Usón Jacqueline, Fernández-Espartero Cruz, Villaverde Virginia, Condés Emilia, Godo Javier, Martínez-Blasco Maria Jesus, Miguélez Roberto
Sección de Reumatología, Hospital Universitario Móstoles, Madrid, España.
Sección de Reumatología, Hospital Universitario Móstoles, Madrid, España.
Reumatol Clin. 2014 Sep-Oct;10(5):278-82. doi: 10.1016/j.reuma.2014.01.008. Epub 2014 Apr 13.
To date few studies have examined whether ultrasonography can depict morphologic differences in painful and painless osteoarthritis (OA). This study describes and compares the clinical, radiographic and ultrasonographic findings of patients with both painful and painless proximal interphalgeal (PIP) and/or distal interphalgeal (DIP) OA.
Patients with PIP and/or DIP OA (ACR criteria) were prospectively recruited. The clinical rheumatologist chose up to 3 painful joints and up to 3 painless symmetric joints in each patient to define 2 cohorts of OA: symptomatic (SG) and asymptomatic (ASG). A conventional postero-anterior hand x ray was performed and read by one rheumatologist following the OARSI atlas, blinded to clinical and sonographic data. Ultrasound (US) was performed by an experienced rheumatologist, blinded to both clinical and radiographic data in joints previously selected by the clinical rheumatologist. US-pathology was assessed as present or absent as defined in previous reports: osteophytes, joint space narrowing, synovitis, intra-articular power doppler signal, intra-articular bony erosion, and visualization of cartilage. Radiographic and ultrasonographic intrareader reliability test was performed.
A total of 50 joints in the SG and ASG were included from 20 right handed women aged 61.85 (46-73) years with PIP and DIP OA diagnosed 6.8 (1-17) years ago. 70% SG joints and ASG were right and left sided respectively. The SG showed significantly more osteophytes, synovitis and non-visualization of joint cartilage. Intrareader radiographic and ultrasonographic agreement was excellent.
This study demonstrates that painful PIP and/or DIP OA have more ultrasonographic structural changes and synovitis.
迄今为止，很少有研究探讨超声检查能否显示疼痛性和无痛性骨关节炎（OA）的形态学差异。本研究描述并比较了患有疼痛性和无痛性近端指间关节（PIP）和/或远端指间关节（DIP）OA患者的临床、影像学和超声检查结果。
前瞻性招募符合PIP和/或DIP OA（美国风湿病学会标准）的患者。临床风湿病学家在每位患者中选择多达3个疼痛关节和多达3个无痛对称关节，以确定2组OA：症状性（SG）和无症状性（ASG）。由一名风湿病学家按照OARSI图谱进行常规的手部后前位X线检查，并在对临床和超声数据不知情的情况下进行解读。超声检查（US）由一名经验丰富的风湿病学家进行，在对临床风湿病学家先前选择的关节的临床和影像学数据不知情的情况下进行。根据先前报告中定义的情况评估US病理表现是否存在：骨赘、关节间隙变窄、滑膜炎、关节内功率多普勒信号、关节内骨质侵蚀以及软骨可视化。进行了影像学和超声检查的阅片者内部可靠性测试。
共纳入了20名61.85（46 - 73）岁右利手女性的SG组和ASG组中的50个关节，这些患者在6.8（1 - 17）年前被诊断为PIP和DIP OA。SG组和ASG组分别有70%的关节为右侧和左侧。SG组显示出明显更多的骨赘、滑膜炎以及关节软骨不可见。阅片者内部影像学和超声检查的一致性极佳。
本研究表明，疼痛性PIP和/或DIP OA具有更多的超声结构改变和滑膜炎。
