编者：韩青，西京医院临床免疫科

目 的

用脊柱关节炎国际协会评估（ASAS）分类标准评估成人脊柱关节炎(SpA)以发热为首发表现的临床特征。

方 法

本研究回顾性分析2010年1月至2016年5月在韩国首尔Severance医院住院患者的电子病历。作为对照组，还招募了100个SpA的患者。比较两组患者的临床特征和实验室结果。

结 果

26例SpA患者首发症状为发热（反应性关节炎50%，未分化SpA26.9%，AS15.4%，炎性肠病关节炎3.8%，银屑病性关节炎3.8%)。外周型SpA患者中发热患者比对照组更为常见(65.4% vs 24.0%，p < 0.001)。发热型SpA患者HLA- B27阳性率低于对照组患者(52.2% vs 77.0%，p < 0.05)。基线期发热型SpA患者系统性炎症标记物明显升高(白细胞计数11.57 vs 7.81cell/μL,p < 0.001;血沉69.2 vs 41.0 mm/ h,p<0.001;c-反应蛋白109.6 vs 15.3 mg/ L,p <0.001)。发热型SpA患者中，使用类固醇治疗的患者比例明显高(57.7% vs 11.0%，p < 0.001)。发热型SpA患者中就诊于风湿病专科的患者比例明显低于对照组(7.7%与59.0%，p < 0.001)。

结 论

SpA的各种亚型均可以发热为首发症状，发热型SpA患者全身炎症表现突出，早期就诊风湿科的概率较低。当评估发热型患者同时具备SpA任一临床特征时，临床医生应该考虑以SpA为主进行评估，包括HLA-B27或骶髂关节放射学的检查。

参考文献：

Fever as an initialmanifestation of spondyloarthritis: A retrospective study.

ByunSJ.et al

Abstract

OBJECTIVES:

We aimed to evaluatea wide spectrum of clinical features of adult patients with spondyloarthritis(SpA) whose initial manifestation was fever, using the Assessment ofSpondyloArthritis international Society (ASAS) classification criteria.

METHODS:

We retrospectivelycollected the electronic medical records of hospitalized SpA patients whoinitially presented to the Severance Hospital (Seoul, Korea) with fever fromJanuary 2010 to May 2016. As a control group, we also recruited one-hundredconsecutive patients who were diagnosed with SpA in our outpatient clinic.Clinical features and laboratory findingswere compared in two patient groups.

RESULTS:

There were 26patients who had fever as initial presentation of SpA (reactive arthritis 50%,undifferentiated SpA 26.9%, ankylosing spondylitis 15.4%,enteropathic arthritis 3.8%, psoriatic arthritis 3.8%). Peripheral SpA was morecommon in febrile SpA patients than in control SpA patients (65.4% vs 24.0%,p<0.001). Febrile SpA patients were less frequently HLA-B27 positive thancontrol SpA patients (52.2% vs 77.0%, p<0.05). At baseline, systemicinflammatory markers were significantly higher in the febrile SpA patients(white blood cell count, 11.57 vs 7.81 cells/μL, p<0.001; erythrocytesedimentation rate, 69.2 vs 41.0 mm/h, p<0.001; C-reactive protein, 109.6 vs15.3 mg/L, p<0.001). The proportion of patients treated with systemicsteroids was significantly higher in febrile SpA patients (57.7% vs. 11.0%,p<0.001). The proportion of patients who visited rheumatology specialty wassignificantly lower in febrile SpA patients than in control SpA patients (7.7%vs 59.0%, p<0.001).

CONCLUSION:

Various subgroups ofSpA can be presented with fever as an initial manifestation. Febrile SpApatients demonstrated higher systemic inflammation and a lower chance to visitrheumatology in early stage. When evaluating febrile patients with any clinicalfeatures of SpA, clinicians are advised to consider performing SpA-focusedevaluation including HLA-B27 or a simple sacroiliac joint radiograph.

PLoS One. 2017 Sep 14;12(9):e0184323.