Lang B A, Schneider R, Reilly B J, Silverman E D, Laxer R M
Department of Pediatrics, Izaak Walton Killam Children's Hospital, Dalhousie University, Halifax, NS, Canada.
J Rheumatol. 1995 Jan;22(1):168-73.
To document the radiologic abnormalities in patients with systemic onset juvenile rheumatoid arthritis (SOJRA) including abnormalities occurring early in the course of disease.
A retrospective review of the charts and radiographs of 42 consecutive children with SOJRA was carried out. Radiographs were reviewed by a single experienced radiologist with no knowledge of the clinical course of the patients.
Soft tissue swelling and osteoporosis were the most common radiologic abnormalities (34/42; 81%). Cartilage loss and/or bone erosions were also common, occurring in 50% of patients. Erosions occurred within 2 years of disease onset in 11/36 (31%). Subchondral irregularity and sclerosis within 2 years of disease onset preceded erosions in 11 patients with serial radiographs. Severe radiologic abnormalities included joint ankylosis (8/42; 19%), subluxation (9/42; 21%), and protrusio acetabuli (4/42; 10%). Joint ankylosis occurred most commonly between 3 and 5 years after disease onset and subluxation between 2 and 6 years.
A subgroup of children with SOJRA develops early destructive radiologic changes whose severity is comparable to those of children with rheumatoid factor positive polyarticular JRA. Early subchondral changes may be predictive of subsequent erosive disease in SOJRA and require prospective study using newer imaging techniques.
记录全身型幼年类风湿关节炎（SOJRA）患者的放射学异常情况，包括疾病早期出现的异常。
对42例连续的SOJRA患儿的病历和X线片进行回顾性研究。由一位对患者临床病程不知情的经验丰富的放射科医生对X线片进行评估。
软组织肿胀和骨质疏松是最常见的放射学异常（34/42；81%）。软骨丢失和/或骨质侵蚀也很常见，见于50%的患者。11/36（31%）的患者在疾病发作2年内出现侵蚀。在11例有系列X线片的患者中，疾病发作2年内的软骨下不规则和硬化先于侵蚀出现。严重的放射学异常包括关节强直（8/42；19%）、半脱位（9/42；21%）和髋臼突出（4/42；10%）。关节强直最常见于疾病发作后3至5年，半脱位见于2至6年。
一部分SOJRA患儿会出现早期破坏性放射学改变，其严重程度与类风湿因子阳性多关节型幼年类风湿关节炎患儿相当。早期软骨下改变可能预示着SOJRA随后的侵蚀性疾病，需要使用更新的成像技术进行前瞻性研究。
