Garg Shriram, Malaviya Anand N, Kapoor Sanjiv, Rawat Roopa, Agarwal Divya, Sharma Amit
Joint Disease Clinic, Indian Spinal Injuries Centre, Superspeciality Hospital, M-M Road, VasantKunj, New Delhi - 110070, Indian.
J Assoc Physicians India. 2011 Feb;59:87-90.
To analyse patients presenting with acute inflammatory ankle arthritis from an aetiological standpoint; whether they had Löfgren's syndrome (acute presentation of sarcoidosis), or Poncet's disease (reactive arthritis due to tuberculosis infection). An additional objective was to establish a simple, practical yet optimal algorithm for diagnostic approach and management of such patients.
The study included 18 patients from northern India presenting with isolated acute inflammatory ankle arthritis. A combination of complete clinical evaluation, Mantoux test and contrast-enhanced computerised tomography (CE-CT) of the chest was carried out and results analysed.
Among 18 patients presenting as inflammatory ankle arthritis is was possible to classify 10 of them as Löfgren's syndrome all of whom had negative Mantoux test and bilateral hilar lymphadenopathy without central necrosis. The other 8 patients could be classified as Poncet's disease as all of them had positive Mantoux test and showed mediastinal lymphadenopathy with or without unilateral hilar lymph nodes, with central necrosis. Finally, appropriate drug treatment (glucocorticoids with glucocorticoid-sparing drugs methotrexate and hydroxychloroquine in patients with Löfgren's syndrome; standard anti-tuberculosis drugs in Poncet's disease) gave excellent clinical response and patients remained well over a period of 1 year of follow-up.
Investigated on standard lines without any invasive procedure, patients with isolated inflammatory ankle arthritis could be classified in 2 distinct categories namely: (1) Löfgren's syndrome in its complete (with EN) or incomplete (without EN) form; (2) Poncet's disease. Appropriate treatment gave satisfactory response and patients remained well over a period of 1 year of follow-up.
从病因学角度分析急性炎症性踝关节关节炎患者；判断他们是否患有 Löfgren 综合征（结节病的急性表现）或蓬塞病（结核感染引起的反应性关节炎）。另一个目的是为这类患者的诊断方法和管理建立一种简单、实用且最佳的算法。
该研究纳入了 18 名来自印度北部的孤立性急性炎症性踝关节关节炎患者。进行了全面的临床评估、结核菌素试验和胸部增强计算机断层扫描（CE-CT），并对结果进行了分析。
在 18 名表现为炎症性踝关节关节炎的患者中，10 名可被归类为 Löfgren 综合征，他们的结核菌素试验均为阴性，双侧肺门淋巴结肿大且无中央坏死。另外 8 名患者可被归类为蓬塞病，因为他们的结核菌素试验均为阳性，显示有纵隔淋巴结肿大，伴有或不伴有单侧肺门淋巴结，且有中央坏死。最后，适当的药物治疗（Löfgren 综合征患者使用糖皮质激素联合糖皮质激素节约药物甲氨蝶呤和羟氯喹；蓬塞病患者使用标准抗结核药物）产生了良好的临床反应，患者在 1 年的随访期内病情稳定。
在没有任何侵入性操作的标准流程下进行检查，孤立性炎症性踝关节关节炎患者可分为 2 个不同类别，即：（1）完全型（伴有结节性红斑）或不完全型（不伴有结节性红斑）的 Löfgren 综合征；（2）蓬塞病。适当的治疗产生了满意的反应，患者在 1 年的随访期内病情稳定。
