Abbreviations

AS:AnkylosingSpondylitis;强直性脊柱炎

RA:RheumatoidArthritis;类风湿关节炎

DMARDs:Disease-ModifyingAntirheumaticDrugs;改善病情抗风湿药物

MCP:Metacarpophalangeal;掌指关节

MTP:Metatarso-Phalangeal;跖趾关节

RF:RheumatoidFactor;类风湿因子

anti-CCP:CyclicCitrullinatedPeptideAntibody抗环瓜氨酸肽抗体

CaseReport

A21-year-oldfemale,hada1-yearhistoryofpaininthelumbosacralarea,intheAchillestendonatthebackoftheankle,andmetatarsalpain,whichhadbeenexacerbatedfor2months.Thepatientfeltpainandhardtoturnedthebodyoveratnight,butthepaincouldbesoftenedafteractivationinthemorning.Sheunderwentaphysicalexaminationonhospitaladmission.Hergeneralhealthandauscultationoftheheartandlungswerenormal.Swellingandtendernessinthejointsofthefourlimbswasnotobserved.ThePatrick’stestandtheSchobertestwerepositive.LaboratoryexaminationswereshowninTable1.X-rayofthelumbosacralareashowedgrade3bilateralsacroiliitis(Figure1).TherewasnoobviousX-raychangeinthejointsofbothhandsandforefoot.Byevaluationofsymptomsandsignsaswellasradiologicalexamination,ourdiagnosiswasASgiventhepresenceoftwoclinicalcriteriainassociationwiththeradiologicalcriterionperthemodifiedNewYorkcriteriaforankylosingspondylitis.Shewasgivenindomethacinmgperdayassymptomatictreatment,andDMARDs(Sulfasalazine2gperday)tocontrolthedisease.

患者女，21岁。病史：腰骶部（跟腱）疼痛和跖骨痛1年，2个月前疼痛开始加重。患者感到疼痛，夜间不能翻身，早晨活动后疼痛缓解。入院时即进行体检，整体状况良好，心脏和肺部听诊正常。未观察到四肢关节肿胀，有压痛。Patrick试验和Schober试验均呈阳性。实验室检查结果见表1。腰骶部X线显示双侧骶髂关节炎3级（图1）。双手和前脚X线未发现明显改变。通过评估患者症状和体征与X线检查结果，考虑到影像学检查标准和强直性脊柱炎纽约修订标准，诊断为AS。给药吲哚美辛mg/天进行对症治疗，并给予DMARDs（柳氮磺胺吡啶2g/天）控制病情。

图1：腰骶部X线显示双侧骶髂关节中部病变和硬化症（双侧骶髂关节炎3级）

表1：实验室检查结果

Thesymptomsandsignsbothimproved.However9monthslater,shedevelopedpaininthejointsofbothhands,forefootandelbows,predominantlyMetacarpophalangeal(MCP)joints.Thiswasac







































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