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脊柱关节病-希氏内科学教程(2)
文章点击率: 栏目点击率：	作者:刘湘源来自：风湿免疫科时间：2008-9-25

TABLE 287-1 -- COMPARISON OF THE SPONDYLOARTHROPATHIES
FEATURE	ANKYLOSING SPONDYLITIS	POST-URETHRAL REACTIVE ARTHRITIS	POST-DYSENTERIC REACTIVE ARTHRITIS	ENTEROPATHIC ARTHRITIS	PSORIATIC ARTHRITIS
Sacroiliitis	+++++	+++	++	+	++
Spondylitis	++++	+++	++	++	++
Peripheral arthritis	+	++++	++++	+++	++++
Articular course	Chronic	Acute or chronic	Acute > chronic	Acute or chronic	Chronic
HLA-B27	95%	60%	30%	20%	20%
Enthesopathy	++	++++	+++	++	++
Common	Eye	Eye	GU	GI	Skin
extra-articular	Heart	GU	Eye	Eye	Nails
manifestations		Oral/GI Heart			Eye
Other names	von Bechterev's Marie-Strumpell	Reiter's syndrome, SARA, NGU, chlamydial arthritis	Reiter's syndrome	Crohn's disease, ulcerative colitis
GU = genitourinary; GI = gastrointestinal; SARA = sexually acquired reactive arthritis; NGU = non-gonococcal urethritis.

TABLE 287-2 -- DIAGNOSTIC CRITERIA FOR THE SPONDYLOARTHROPATHIES
*Rome* *Criteria for Ankylosing Spondylitis (1961)*	*1981 ARA Criteria for Reiter's Syndrome*
1. Low back pain and stiffness >3 mo, not relieved by rest 2. Pain and stiffness in the thoracic region 3. Limited motion of the lumbar spine 4. Limited chest expansion 5. History of iritis 6. Radiograhic evidence of bilateral sacroiliitis Diagnosis requires 4 of the 1st 5 criteria or sacroiliitis plus 1 of the clinical criteria	Peripheral arthritis >1 mo in association with urethritis and/or cervicitis Criteria for Psoriatic Arthritis Cutaneous evidence of psoriasis plus inflammatory peripheral arthritis or spondylitis 6 wk

*ESSG Criteriafor Spondyloarthropathy (1992)*	*Criteria for Diagnosing Spondyloarthropathies by Amor et al. (1993)*	*SCORE*
Inflammatory spinal pain or peripheral synovitis (asymmetrical or lower limbs) Plus one or more of the following: Alternate buttock pain Sacroiliitis Enthesopathy Positive family history Psoriasis Inflammatory bowel disease Urethritis, cervicitis, or acute diarrhea occuring within 1 mo of the onset of arthritis	Lumbar pain at night or morning stiffness Asymmetrical oligoarthritis Buttock pain Alternating buttock pain Sausage-like toe or digit(s) Heel pain or enthesitis Iritis Non-gonococcal urethritis/cervicitis within 1 mo of onset Acute diarrhea within 1 mo of arthritis onset Psoriasis, balanitis, or inflammatory bowel disease Sacroiliitis (bilateral grade 2 or unilateral grade 3) HLA-B27+ or positive family history of a spondyloarthropathy Rapid (<48 hr) response to NSAIDs Diagnosis requires score 6	1 2 1 2 2 2 2 1 1 2 2 2 2
Note: Older criteria (top) are being replaced by newer, more liberal criteria (bottom) for the spondyloarthropathies.
ARA = American Rheumatism Association; ESSG = European Spondyloarthropathy Study Group; NSAIDs = non-steroidal anti-inflammatory drugs.