatology/Immunology, New England Medical Center, Tufts University School of Medicine, Boston, MA 02111.
Scand J Infect Dis Suppl. 1991;77:51-4.
Joint symptoms associated with B. burgdorferi infection range from arthralgias, to brief attacks of arthritis, to chronic erosive synovitis. From 2 weeks to 2 years after the onset of disease, commonly following migratory arthralgias, about 60% of untreated patients with Lyme disease in the United States develop brief attacks of oligoarticular arthritis, primarily in large joints, especially the knee. Episodes of arthritis often become longer during the second or third years of illness, lasting months rather than weeks, and in about 10% of patients, chronic arthritis begins during this period. Chronic Lyme arthritis appears to have an immunogentic basis. Of 28 patients with chronic arthritis, 25 (89%) had the HLA-DR4 or -DR2 specificities compared with only 6 of 22 patients (27%) with arthritis of short duration (P = 0.00006). In adults, Lyme arthritis is most like Reiter's syndrome or reactive arthritis, and in children, it is most similar to the pauciarticular form of juvenile rheumatoid arthritis.
与伯氏疏螺旋体感染相关的关节症状范围从关节痛到短暂的关节炎发作，再到慢性侵蚀性滑膜炎。在疾病发作后的2周内至2年，通常在游走性关节痛之后，美国约60%未经治疗的莱姆病患者会出现少关节性关节炎的短暂发作，主要累及大关节，尤其是膝关节。关节炎发作在疾病的第二年或第三年通常会持续更长时间，持续数月而非数周，约10%的患者在此期间开始出现慢性关节炎。慢性莱姆关节炎似乎有免疫遗传基础。在28例慢性关节炎患者中，25例（89%）具有HLA-DR4或-DR2特异性，而在22例病程较短的关节炎患者中只有6例（27%）具有该特异性（P = 0.00006）。在成人中，莱姆关节炎最像赖特综合征或反应性关节炎，而在儿童中，它最类似于幼年类风湿关节炎的少关节型。
