Jeka Sławomir, Dura Marta, Żuchowski Paweł, Zwierko Beata, Wojciechowski Rafał
Jan Biziel University Hospital No. 2, Department of Rheumatology and Connective Tissue Diseases, Bydgoszcz, Collegium Medicum in Bydgoszcz, UMK, Torun, Poland.
Jan Biziel University Hospital No. 2, Department of Radiology, Bydgoszcz, Poland.
Reumatologia. 2017;55(4):177-182. doi: 10.5114/reum.2017.69781. Epub 2017 Aug 31.
Rheumatoid arthritis (RA) is a condition that poses many diagnostic problems. As a result, it is often diagnosed too late, which makes effective treatment more difficult. The course of the disease is chronic, and it causes irreversible changes in the musculoskeletal system, as well as bone destruction, and this in turn impairs the proper monitoring of the treatment. Therefore, in order to assess the treatment's efficacy, as well as a clinical examination of the patient and laboratory tests, diagnostic imaging is being used more frequently in routine practice. The aim of this paper is to assess the usefulness of power Doppler ultrasonography in the assessment of MCP joints in patients with chronic RA (LSRA), in comparison with DAS28, X-ray, and MRI.
The study involved 26 patients with LSRA, treated with biologics. It lasted for a year. At the moment of enrolment, the condition had lasted for a minimum of 5 years, and DAS28 was > 5.1. The patients had visits every three months. During every visit, a PDUS test was performed and the DAS28 was determined. In the first and last month of the study the patients underwent X-ray and MRI tests.
At the end of the study, the DAS28 of 26 (100%) patients was lower or equal to 3.2. Based on PDUS and MRI tests, no synovitis was found in 21 (81%) and 18 (69%) patients, respectively. According to the MRI results, radiological changes progressed in 5 (19%) of them. All patients who showed progress of radiological changes also had visible synovitis during their PDUS test.
PDUS in patients with LSRA can be helpful in selecting patients, who are likely to develop a progression of radiological changes.
类风湿性关节炎（RA）是一种存在诸多诊断难题的疾病。因此，其常常被诊断过晚，这使得有效治疗更加困难。该疾病病程呈慢性，会导致肌肉骨骼系统发生不可逆变化以及骨质破坏，进而影响治疗的正确监测。所以，为了评估治疗效果以及对患者进行临床检查和实验室检测，诊断成像在常规实践中使用得越来越频繁。本文旨在评估能量多普勒超声检查在评估慢性类风湿性关节炎（LSRA）患者掌指关节方面的效用，并与疾病活动评分28（DAS28）、X线和磁共振成像（MRI）进行比较。
该研究纳入了26例接受生物制剂治疗的LSRA患者。研究持续一年。入组时，病情至少已持续5年，且DAS28大于5.1。患者每三个月就诊一次。每次就诊时，均进行能量多普勒超声检查（PDUS）并测定DAS28。在研究的第一个月和最后一个月，患者接受X线和MRI检查。
研究结束时，26例（100%）患者的DAS28低于或等于3.2。基于PDUS和MRI检查，分别有21例（81%）和18例（69%）患者未发现滑膜炎。根据MRI结果，其中5例（19%）患者的放射学改变有进展。所有放射学改变有进展的患者在PDUS检查时也有明显的滑膜炎。
PDUS有助于筛选出可能出现放射学改变进展的LSRA患者。
