Roberton D M, Cabral D A, Malleson P N, Petty R E
Department of Pediatrics, University of British Columbia, Vancouver, Canada.
J Rheumatol. 1996 Jan;23(1):166-70.
To describe the course of juvenile psoriatic arthritis (JPsA) defined by the "Vancouver Criteria."
A retrospective review of JPsA in 63 children, (44 girls, median age at onset 4.5 yrs; 19 boys, median age at onset 10.1 yrs) who fulfilled the Vancouver Criteria, as follows. Definite JPsA: arthritis with psoriasis, or arthritis with 3 of 4 minor criteria (nail pits, dactylitis, psoriasis-like rash, family history of psoriasis); probable JPsA: arthritis with 2 of the minor criteria.
At last followup, 50 children had definite JPsA and 13 had probable JPsA. Rheumatoid factor was absent in all; antinuclear antibody was present in 50%. Thirty-eight children were followed for > 5 yrs, 18 for > 10 yrs, and 7 for > 15 yrs. Forty-four children had active arthritis; 32% were in functional class I, 38% in class II, 22% in class III, and 8% in class IV. Of the 46 patients with oligoarticular onset, 21 remained oligoarticular, and 25 became polyarticular. Arthritis in the small joints of the hands and feet increased in frequency, with arthritis eventually occurring in proximal interphalangeal joints in 63%, metacarpophalangeal or metatarsophalangeal joints in 55%, and distal interphalangeal joints in 27%. Dactylitis occurred in 35%, most commonly in 2nd toes and index fingers. Nine patients (14%) developed chronic anterior uveitis. Eleven of 24 patients (46%) who initially had probable JPsA evolved to definite JPsA after a median of 2.1 yrs. Five developed psoriasis and the remainder developed additional minor criteria. The 13 patients with a current diagnosis of probable JPsA did not differ significantly from the 50 patients with definite JPsA with respect to number of joints involved at onset or during the disease course. Patients with psoriasis (n = 41) did not differ from those with definite JPsA without psoriasis (n = 9) with respect to the number of joints involved at onset or during the disease course, functional class, or need for 2nd line therapy.
JPsA defined by the Vancouver Criteria is a relatively common chronic arthropathy of childhood that differs clinically, serologically, and genetically from both juvenile rheumatoid arthritis and juvenile ankylosing spondylitis.
描述根据“温哥华标准”定义的幼年型银屑病关节炎（JPsA）的病程。
对63名符合温哥华标准的儿童JPsA患者进行回顾性研究，其中女孩44名，发病中位年龄4.5岁；男孩19名，发病中位年龄10.1岁。具体标准如下。确诊JPsA：关节炎伴银屑病，或关节炎伴4项次要标准中的3项（甲凹点、指（趾）炎、银屑病样皮疹、银屑病家族史）；疑似JPsA：关节炎伴2项次要标准。
末次随访时，50名儿童确诊为JPsA，13名疑似JPsA。所有患者类风湿因子均为阴性；50%患者抗核抗体阳性。38名儿童随访时间>5年，18名>10年，7名>15年。44名儿童有活动性关节炎；32%为功能Ⅰ级，38%为Ⅱ级，22%为Ⅲ级，8%为Ⅳ级。46名单关节起病的患者中，21名仍为单关节受累，25名发展为多关节受累。手足小关节关节炎发生率增加，最终近端指间关节关节炎发生率为63%，掌指或跖趾关节为55%，远端指间关节为27%。指（趾）炎发生率为35%，最常见于第2趾和示指。9名患者（14%）发生慢性前葡萄膜炎。24名最初疑似JPsA的患者中，11名（46%）在中位时间2.1年后发展为确诊JPsA。5名出现银屑病，其余出现其他次要标准。目前诊断为疑似JPsA的13名患者与50名确诊JPsA患者在起病时或病程中受累关节数量方面无显著差异。银屑病患者（n = 41）与无银屑病的确诊JPsA患者（n = 9）在起病时或病程中受累关节数量、功能分级或二线治疗需求方面无差异。
根据温哥华标准定义的JPsA是儿童期相对常见的慢性关节病，在临床、血清学和遗传学方面与幼年类风湿关节炎和幼年强直性脊柱炎均不同。
