类风湿关节炎中的结构损伤：超声评估的肌腱损伤与放射学损伤的比较
Structural damage in rheumatoid arthritis: comparison between tendon damage evaluated by ultrasound and radiographic damage.
作者信息
Janta Iustina, Stanciu Denisa, Hinojosa Michelle, Nieto-González Juan Carlos, Valor Lara, Bello Natalia, Serrano Belen, Mata-Martínez Carmen, Martínez-Barrio Julia, Ovalles-Bonilla Juan Gabriel, González Carlos Manuel, López-Longo Francisco Javier, Monteagudo Indalecio, Naredo Esperanza, Carreño Luis
机构信息
Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain and
Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain and Clinical Center of Rheumatic Diseases 'Dr Ion Stoia', Bucharest, Romania.
出版信息
Rheumatology (Oxford). 2016 Jun;55(6):1042-6. doi: 10.1093/rheumatology/kew020. Epub 2016 Mar 3.
OBJECTIVE
To compare structural damage assessed by conventional radiography and tendon damage assessed by musculoskeletal US (MSUS) at wrist and ankle in RA patients.
METHODS
We evaluated 72 consecutive patients [56 (77.8%) females] with RA. The MSUS evaluation consisted in a B-mode examination of bilateral extensor carpi ulnaris and tibialis posterior tendons. Tendon damage was defined and scored according to OMERACT. A total score for the tendon damage score (TDS) was calculated by summing the grades for each tendon. For the radiographic evaluations we used the van der Heijde score; a total radiographic score (RTS) was calculated by summing a bone erosion score (ERS) and a joint space narrowing score (JSNS).
RESULTS
We evaluated 288 tendons. The mean (s.d.) of TDS was 2.3 (1.8). Fifty-four (75%) patients presented tendon damage of at least one tendon. From all evaluated tendons, 134 (46.5%) had no tendon damage, 146 (50.7%) had grade 1 and 8 (2.8%) had grade 2 tendon damage. The mean (s.d.) for RTS was 91.4 (97), for ERS was 47.3 (61.9) and for JSNS was 44.1 (37.2). We found a significant correlation between disease duration and both TDS and RTS (r = 0.413 and r = 0.560, respectively; P < 0.0001). We found a good significant correlation between TDS and all variables of radiographic structural damage (RTS, r = 0.65; ERS, r = 0.637; JSNS, r = 0.618; P < 0.001).
CONCLUSION
The MSUS assessment of only four tendons can be an additional feasible method to assess structural damage in RA patients.
目的
比较类风湿性关节炎（RA）患者手腕和脚踝处通过传统X线摄影评估的结构损伤与通过肌肉骨骼超声（MSUS）评估的肌腱损伤。
方法
我们评估了72例连续的RA患者[56例（77.8%）为女性]。MSUS评估包括对双侧尺侧腕伸肌和胫后肌腱进行B型检查。根据OMERACT对肌腱损伤进行定义和评分。通过将每条肌腱的分级相加计算肌腱损伤评分（TDS）的总分。对于X线摄影评估，我们使用了范德海伊德评分；通过将骨侵蚀评分（ERS）和关节间隙狭窄评分（JSNS）相加计算总放射学评分（RTS）。
结果
我们评估了288条肌腱。TDS的均值（标准差）为2.3（1.8）。54例（75%）患者至少有一条肌腱出现损伤。在所有评估的肌腱中，134条（46.5%）没有肌腱损伤，146条（50.7%）为1级损伤，8条（2.8%）为2级肌腱损伤。RTS的均值（标准差）为91.4（97），ERS为47.3（61.9），JSNS为44.1（37.2）。我们发现病程与TDS和RTS均存在显著相关性（分别为r = 0.413和r = 0.560；P < 0.0001）。我们发现TDS与放射学结构损伤的所有变量（RTS，r = 0.65；ERS，r = 0.637；JSNS，r = 0.618；P < 0.001）之间存在良好的显著相关性。
结论
仅对四条肌腱进行MSUS评估可以作为评估RA患者结构损伤的一种额外可行方法。
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