Lawrence J M, Moore T L, Osborn T G, Nesher G, Madson K L, Kinsella M B
Department of Internal Medicine, St Louis University School of Medicine, MO 63104.
Semin Arthritis Rheum. 1993 Feb;22(4):265-74. doi: 10.1016/0049-0172(93)80074-p.
Early studies showed few immunologic abnormalities in juvenile rheumatoid arthritis (JRA) patients. There were no specific laboratory markers useful for diagnosis and assessment of the course of disease in JRA. Previous work showed an association of antinuclear antibodies (ANA) with early-onset pauciarticular disease and iridocyclitis. Similarly, the presence of 19S immunoglobulin (Ig) M rheumatoid factors (RF) was associated with late-onset polyarticular disease in girls. More recent studies have detected many unique autoantibodies. Newer assays show 19S IgM RF in up to 35% of JRA patients, although still mainly in girls with late-onset polyarticular disease. Hidden 19S IgM RF can be shown in up to 75% of JRA patients using different procedures, primarily in those with active polyarticular-or pauciarticular-onset disease. Immune complexes have been detected in JRA patients by means of different techniques; their presence usually correlates with active disease. Studies on a specific ANA in JRA have shown no common extractable nuclear antigen, but antihistone antibodies have been found in up to 75% of cases, again mainly in those with pauciarticular onset and iritis. Finally, a variety of unusual immunologic proteins have also been detected, including anti-ocular, anti-cellular, anti-cardiolipin, anti-perinuclear factor, and anti-collagen antibodies. This review evaluates the significance of these antibodies that can now be found in JRA.
早期研究显示青少年类风湿性关节炎（JRA）患者几乎没有免疫异常。在JRA中，没有可用于疾病诊断和病程评估的特异性实验室标志物。先前的研究表明抗核抗体（ANA）与早发性少关节疾病和虹膜睫状体炎有关。同样，19S免疫球蛋白（Ig）M类风湿因子（RF）的存在与女孩晚发性多关节疾病有关。最近的研究发现了许多独特的自身抗体。更新的检测方法显示，高达35%的JRA患者存在19S IgM RF，尽管仍主要见于晚发性多关节疾病的女孩。使用不同方法，高达75%的JRA患者可检测到隐匿性19S IgM RF，主要见于多关节或少关节起病的活动性疾病患者。通过不同技术在JRA患者中检测到了免疫复合物；其存在通常与活动性疾病相关。对JRA中一种特异性ANA的研究表明，没有常见的可提取核抗原，但高达75%的病例中发现了抗组蛋白抗体，同样主要见于少关节起病和虹膜炎患者。最后，还检测到了多种异常的免疫蛋白，包括抗眼、抗细胞、抗心磷脂、抗核周因子和抗胶原蛋白抗体。本综述评估了目前在JRA中发现的这些抗体的意义。
