Jindal Sandeep, Kaushik Reshma, Raghuvanshi Shailendra, Kaushik Rajeev M, Kakkar Rajesh
Department of Medicine, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, P.O. Jolly Grant-248016, Dehradun, India.
Department of Radiodiagnosis, Himalayan Institute of Medical Sciences, Swami Rama Himalayan University, P.O. Jolly Grant-248016, Dehradun, India.
Curr Rheumatol Rev. 2018;14(2):153-162. doi: 10.2174/1573397113666170120094136.
To study the utility of gray scale and power Doppler ultrasonography in assessing the disease activity and correlation of ultrasonographic findings with disease activity parameters in Rheumatoid Arthritis (RA).
This cross-sectional study was conducted on 100 RA patients diagnosed as per 2010 classification criteria. Rheumatoid Factor (RF), serum Anti-cyclic Citrullinated Peptide Antibodies (ACPA), Erythrocyte Sedimentation Rate (ESR), C-reactive Protein (CRP), disease activity score with 28-joint counts and ESR (DAS28-ESR), Visual Analogue Scale (VAS) for global disease activity and Gray Scale Ultrasonography (GSUS) and Power Doppler Ultrsonography (PDUS) scores in hands and wrists were determined.
Of 100 RA patients with clinically active arthritis, GSUS detected disease activity in all and PDUS in 95 (95%) patients. Of total 2200 joints assessed, disease activity was seen by clinical assessment in 51.31% (1116/2200), GSUS in 57.36% (1262/2200) and PDUS in 48.36% (1064/2200) joints. For detecting active arthritis, clinical assessment showed 79.5% sensitivity and 76.2% specificity while GSUS showed 100% sensitivity and 82.5% specificity using PDUS as a gold standard. GSUS findings of synovitis, joint effusion and bone erosions and PDUS score showed significant correlations with the swollen joint count, tender joint count, ESR and DAS28- ESR (p<0.05 each) but not with VAS, CRP, RF and ACPA (p>0.05 each). Multivariate analysis showed that swollen joint count was independently associated with synovitis (p=0.029) and tender joint count with PDUS score (p=0.036).
GSUS and PDUS findings are useful in ascertaining the disease activity and correlate with clinical disease activity in joints in RA.
研究灰阶超声和能量多普勒超声在评估类风湿关节炎（RA）疾病活动度方面的效用，以及超声检查结果与疾病活动度参数之间的相关性。
本横断面研究对100例根据2010年分类标准确诊的RA患者进行。测定类风湿因子（RF）、血清抗环瓜氨酸肽抗体（ACPA）、红细胞沉降率（ESR）、C反应蛋白（CRP）、28关节计数及ESR的疾病活动评分（DAS28-ESR）、整体疾病活动度的视觉模拟评分（VAS）以及双手和腕关节的灰阶超声（GSUS）和能量多普勒超声（PDUS）评分。
在100例临床活动性关节炎的RA患者中，GSUS检测出所有患者的疾病活动度，PDUS检测出95例（95%）患者的疾病活动度。在总共评估的2200个关节中，临床评估发现51.31%（1116/2200）的关节有疾病活动度，GSUS发现57.36%（1262/2200）的关节有疾病活动度，PDUS发现48.36%（1064/2200）的关节有疾病活动度。以PDUS作为金标准，对于检测活动性关节炎，临床评估的敏感性为79.5%，特异性为76.2%，而GSUS的敏感性为100%，特异性为82.5%。GSUS的滑膜炎、关节积液和骨侵蚀表现以及PDUS评分与肿胀关节计数、压痛关节计数、ESR和DAS28-ESR显著相关（各p<0.05），但与VAS、CRP、RF和ACPA无关（各p>0.05）。多因素分析显示，肿胀关节计数与滑膜炎独立相关（p=0.029），压痛关节计数与PDUS评分独立相关（p=0.036）。
GSUS和PDUS检查结果有助于确定RA的疾病活动度，并与关节的临床疾病活动度相关。
