McGonagle D, Gibbon W, Emery P
Department of Rheumatology, University of Leeds, UK.
Lancet. 1998 Oct 3;352(9134):1137-40. doi: 10.1016/S0140-6736(97)12004-9.
Imaging studies of early synovitis suggest that the first abnormality to appear in swollen joints associated with spondyloarthropathy is an enthesitis (inflammation at sites where ligaments, tendons, or joint capsules are attached to bone). We propose that the synovitis of spondyloarthropathy is secondary to liberation of proinflammatory mediators from the enthesis, whereas the synovitis of rheumatoid arthritis is primary. This suggestion allows a classification of arthritis as either primary synovial (rheumatoid-like) or entheseal (spondyloarthropathy-like) and allows differentiation of presentation of a polyarthritis with a good prognosis (spondyloarthropathy-like), from that with a bad prognosis (rheumatoid arthritis). Pathogenesis of spondyloarthropathy, in particular the part played by HLA-B27 and micro-organisms, should be assessed at the enthesis rather than in the synovium.
早期滑膜炎的影像学研究表明，与脊柱关节病相关的肿胀关节中最早出现的异常是附着点炎（韧带、肌腱或关节囊附着于骨骼处的炎症）。我们提出，脊柱关节病的滑膜炎继发于附着点促炎介质的释放，而类风湿关节炎的滑膜炎是原发性的。这一观点使得关节炎可分为原发性滑膜性（类风湿样）或附着点性（脊柱关节病样），并有助于区分预后良好的多关节炎（脊柱关节病样）和预后不良的多关节炎（类风湿关节炎）。脊柱关节病的发病机制，尤其是HLA - B27和微生物所起的作用，应在附着点而非滑膜处进行评估。
