Gelman M I, Ward J R
Radiology. 1977 Jan;122(1):17-23. doi: 10.1148/122.1.17.
Eighteen cases of long-standing rheumatoid arthritis and superimposed pyarthrosis were reviewed to determine the most distinguishing radiographic features. Soft-tissue changes allowed earlier diagnosis in the knee and ankle joints and consisted of large asymmetrical joint effusion and fat-pad edema. Bony articular changes were more helpful than soft-tissue changes in the wrist and hip because of the paucity of adjacent extracapsular fat and were associated with delayed radiographic recognition of superimposed pyarthrosis. These changes are presumptive evidence of complicating septic arthritis and their presence necessitates needle aspiration and culture of the joint for proper definitive treatment.
回顾了18例长期类风湿性关节炎合并脓性关节炎的病例，以确定最具鉴别性的影像学特征。软组织改变有助于早期诊断膝关节和踝关节病变，表现为大量不对称性关节积液和脂肪垫水肿。由于腕关节和髋关节周围缺乏关节外脂肪，骨关节改变比软组织改变更有诊断价值，且与脓性关节炎的影像学延迟诊断有关。这些改变提示合并化脓性关节炎，出现这些改变时必须进行关节穿刺和培养，以便进行适当的确定性治疗。
