만성관절염 관절액의 일반적 성상 및 immunoglobulin에 관한 고찰

Abstract

[한글]

만성 관절염 환자의 주소인 관절의 종창은 여러 병적조건에서 나타나는데 이 관절액을 채취하여 질병의 진단, 경과, 예후등의 판정에 이용하여 왔다.

이에 저자는 1979년 9월부터 1980년 4월까지 약 8개월간 연세대학교 의과대학 부속 원주기독병원 정형외과에 내원하거나 입원한 만성관절염 환자 47예를 대상으로 관절액 검사를 시행하여 다음과 같은 결과를 얻었다

1. 관절액의 일반적 성상으로 보아 퇴행성, 외상성관절염과 연골연화증에서는 비염증성 관절액의 양상을 보였고, 류마토이드관절염과 통풍환자에서는 염증성 관절액양상을 보였으며 화농성 및 결핵성관절염은 감염성 관절액의 양상을 보였다. 한편 비특이성 활막염은 혼합된 양상을 보여 주었다.

2. 관절액의 총단백량은 일반적으로 모든 질환에서 증가된 양상을 보였다.

3. 관절액내의 IgG와 IgM은 전질환에서 약간의 증가를 보였으며 특히 류마토이드 관절염에서 상당량의 증가를 보여 주었다.

4. 관절액내의 IgA는 류마토이드 관절염과 외상성 관절염에서는 약간의 증가를 보인 반면 다른 질환군에서는 오히려 감소의 경향을 보였다.

5. 관절액내의 모든 immunoglobulin의 농도는 류마토이드 관절염에서 제일 높았으며 퇴행성 관절염에서 제일 낮았다.

[영문]

The swelling of arthritic joints due to fluid accumulation is the major pathologic changes in several arthritis conditions

The fluid from selected patients were analysed for routine examination and immunoglobulins in the fluid were also quantitatively studied to evaluate their diagnostic value upon clinical application.

Following are the summary of the study:

1. Forty seven cases the registered or were admitted to Won ju Christian Hospital with a complaint of joint swelling were selected and the joint fluid were aseptically col looted for the studies.

2. Among thoses, 11 were diagnosed as rhumatoid arthritis, 7 as nonspecific synovitis, 18 as degenerative arthritis. and 7 as traumatic arthritis respectively, Four remainders were diagnosed to have 4 different diseases, i,e., gout, tuberculosis, chondromalacia and pyogenic arthritis.

3. By routine analysis of joint fluids from the patients with degenerative, traumatic arthritis and chondromalacia, all of them were classified into the group of non-inflammatory fluid, the patients with rheumatoid, gout arthritis were classified into the inflammatory fluid group and the patients with tuberculosis and

pyogenic arthritis were classifide into the group of infectious fluid.

4. The level of total protein in the fluid from almost all cases was increased.

5. In most of the cases with chronic arthritis, the elevated levee of Ig G and Ig M were noticed, especially in the case of rheumatoid arthritis those levels were markedly elevated.

6. In the cases of rheumatoid and traumatic arthritis, the level of IgA was elevated compare to normal although it was decreased in degenerative and nonspecific synovitis.

7. The average levels of all classes imunoglobulins were found to be higher in rheumatoid arthritis then that in degenerative arthritis.

Although these results from the analysis of the joint fluid of the study cases appeared to be associated with their specific symptoms of each type of arthritis it was also noticed that it can net be applied in clinincal applications to provide conclusive and definite diagnosis of arthritis.