Ponikowska Monika, Świerkot Jerzy, Nowak Beata
Department of Rheumatology and Internal Medicine, Wrocław University Hospital, Wrocław, Poland.
Department and Clinic of Rheumatology and Internal Medicine, Wrocław Medical University, Wrocław, Poland.
Reumatologia. 2018;56(6):354-361. doi: 10.5114/reum.2018.80712. Epub 2018 Dec 23.
To assess the importance of ultrasound (US) examination of joints in hands and feet in patients with early arthritis and perform comparative analysis of the diagnostic value of US examination for 8, 12 and 52 selected joints.
123 patients (87 women, 36 men) with arthritis lasting less than 12 months, naive to disease-modifying anti-rheumatic drugs and glucocorticosteroids. Necessary differential diagnostics was performed for each patient. After the preliminary analysis, 72 patients met the classification criteria for rheumatoid arthritis (RA) according to ACR/EULAR of 2010, and undifferentiated arthritis (UA) was diagnosed in 51 patients. UA patients were followed up after 6 and 12 months, and verification of the initial diagnosis yielded the following groups of patients: patients meeting classification criteria for RA, patients with maintained diagnosis of UA, patients in remission, and patients with other diagnoses. Ultrasound examination was performed considering the volume of joint effusion (JE), synovial membrane hypertrophy (GS), and synovial membrane hyperaemia assessed by power Doppler (PD). Results were assessed using the semi-qualitative scale. Coefficients being the sum of US scores for the assessment of JE, GS and PD for 52 and 12 joints in hands and feet, and 8 joints in hands were determined for the purpose of the study.
In patients meeting classification criteria for RA during the initial assessment the US examination yielded significantly higher PD-52I, PD-12I and PD-8I coefficients. In UA patients who were diagnosed with RA after 12 months, the GS-8I coefficient was significantly higher.
Ultrasonography is a valuable tool in diagnostics of early arthritis. The GS assessment has prognostic value for UA patients. The assessment of 8 or 12 selected joints is often sufficient for the diagnostics of patients with early arthritis.
评估超声（US）检查对手足早期关节炎患者关节的重要性，并对超声检查8个、12个和52个选定关节的诊断价值进行比较分析。
123例关节炎病程小于12个月的患者（87例女性，36例男性），未使用过改善病情抗风湿药物和糖皮质激素。对每位患者进行必要的鉴别诊断。初步分析后，72例患者符合2010年美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）类风湿关节炎（RA）分类标准，51例患者诊断为未分化关节炎（UA）。对UA患者进行6个月和12个月的随访，初始诊断的验证产生了以下几组患者：符合RA分类标准的患者、维持UA诊断的患者、缓解期患者和其他诊断的患者。超声检查考虑关节积液（JE）量、滑膜肥厚（GS）以及通过能量多普勒（PD）评估的滑膜充血情况。结果采用半定量量表进行评估。为研究目的，确定了手足52个和12个关节以及手部8个关节的JE、GS和PD评估的超声评分总和系数。
在初始评估中符合RA分类标准的患者，超声检查得出的PD-52I、PD-12I和PD-8I系数显著更高。在12个月后诊断为RA的UA患者中，GS-8I系数显著更高。
超声检查是早期关节炎诊断的有价值工具。GS评估对UA患者具有预后价值。对8个或12个选定关节的评估通常足以诊断早期关节炎患者。
