Ruano Carina A, Malheiro Rui, Oliveira João F, Pinheiro Sofia, Vieira Luís S, Moraes-Fontes Maria Francisca
Radiology Department , Hospital de Santo António dos Capuchos, Centro Hospitalar de Lisboa Central (CHLC) , Lisbon , Portugal.
Autoimmune Disease Unit,Unidade de Doenças Auto-imunes/Serviço Medicina 3, Hospital de Santo António dos Capuchos, CHLC, Lisbon, Portugal; Núcleo de Estudos de Doenças Auto-imunes da Sociedade Portuguesa de Medicina Interna (NEDAI/SPMI), Lisbon, Portugal.
Lupus Sci Med. 2017 Jan 19;4(1):e000184. doi: 10.1136/lupus-2016-000184. eCollection 2017.
To assess the prevalence and severity of ultrasonographic abnormalities of the hand and wrist of asymptomatic patients with systemic lupus erythematosus (SLE) and compare these findings with those from patients with SLE with musculoskeletal signs or symptoms and healthy controls.
We conducted a prospective cross-sectional study that evaluated bilaterally, with grey-scale and power Doppler (PD) ultrasound (US), the dorsal hand (2nd to 5th metacarpophalangeal and 2nd to 5th proximal interphalangeal joints) and wrist (radiocarpal, ulnocarpal and intercarpal joints) of 30 asymptomatic patients with SLE, 6 symptomatic patients with SLE and 10 controls. Synovial hypertrophy (SH) and intra-articular PD signal were scored using semiquantitative grading scales (0-3). Individual scores were graded as normal (SH≤1 and PD=0) or abnormal (SH≥2 or PD≥1). Global indexes for SH and PD were also calculated. US findings were correlated with clinical and laboratory data and disease activity indexes.
US detected SH (score ≥1) in 77% asymptomatic patients with SLE, mostly graded as minimal (score 1: 63%). 23% of the asymptomatic patients with SLE showed abnormal US PD findings (SH≥2 or PD≥1). SH was present in all symptomatic patients with SLE, mostly graded as moderate (grade 2: 67%), and with associated PD signal (83%). SH (score 1) was identified in 50% of controls, however, none presented abnormal US PD findings. SH index in the asymptomatic SLE group was higher than in the control group (2.0 (0-5) vs 0.5 (0-2), median (range), p=0.01) and lower than in the symptomatic SLE group (7.0 (4-23), median (range), p<0.001). No significant correlation was demonstrated between US PD findings and clinical or laboratory variables and disease activity indexes.
A small subgroup of asymptomatic patients with SLE may present subclinical joint inflammation. Global US scores and PD signal may be important in disease evaluation and therapeutic monitoring.
评估无症状系统性红斑狼疮（SLE）患者手部和腕部超声异常的患病率及严重程度，并将这些结果与有肌肉骨骼体征或症状的SLE患者及健康对照者的结果进行比较。
我们进行了一项前瞻性横断面研究，使用灰阶和能量多普勒（PD）超声对30例无症状SLE患者、6例有症状SLE患者和10名对照者的双手背（第2至第5掌指关节及第2至第5近端指间关节）和腕部（桡腕关节、尺腕关节和腕骨间关节）进行双侧评估。滑膜增生（SH）和关节内PD信号使用半定量分级量表（0 - 3级）进行评分。个体评分分为正常（SH≤1且PD = 0）或异常（SH≥2或PD≥1）。还计算了SH和PD的总体指数。超声检查结果与临床和实验室数据以及疾病活动指数相关。
超声检查发现77%的无症状SLE患者存在SH（评分≥1），大多为轻度（评分1：63%）。23%的无症状SLE患者超声PD检查结果异常（SH≥2或PD≥1）。所有有症状的SLE患者均存在SH，大多为中度（2级：67%），并伴有PD信号（83%）。50%的对照者发现有SH（评分1），然而，无人出现超声PD检查结果异常。无症状SLE组的SH指数高于对照组（中位数（范围）2.0（0 - 5）对0.5（0 - 2），p = 0.01），低于有症状SLE组（中位数（范围）7.0（4 - 23），p < 0.001）。超声PD检查结果与临床或实验室变量以及疾病活动指数之间未显示出显著相关性。
一小部分无症状SLE患者可能存在亚临床关节炎症。超声总体评分和PD信号在疾病评估和治疗监测中可能很重要。
