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目的 分析无皮损银屑病关节炎（PsA）患者早期关节病变的高频超声特点及误诊原因。方法 回顾性分析2023年3月至2024年10月收治的无皮损PsA患者2例的临床资料。结果 2例患者均表现为膝关节疼痛，同时伴有双手关节疼痛，首诊查体时均未见皮疹。高频超声检查结果显示：1例双侧膝关节滑膜炎伴积液，双侧膝关节骨赘形成；1例双侧膝关节积液，右侧为著，右侧膝关节滑膜增厚，右侧腘窝外下方囊肿。2例患者均被误诊为关节炎，给予相应治疗无效后，1例头皮出现红斑鳞屑，伴瘙痒；1例十指指甲伴不同程度顶针样改变、纵嵴，脐9～10点位见条状皮疹，其余部位未见皮疹。经相关检查确诊为PsA。调整治疗后，患者关节疼痛缓解，6个月后皮疹完全消失。结论 无皮损表现PsA早期缺乏典型皮损，但高频超声可显示关节滑膜炎、积液、滑膜增厚及腘窝囊肿等改变。无明显皮损是导致误诊的主要原因，临床医生应提高对该病的认识，对不明原因关节痛患者注意皮肤、指甲检查，并结合高频超声等辅助手段，减少误诊。
Abstract：Objective To analyze the high-frequent ultrasonic characteristics of early joint lesions in patients with psoriatic arthritis(PsA) without skin lesions and the causes of misdiagnosis. Methods A retrospective analysis was conducted on the clinical data of 2 patients with PsA without skin lesions who were admitted from March 2023 to October 2024. Results Both of the two patients presented with knee joint pain, accompanied by pain in the joints of both hands. At the initial examination, no rashes were observed. The high-frequency ultrasound examination results showed one case of synovitis with effusion in both knee joints, and osteophyte formation in both knees, and one case of bilateral knee joint effusion, with the right side being more prominent, with thickening of the right knee synovium and a cyst inferolateral to the right popliteal fossa. Both patients were initially misdiagnosed as having arthritis and received corresponding treatments but without any improvement. In one patient, a red rash and scales appeared on the scalp, accompanied by itching; in the other patient, the fingernails of ten fingers showed varying degrees of thimble-like changes and longitudinal ridges, and a strip-like rash was observed at the 9-10 o'clock position around the umbilicus. No rashes were found in other areas. After relevant examinations, they were diagnosed with PsA. After adjusting the treatment, the joint pain of the patients was relieved, and the rash completely disappeared after 6 months. Conclusion In the early stage of PsA without skin lesion manifestations, there are no typical skin lesions. However, high-frequency ultrasound can reveal changes such as synovitis, joint effusion, thickening of the synovium, and popliteal cysts. The main reason for misdiagnosis is that patients have no obvious skin lesion symptoms. Clinicians should enhance their understanding of this disease and pay attention to skin and nail examinations for patients with unexplained joint pain. Combined with auxiliary methods such as high-frequency ultrasound, the rate of misdiagnosis can be reduced.
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基本信息:
中图分类号:R684.3;R758.63
引用信息:
[1]周静,赵园莹,马雪莹,等.无皮损银屑病关节炎早期关节病变高频超声特点及误诊原因[J].临床误诊误治,2026,39(02):14-20.
基金信息:
沧州市重点研发计划指导项目（23244102054）
2026-01-27
2026-01-27