Rheumatology, Jan van Breemen Institute, Dr Jan van Breemenstraat 2, 1056 AB, Amsterdam, The Netherlands.
Arthritis Res Ther. 2010;12(3):R98. doi: 10.1186/ar3028. Epub 2010 May 20.
Ultrasonography (US) has better sensitivity than clinical evaluation for the detection of synovitis in early rheumatoid arthritis (RA). Patients presenting with arthralgia and a positive anti-citrullinated protein antibodies (ACPA) and/or Rheumatoid Factor (IgM-RF) status are at risk for developing RA. In the present study, US utility and predictive properties in arthralgia patients at risk for the development of arthritis were studied.
192 arthralgia patients with ACPA and/or IgM-RF were included. Absence of clinical arthritis was confirmed by two physicians. US was performed by one of two trained radiologists of any painful joint, and of adjacent and contralateral joints. Joint effusion, synovitis and power Doppler (PD) signal in the synovial membrane of the joints and tenosynovitis adjacent to the joint were evaluated and classified on a 4-grade semi-quantitative scale. Grade 2-3 joint effusion, synovitis, tenosynovitis and grade 1-3 Power Doppler signal were classified as abnormal.
Forty-five patients (23%) developed arthritis after a mean of 11 months. Inter-observer reliability for synovitis and PD was moderate (kappa 0.46, and 0.56, respectively) and for joint effusion low (kappa 0.23). The prevalence of tenosynovitis was too low to calculate representative kappa values. At joint level, a significant association was found between US abnormalities and arthritis development in that joint for joint effusion, synovitis and PD. At patient level, a trend was seen towards more arthritis development in patients who had US abnormalities for joint effusion, synovitis, PD and tenosynovitis.
US abnormalities were associated with arthritis development at joint level, although this association did not reach statistical significance at patient level. US could potentially be used as a diagnostic tool for subclinical arthritis in seropositive arthralgia patients. However, further research is necessary to improve test characteristics.
超声检查（US）在检测早期类风湿关节炎（RA）的滑膜炎方面比临床评估更敏感。出现关节痛且抗瓜氨酸化蛋白抗体（ACPA）和/或类风湿因子（IgM-RF）阳性的患者有发生 RA 的风险。本研究旨在探讨超声检查在有发生关节炎风险的关节痛患者中的应用价值和预测价值。
共纳入 192 例 ACPA 和/或 IgM-RF 阳性的关节痛患者。两名医生确认无临床关节炎。由两名经过培训的放射科医生中的一名对任何疼痛关节及相邻和对侧关节进行超声检查。评估和分级关节积液、滑膜炎和关节滑膜的多普勒能量图（PD）信号，以及关节附近的腱鞘炎，并采用 4 级半定量评分。将 2-3 级关节积液、滑膜炎、腱鞘炎和 1-3 级 PD 信号分类为异常。
平均 11 个月后，45 例（23%）患者发展为关节炎。滑膜炎和 PD 的观察者间一致性为中度（kappa 值分别为 0.46 和 0.56），关节积液的一致性为低度（kappa 值为 0.23）。腱鞘炎的患病率过低，无法计算有代表性的 kappa 值。在关节水平，关节积液、滑膜炎和 PD 的超声异常与该关节的关节炎发展显著相关。在患者水平，关节积液、滑膜炎、PD 和腱鞘炎的超声异常患者中关节炎的发展趋势更为明显。
关节水平的超声异常与关节炎的发展相关，但在患者水平上未达到统计学意义。超声检查可能可作为血清阳性关节痛患者亚临床关节炎的诊断工具。但是，需要进一步的研究来提高检测的特征。
