Department of Rheumatology and Rheumatology Unit, University Clinic and AOU of Cagliari, Cagliari, Italy.
Rheumatology (Oxford). 2012 Dec;51(12):2278-85. doi: 10.1093/rheumatology/kes226. Epub 2012 Sep 6.
To estimate the prevalence of, and identify factors associated with, hand and wrist US alterations in a large cohort of SLE patients.
One hundred and eight consecutive SLE patients were recruited and classified according to arthropathy type and the musculoskeletal item of the British Isles Lupus Assessment Group (BILAG) 2004 score. US examinations were performed on hand and wrist flexor tendons, wrist extensor tendons, second and third MCP and wrist joints bilaterally using a multi-planar scanning technique.
US examination showed joint involvement in 42/108 (38.8%) subjects, tendon involvement in 44/108 (40.7%) and both in 22/108 (20.3%). Patients with rhupus syndrome (n = 8) carried a higher incidence of inflammatory changes (87%) and erosions (87%) compared with the six with Jaccoud's arthropathy (50% and 17%, respectively) and the 94 with non-deforming X-ray non-erosive arthropathy (37% and 21%, respectively). Power Doppler signal was prevalent in patients scoring A (n = 4) or B (n = 9) on the musculoskeletal item of the BILAG 2004, and was significantly more frequent at the joint (92%) and tendon (54%) level than in the 26 patients scoring C (19%, P = 0.0007 and 15%, P = 0.016, respectively) and in the 69 scoring D (3%, P < 0.0001 and 3%, P < 0.0001). US changes in patients who scored C or D were more expressed at the tendon level (50% and 29%, respectively) than at the joint level (35% and 9%, respectively).
The picture of musculoskeletal US in SLE depends on arthropathy subtype and disease activity. US examination could be a valid and reliable tool to monitor musculoskeletal features and therapeutic outcomes in SLE patients.
评估大样本系统性红斑狼疮（SLE）患者手部和腕部超声改变的患病率，并确定其相关影响因素。
共招募了 108 例连续的 SLE 患者，并根据关节病类型和 2004 年英国狼疮评估组（BILAG）的肌肉骨骼项目评分进行分类。使用多平面扫描技术对双侧手部和腕部屈肌腱、伸肌腱、第二和第三掌指关节（MCP）和腕关节进行超声检查。
超声检查显示 42/108（38.8%）例患者存在关节受累，44/108（40.7%）例患者存在肌腱受累，22/108（20.3%）例患者同时存在关节和肌腱受累。8 例出现类风湿疹综合征（rhupus syndrome）的患者，其炎症性改变（87%）和侵蚀性改变（87%）的发生率明显高于 6 例出现 Jaccoud 关节病（分别为 50%和 17%）和 94 例存在非破坏性 X 线非侵蚀性关节病（分别为 37%和 21%）。在 BILAG 2004 肌肉骨骼项目评分为 A（n = 4）或 B（n = 9）的患者中，存在较多的功率多普勒信号，且在关节（92%）和肌腱（54%）水平比 26 例评分为 C（19%，P = 0.0007 和 15%，P = 0.016）和 69 例评分为 D（3%，P < 0.0001 和 3%，P < 0.0001）的患者更为常见。评分为 C 或 D 的患者的超声改变在肌腱水平（分别为 50%和 29%）比在关节水平（分别为 35%和 9%）更为明显。
SLE 的肌肉骨骼超声表现取决于关节病亚型和疾病活动度。超声检查可能是监测 SLE 患者肌肉骨骼特征和治疗效果的有效且可靠的工具。
