Kellner H, Füessl H S, Herzer P
Medical Policlinic, University of Munich, Germany.
Rheumatol Int. 1994;13(5):211-3. doi: 10.1007/BF00390270.
Reiter's syndrome and reactive arthritis in individuals with human immunodeficiency virus (HIV) infection are characterized by severe and persistent arthritis, intense enthesopathy, and poor response to treatment. These uncommon clinical features suggest a direct role of HIV in the pathogenesis of seronegative spondylarthropathies. We report on widely differing clinical features in two HIV-infected patients with undifferentiated seronegative spondylarthropathy or reactive arthritis. Both patients were HLA-B27-positive. The first patient presented with heel swelling and dactylitis ("sausage" toes). Subsequently he developed polyarticular erosive arthritis. The clinical course was complicated by fulminant ulcerative colitis leading to hemicolectomy. After hemicolectomy, a temporary resolution of arthritis occurred. In the second patient, heel swelling and polyarticular arthritis occurred 2 months after Shigella dysentery. After 3 years of continuing joint inflammation, he presented with a Jaccoud-like arthropathy. In a cohort of 700 HIV-infected patients receiving continuous care in our department, these were the only patients with seronegative spondylarthropathy observed between 1984 and 1992.
患有人类免疫缺陷病毒（HIV）感染的患者出现赖特综合征和反应性关节炎时，其特征为严重且持续的关节炎、强烈的附着点病以及对治疗反应不佳。这些不常见的临床特征表明HIV在血清阴性脊柱关节病的发病机制中起直接作用。我们报告了两名感染HIV且患有未分化血清阴性脊柱关节病或反应性关节炎患者的截然不同的临床特征。两名患者均为HLA - B27阳性。首例患者出现足跟肿胀和指（趾）炎（“腊肠样”趾）。随后他发展为多关节侵蚀性关节炎。临床病程因暴发性溃疡性结肠炎而复杂化，最终导致半结肠切除术。半结肠切除术后，关节炎出现了暂时缓解。第二例患者在志贺氏菌痢疾2个月后出现足跟肿胀和多关节关节炎。在持续关节炎症3年后，他出现了类雅各布关节病。在我们科室接受持续护理的700名HIV感染患者队列中，这是1984年至1992年间仅观察到的血清阴性脊柱关节病患者。
