The Early Detection of Juvenile Rheumatoid Arthritis(JRA)  <?xml:namespace prefix = o ns = "urn:schemas-microsoft-com:office:office" />

徐　健综述 　 宋　伟审校

ABSTRACT

Recently, with the development of the imaging technique, magnetic resonance imaging(MRI),all of the ultrasound (US),computered tomography (CT),bone densitometry, nuclear medicine make it become the main tools to aid the diagnosis the JRA.MRI can detect the pathologic feature precisely. When compared with the traditional radiography, it can differentiate the cartilage thining, synovial hypertrophy and joint effusion. US is more sensitive than the traditional radiography in detecting the early inflammatory changes in JRA, although it is less sensitive than MRI in detecting the bone erosions and the injury of the cartilages and ligamerts. The nuclear medicine is also very sensitive in detecting the early inflammatory changes in JRA, but it can’t indicate the details, while the born densitometry only indicates the mineral changes in the bone. So, especially Gadolinium DYPA enhancement MRI, MRI is the optimal in detecting the early inflammatory changes in JRA owing to its non-planar imaging and high resolution.

Kay words: Juvenile rheumatoid arthritis(JRA); MRI;CT; Ultrasound; Bone densitometry; Nuclear madicine.

幼年型类风湿性关节炎在美国被称为称为幼年型类风湿性关节炎(juvenile rheumatoid arthritis)，在英国及欧洲被称为幼年型慢性关节炎(juvenile chronic arthritis )。幼年型类风湿性关节炎的诊断主要依据美国风湿学会1987年修订的标准:发病年龄在16岁以下，病程持续6周以上，一个或几个关节的炎症，需要除外其他类型的幼年关节炎。幼年型类风湿性关节炎的关节损害的机制是急性滑膜炎和滑膜肥厚（增生的滑膜被称作关节羽^[1]），发炎的滑膜组织释放酶造成骨和软骨破坏，破坏从边缘向中心扩展，最后，引起关节骨性强直^［2-4］。骨侵蚀从关节边缘开始的原因是在关节囊的边缘滑膜直接附着在骨组织上。幼年型类风湿性关节炎的最早期临床为关节肿、痛、活动受限，查体时可以看到关节周围软组织梭形肿胀。早期的幼年型类风湿性关节炎表现为活动性滑膜炎，普通X线平片评价滑膜和软骨病变不敏感^［3,5-6］。

近年来，影像技术的发展，磁共振成像（MRI）、超声、计算机体层扫描（CT）、骨密度扫描、放射性核素检查等使影像学检查成为幼年型类风湿性关节炎重要的辅助诊断手段^［7-8］。