Department of Pediatrics, Yokohama City University School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan.
Mod Rheumatol. 2012 Aug;22(4):558-64. doi: 10.1007/s10165-011-0540-6. Epub 2011 Oct 9.
We performed this study to investigate the differences in radiological and laboratory findings between systemic juvenile idiopathic arthritis (s-JIA) and polyarthritis (p-JIA). Twenty-two patients with s-JIA and 18 with p-JIA were enrolled. Their laboratory findings and radiographs were examined retrospectively. Plain radiographs were obtained before the induction of biological agents. All radiographs were examined for the presence of soft tissue swelling, juxta-articular osteopenia, joint space narrowing, subchondral bone cyst, erosion, epiphyseal irregularity, and growth abnormalities. Carpal length and bone mineral density of the lumbar spine, an indicator of generalized osteoporosis, were also investigated in all the patients enrolled. Laboratory examinations involved white blood cell counts, platelets, C-reactive protein (CRP), rheumatoid factor (RF), anti-cyclic citrullinated peptide (CCP) antibody, and matrix metalloproteinase (MMP)-3. Comparisons of the laboratory findings between s-JIA and p-JIA indicated that the titers of anti-CCP antibody and RF were significantly increased in p-JIA sera (P < 0.05). There was no difference in BMD between the two groups of patients. Carpal length was significantly shorter in p-JIA patients than in s-JIA patients (P < 0.05). The most frequent radiological abnormality in s-JIA was juxta-articular osteopenia (93.8%), in comparison to a frequency of 50.0% in p-JIA. Joint space narrowing was shown in 9.8% of the s-JIA patients compared to 35.7% of the p-JIA patients. Subchondral bone cyst and erosion were more frequent in p-JIA than s-JIA. In conclusion, there were differences in radiographic characteristics and laboratory data between s-JIA and p-JIA in this study. In the radiological evaluation, bone-related abnormality was prominent in s-JIA and joint-related abnormality was striking in p-JIA, and these results indicated that the pathogenic bases of arthritis appear to differ between these two subtypes of JIA.
我们进行这项研究，旨在探究全身型幼年特发性关节炎（s-JIA）与多关节型幼年特发性关节炎（p-JIA）的影像学和实验室检查结果的差异。共纳入 22 例 s-JIA 患者和 18 例 p-JIA 患者。回顾性分析其实验室检查和影像学资料。所有影像学资料均在使用生物制剂前获得。所有影像学均评估软组织肿胀、关节旁骨质疏松、关节间隙狭窄、软骨下骨囊肿、侵蚀、骺板不规则和生长异常。同时还检测了所有纳入患者的腕骨长度和腰椎骨密度，以反映全身性骨质疏松。实验室检查包括白细胞计数、血小板、C 反应蛋白（CRP）、类风湿因子（RF）、抗环瓜氨酸肽（CCP）抗体和基质金属蛋白酶（MMP）-3。s-JIA 与 p-JIA 患者的实验室检查结果比较结果显示，p-JIA 患者的抗 CCP 抗体和 RF 滴度明显升高（P<0.05）。两组患者的骨密度无差异。p-JIA 患者的腕骨长度明显短于 s-JIA 患者（P<0.05）。s-JIA 最常见的影像学异常为关节旁骨质疏松（93.8%），而 p-JIA 的发生率为 50.0%。s-JIA 患者中出现关节间隙狭窄的比例为 9.8%，而 p-JIA 患者为 35.7%。s-JIA 患者中出现软骨下骨囊肿和侵蚀的比例高于 p-JIA 患者。总之，本研究中 s-JIA 和 p-JIA 的影像学特征和实验室数据存在差异。在影像学评估中，s-JIA 以骨骼相关异常为主，p-JIA 以关节相关异常为主，这些结果表明这两种 JIA 亚型的关节炎发病机制可能不同。
