Sneh E, Pras M, Michaeli D, Shanin N, Gafni J
Rheumatol Rehabil. 1977 May;16(2):102-6. doi: 10.1093/rheumatology/16.2.102.
A review of the files of familial Mediterranean fever (FMF) confirmed the rarity of patients suffering protracted arthritic attacks and the propensity of the joints, in general, to recover. While 70% of those afflicted suffered bouts of synovitis, only 57 patients (5% of the FMF-population) experienced protracted attacks involving a total of 84 joints, 36 of them knees and 25 hips. Functional and, usually, anatomical integrity was regained in all but 27 joints. Of the 27 joints producing residual incapacity, 21 were hips. Seven hips showed roentgenologically typical aseptic necrosis of the femoral head and 14 only sclerosis and narrowing of the joint space. Eight hips eventually required total prosthetic replacement. We suggest that the poor prognosis of the hip, in contrast to other joints affected by protracted FMF-arthritis, is related not directly to the metabolic aberrration underlying the disease but to attenuation of the arterial blood supply of the femoral head by synovial exudation. Early aspiration of exudate could alter the prognosis by preventing the complication of aseptic necrosis.
对家族性地中海热（FMF）病例档案的回顾证实，患有持续性关节炎发作的患者很罕见，而且一般来说关节有恢复的倾向。虽然70%的患者会出现滑膜炎发作，但只有57例患者（占FMF患者总数的5%）经历了持续性发作，累及总共84个关节，其中36个是膝关节，25个是髋关节。除27个关节外，其余所有关节的功能以及通常的解剖完整性都得以恢复。在导致残留功能障碍的27个关节中，21个是髋关节。7个髋关节在X线片上显示出典型的股骨头无菌性坏死，14个仅有关节间隙硬化和变窄。8个髋关节最终需要进行全髋关节置换。我们认为，与受持续性FMF关节炎影响的其他关节相比，髋关节预后不良并非直接与该疾病潜在的代谢异常有关，而是与滑膜渗出导致股骨头动脉血供减少有关。早期抽吸渗出物可通过预防无菌性坏死并发症来改变预后。
