Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy.
NIHR Leeds Musculoskeletal Biomedical Research Centre, Leeds Teaching Hospitals Trust, Leeds, and the University of Leeds, UK.
Clin Exp Rheumatol. 2018 Sep-Oct;36(5):785-790. Epub 2018 Feb 28.
To determine whether a detailed sonographic evaluation of the hand flexor tendon compartment could help differentiate between psoriatic arthritis (PsA) and rheumatoid arthritis (RA).
Thirty-seven patients with PsA, 47 with RA and 10 healthy controls (HC) had flexor tendon (FT) compartment imaging of the dominant hand 2nd to 4th tendons using grey scale (GS) and power Doppler (PD) ultrasound (US) with evaluation for tenosynovitis, peri-tendinous lesions, soft tissue oedema and bony changes at FT insertions. 24/37 PsA and 19/47 RA cases had morning stiffness and 19/37 PsA and 10/47 RA had swollen and/or tender fingers.
Tenosynovitis was more common in PsA (25/37) despite higher DAS28 scores in RA (25/37 versus 10/45; p<0.001). Peri-tendinous dermal soft tissue oedema with associated PD signal was evident in one third of PsA patients but in no RA patients (p=0.003). Flexor tendon enthesopathy including new bone formation at the insertional site was significantly more common in PsA (p=0.001). Considering a total inflammatory score per patient summing up the three modifications of the flexor tendon (tenosynovitis, peri-tendinous oedema and insertional enthesophytes) the difference between PsA and RA remained statistically significant (p<0.001).
Our study adds to the growing body of literature that high resolution US of the hand FT compartment may help differentiate between RA and PsA, which needs assessment in the diagnostic setting.
确定对手部屈肌腱鞘的详细超声评估是否有助于区分银屑病关节炎（PsA）和类风湿关节炎（RA）。
对 37 例 PsA 患者、47 例 RA 患者和 10 例健康对照者（HC）的优势手第 2 至 4 指屈肌腱进行灰阶（GS）和功率多普勒（PD）超声成像，评估肌腱滑膜炎、肌腱周围病变、软组织水肿和肌腱止点处的骨改变。24/37 例 PsA 和 19/47 例 RA 患者有晨僵，19/37 例 PsA 和 10/47 例 RA 患者有肿胀和/或压痛的手指。
尽管 RA 的 DAS28 评分更高（25/37 例），但 PsA 的肌腱滑膜炎更常见（25/37 例）（p<0.001）。三分之一的 PsA 患者存在肌腱周围真皮软组织水肿并伴有 PD 信号，但在 RA 患者中没有（p=0.003）。PsA 患者的屈肌腱附着病，包括附着点处新骨形成，明显更常见（p=0.001）。考虑到每位患者的总炎症评分，即三个屈肌腱改变（肌腱滑膜炎、肌腱周围水肿和附着点骨赘）的总和，PsA 和 RA 之间的差异仍具有统计学意义（p<0.001）。
本研究增加了越来越多的文献证据，表明手部屈肌腱鞘的高分辨率超声可能有助于区分 RA 和 PsA，这需要在诊断环境中进行评估。
