Schulze P, Loreck D, Hüge H, Hüge W
Z Gesamte Inn Med. 1984 Jun 1;39(11):253-7.
For differential-diagnostic considerations concerning seronegative arthritides two groups of patients with 25 patients each of the disease groups psoriasis arthropathica and serologically negative rheumatoid arthritis were selected. The differentiation of the two diseases was performed by clinical, paraclinical and radiological findings. When there are no typical psoriatic changes of skin and/or nails and there is an empty family anamnesis concerning this dermatosis, respectively, the coordination of seronegative arthritides is considerably rendered more difficult. Here the radiomorphological investigations particularly of the sacroiliacal joint and/or of the spine essentially contribute, since the arthritis of the sacroiliacal joint is to seen in high incidence in psoriasis arthropathica. Out of the number of the paraclinical values the determination of the complement factor C 4 and of immunoglobulin M gets the importance of a sign of differentiation, in which case C 4 in the psoriasis arthropathica and the immunoglobulin M in the seronegative rheumatoid arthritis are statistically significantly increased. The problems of the often difficult differential diagnosis between the two groups of disease can be clarified only by complex clinical examinations, paraclinical parameters and subtile radiodiagnosis. A close interdisciplinary cooperation between experienced dermatologists, rheumatologists and radiologists seems reasonable.
为了对血清阴性关节炎进行鉴别诊断，我们选择了两组患者，每组25例，分别来自银屑病关节炎组和血清学阴性类风湿关节炎组。这两种疾病的鉴别通过临床、副临床和放射学检查结果进行。当皮肤和/或指甲没有典型的银屑病改变，且家族中没有这种皮肤病的病史时，血清阴性关节炎的鉴别就会变得相当困难。在这种情况下，放射形态学检查，特别是对骶髂关节和/或脊柱的检查起着重要作用，因为骶髂关节炎在银屑病关节炎中发病率较高。在副临床指标中，补体因子C4和免疫球蛋白M的测定具有鉴别意义，在银屑病关节炎中C4以及在血清学阴性类风湿关节炎中免疫球蛋白M在统计学上显著升高。只有通过综合的临床检查、副临床参数和精细的放射诊断，才能明确这两组疾病之间常常难以鉴别的问题。经验丰富的皮肤科医生、风湿病学家和放射科医生之间密切的跨学科合作似乎是合理的。
