Lazaar Hakim, Lhoste-Trouilloud Agnes, Pereira Bruno, Couderc Marion, Mathieu Sylvain, Soubrier Martin
Clermont-Ferrand Teaching Hospital, Radiology A Department, Place H. DUNANT, Clermont-Ferrand, 63000, France.
Clermont-Ferrand Teaching Hospital, Biostatistics Unit, Clermont-Ferrand, 63003, France.
BMC Musculoskelet Disord. 2017 Mar 4;18(1):98. doi: 10.1186/s12891-017-1450-3.
Clinical symptoms of rheumatoid arthritis (RA) improve in the course of the day, as can synovitis activity, reported via doppler ultrasound (US). The aim of the study was to establish whether the Color Doppler (CD) scores of synovitis in RA changes throughout the day.
In total, 27 patients with active RA, including 14 patients receiving corticosteroids were studied. US evaluation was performed twice in each patient, at 9 a.m. (T0) and after 4 p.m. (T1) on the same day by a single radiologist and using the same instrument. Overall, 30 joints were assessed, including grey scale and CD (S0 = no flow [no detectable CD)]; S1 = mild [CD <1/3 of the synovium]; S2 = moderate [CD <2/3]; S3 = pronounced [CD >2/3]).
In the total population, synovitis was detected more often in the evening than in the morning (39% vs. 33%, p = 0.02). The difference remained significant only in patients without corticosteroid administration (44% vs. 37%, p = 0.04). Moreover, a greater number of CD-positive joints were likewise found (S0 vs. S1 + S2 + S3) in the evening (57% vs. 51%, p = 0.04) in patients not receiving corticosteroids (67% vs. 41%, p = 0.002). More moderate (S2) and pronounced (S3) than mild (S1) synovitis was observed at T1 vs. T0 (39% vs. 24%, p = 0.03) in patients not receiving corticosteroids. More synovitis (40% vs 36% p = 0.02) in the dominant hand were found in the evening than in the morning.
Synovitis and CD activity increase during the day in RA patients, especially in joints of the dominant hands and in patients without corticosteroids.
类风湿关节炎（RA）的临床症状在一天中会有所改善，通过多普勒超声（US）报告的滑膜炎活动情况也是如此。本研究的目的是确定RA患者滑膜炎的彩色多普勒（CD）评分在一天中是否会发生变化。
共研究了27例活动性RA患者，其中包括14例接受皮质类固醇治疗的患者。由同一位放射科医生使用同一台仪器，在同一天上午9点（T0）和下午4点后（T1）对每位患者进行两次超声评估。总共评估了30个关节，包括灰阶和CD（S0 =无血流[未检测到CD]；S1 =轻度[CD<滑膜的1/3]；S2 =中度[CD<2/3]；S3 =明显[CD>2/3]）。
在总体人群中，晚上检测到滑膜炎的频率高于早上（39%对33%，p = 0.02）。仅在未接受皮质类固醇治疗的患者中，这种差异仍然显著（44%对37%，p = 0.04）。此外，在未接受皮质类固醇治疗的患者中，晚上同样发现更多的CD阳性关节（S0对S1 + S2 + S3）（57%对51%，p = 0.04）（67%对41%，p = 0.002）。在未接受皮质类固醇治疗的患者中，与T0相比，T1时观察到的中度（S2）和明显（S3）滑膜炎多于轻度（S1）滑膜炎（39%对24%，p = 0.03）。晚上在优势手中发现更多的滑膜炎（40%对36%，p = 0.02）。
RA患者的滑膜炎和CD活动在白天增加，尤其是在优势手的关节和未接受皮质类固醇治疗的患者中。
