University of California, San Diego, La Jolla.
Arthritis Care Res (Hoboken). 2014 Feb;66(2):236-44. doi: 10.1002/acr.22119.
To investigate the usefulness of point-of-care hand and wrist joint ultrasound (US) examination in patients with established rheumatoid arthritis (RA).
Fifty-one RA patients were evaluated using clinical disease activity measures and gray-scale and power Doppler (PD) US. Agreement between US and clinical findings and its impact on physicians' confidence and clinical decision were assessed.
Agreement between intraarticular PD signal and joint swelling (JS) was moderate (82%; κ = 0.44). Agreement between PD signal and joint tenderness to palpation (TTP) was fair (75%; κ = 0.24). The greatest agreement between PD signal and clinical findings was seen in the 5th metacarpophalangeal (MCP) joint (96% JS, 88% TTP) and the poorest agreement was seen in the wrist (69% JS, 65% TTP) and 2nd (75% JS, 72% TTP) and 3rd (82% JS, 72% TTP) MCP joints. The presence of PD signal in nonswollen and/or nontender joints accounted for most of the disagreement in the wrists, while the opposite was true for the 2nd/3rd MCP joints. Agreement between sonographic synovial thickening and clinical findings was poor. Total sonographic synovial hypertrophy or PD score correlated significantly with physician-recorded, but not patient-recorded, clinical outcomes. US increased both physicians' confidence in their clinical decision (P < 0.0005, irrespective of Clinical Disease Activity Index score) and patients' confidence in physicians' medical decisions (88.4% of the cases). US modified biologic agent and/or disease-modifying antirheumatic drug (DMARD) use in 7 individual cases, but it did not affect the overall treatment plan (P > 0.15) or DMARD (P < 0.062) or biologic agent (P > 1.0) use in this group of RA patients.
PD examination of the wrist and 2nd/3rd MCP joints might be feasible and clinically meaningful in evaluation of disease activity in patients with established RA. US examination of the hand/wrist joints in RA increases physicians' confidence in their clinical decision and can help to individualize DMARD and biologic agent use.
探讨即时手部和腕关节超声（US）检查在确诊类风湿关节炎（RA）患者中的应用价值。
对 51 例 RA 患者进行临床疾病活动评估，并进行灰阶和能量多普勒（PD）US 检查。评估 US 与临床检查结果的一致性及其对医生信心和临床决策的影响。
关节内 PD 信号与关节肿胀（JS）的一致性为中度（82%；κ=0.44）。PD 信号与关节压痛（TTP）的一致性为尚可（75%；κ=0.24）。PD 信号与临床发现之间最大的一致性见于第 5 掌指关节（MCP）（96%JS，88%TTP），而在腕关节（69%JS，65%TTP）和第 2（75%JS，72%TTP）和第 3（82%JS，72%TTP）MCP 关节处一致性最差。在无肿胀和/或无压痛关节中存在 PD 信号，这是导致腕关节出现最大分歧的原因，而在第 2/3 MCP 关节中则恰恰相反。超声滑膜增厚与临床发现的一致性较差。总超声滑膜增生或 PD 评分与医生记录的但不是患者记录的临床结局显著相关。US 不仅增加了医生对临床决策的信心（无论疾病活动度指数评分如何，P<0.0005），也增加了患者对医生医疗决策的信心（88.4%的病例）。US 在 7 例患者中改变了生物制剂和/或改善病情抗风湿药（DMARD）的使用，但并未影响整体治疗计划（P>0.15）或 DMARD（P<0.062）或生物制剂（P>1.0）在这组 RA 患者中的使用。
即时 PD 检查腕关节和第 2/3 MCP 关节可能在评估确诊 RA 患者的疾病活动中具有可行性和临床意义。RA 手部/腕关节的 US 检查增加了医生对临床决策的信心，并有助于实现 DMARD 和生物制剂的个体化使用。
