Lerch K, Herold T, Borisch N, Grifka J
Orthopädische Klinik, Universität, Regensburg, Germany.
Orthopade. 2003 Aug;32(8):691-8. doi: 10.1007/s00132-003-0509-z.
Early specific radiologic changes of rheumatoid arthritis can usually be detected in the hands and feet. Later stages of the disease process show a typical centripetal spread of the affected joints, i.e., shoulder, elbow, and knee. For prognostic assessment of cubital rheumatoid arthritis, conventional radiography still remains the gold standard. X-rays allow objective scoring and thus classification into standardized stages. A concentric destruction of the rheumatic joint as compared to deformity in the degenerative joint is the typical radiologic symptom to look for. For soft tissue assessment, ultrasound (US) should be the diagnostic tool of choice. Due to the thin surrounding soft tissue layer, as well as the advanced high-resolution technology, bony structures can also be well demonstrated in any plane. In the early arthritic stages, particularly the small changes, e.g., minimal erosions of the cortical area, are very well detectable by US. The use of "color" allows good evaluation of the synovial inflammatory status. Modern imaging methods such as computer- assisted tomography (CAT) scan and magnetic resonance imaging (MRI) are restricted to a few set indications and should not be chosen for routine examination. More invasive methods such as arthrography are no longer indicated for assessment of cubital rheumatoid arthritis.
类风湿关节炎早期的特定放射学改变通常可在手部和足部检测到。疾病进程的后期阶段显示出受累关节典型的向心性扩散，即肩部、肘部和膝部。对于肘类风湿关节炎的预后评估，传统放射摄影仍然是金标准。X射线可进行客观评分，从而将其分类为标准化阶段。与退行性关节畸形相比，风湿性关节的同心性破坏是要寻找的典型放射学症状。对于软组织评估，超声（US）应是首选的诊断工具。由于周围软组织层较薄，以及先进的高分辨率技术，在任何平面都能很好地显示骨骼结构。在关节炎早期阶段，尤其是微小变化，例如皮质区域的微小侵蚀，超声能够很好地检测到。使用“彩色”可很好地评估滑膜炎症状态。计算机辅助断层扫描（CAT）和磁共振成像（MRI）等现代成像方法仅限于少数特定指征，不应选择用于常规检查。关节造影等侵入性更强的方法不再适用于肘类风湿关节炎的评估。
