Jevtic V, Watt I, Rozman B, Kos-Golja M, Demsar F, Jarh O
Institute of Radiology, University Medical Centre, Ljubljana, Sovenia.
Skeletal Radiol. 1995 Jul;24(5):351-5. doi: 10.1007/BF00197064.
A series of patients with clinically early inflammatory joint disease due to rheumatoid arthritis, psoriatic arthritis and Reiter's syndrome were examined by plain film radiography and magnetic resonance imaging (MRI). The spin echo T1-weighted precontrast, T2-weighted, and, especially, T1-weighted postcontrast images demonstrated distinct differences in the distribution of inflammatory changes, both within and adjacent to involved small hand joints. Two major subtypes of inflammatory arthritis were shown, thus providing a specific differential diagnosis between rheumatoid arthritis and some patients with seronegative spondyloarthritis. In particular, all the patients with Reiter's syndrome who were studied, and half of those with psoriatic arthritis, had a distinctive pattern of extra-articular disease involvement. The need for a new classification of clinical subsets in psoriatic arthritis has been recently suggested. The present findings suggest that magnetic resonance imaging could be useful in such a reclassification of seronegative spondyloarthritis, as well as offering considerable potential for a reappraisal of pathogenesis and therapy. In this series, it was also noted that juxta-articular osteoporosis on plain film did not correlate with bone marrow oedema on MRI. Hence the aetiology of this common radiographic finding also merits further consideration.
对一系列因类风湿性关节炎、银屑病关节炎和赖特综合征导致的临床早期炎症性关节疾病患者进行了X线平片摄影和磁共振成像（MRI）检查。自旋回波T1加权对比前、T2加权，尤其是T1加权对比后图像显示，在受累手部小关节内及其附近，炎症变化的分布存在明显差异。显示出两种主要的炎症性关节炎亚型，从而为类风湿性关节炎和一些血清阴性脊柱关节炎患者提供了特异性鉴别诊断。特别是，所有接受研究的赖特综合征患者以及一半的银屑病关节炎患者都有独特的关节外疾病受累模式。最近有人提出需要对银屑病关节炎的临床亚组进行新的分类。目前的研究结果表明，磁共振成像在血清阴性脊柱关节炎的这种重新分类中可能有用，同时也为重新评估发病机制和治疗提供了相当大的潜力。在这个系列中，还注意到平片上的关节周围骨质疏松与MRI上的骨髓水肿不相关。因此，这一常见影像学表现的病因也值得进一步研究。
