Kaplan G, Ziza J M, Prier A, Chamaret S, Piette J C, Godeau P
Service de Rhumatologie, Hôpital Saint-Antoine, Paris.
Presse Med. 1989 Mar 11;18(10):525-8.
Articular manifestations were observed in 10 patients (8 men, 2 women, aged from 23 to 46 years) with human immunodeficiency virus (HIV) infection. All men were homosexuals, except for an intravenous drug addict. One woman was a native of Gabon and the other had multiple transfusions. The joint diseases were of the polyarthritis and acute oligoarthritis types, affecting mainly the knees and ankles but also the wrist and fingers; the spine was involved in one case. The synovial fluid present in 4 patients contained 5,000 to 27,000 cells per cubic millimeter, with a strong predominance of polymorphonuclears. In 3 cases, infective viral particles were found in the fluid with anti-HIV antibodies. In 2 patients biopsy of the synovial membrane provided evidence of non-specific subacute synovitis. All X-ray films, including those of the sacro-iliac joint, were and remained normal. The course of the joint disease was acute and regressive in 5 cases, chronic and prolonged in the remaining 5 cases. In 5 patients the arthropathies were the first clinical manifestations of the HIV infection. Three patients who had stage IV C AIDS died; the others were in stages II (5), III (1) or IV E (1) and did not progress to a more severe stage. This study shows that various types of inflammatory arthritis may occur in HIV positive patients. In most cases the arthritis is reactive, but certain data suggest that it may be directly related to the virus in some patients.
在10例人类免疫缺陷病毒(HIV)感染患者中观察到关节表现,其中8例男性,2例女性,年龄在23至46岁之间。除1名静脉吸毒者外,所有男性均为同性恋者。1名女性来自加蓬,另1名有多次输血史。关节疾病类型为多关节炎和急性少关节炎,主要影响膝关节和踝关节,也累及腕关节和手指;1例累及脊柱。4例患者的滑液每立方毫米含5000至27000个细胞,以多形核白细胞为主。3例在滑液中发现感染性病毒颗粒及抗HIV抗体。2例患者滑膜活检显示为非特异性亚急性滑膜炎。所有X线片,包括骶髂关节片,均正常且一直保持正常。关节疾病病程5例为急性且呈消退性,其余5例为慢性且病程延长。5例患者的关节病是HIV感染的首发临床表现。3例处于IV C期艾滋病患者死亡;其他患者分别处于II期(5例)、III期(1例)或IV E期(1例),且未进展至更严重阶段。本研究表明,HIV阳性患者可能出现各种类型的炎性关节炎。在大多数情况下,关节炎是反应性的,但某些数据表明在一些患者中可能与病毒直接相关。