Xue Shao-Wei, Luo Yu-Kun, Zhao Yu-Rong, Jiao Zi-Yu
Shao-wei Xue, Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, P. R. China.
Yu-kun Luo, Department of Ultrasound, The First Medical Center of Chinese PLA General Hospital, Beijing 100853, P. R. China.
Pak J Med Sci. 2020 Jul-Aug;36(5):977-981. doi: 10.12669/pjms.36.5.2716.
To explore the role of musculoskeletal ultrasound (MSUS) in the differential diagnosis of gouty arthritis (GA) and rheumatoid arthritis (RA) and to analyze the ultrasound imaging features of the two diseases.
A retrospective study was carried out. A total of 66 patients who had been admitted to The First Medical Center of Chinese PLA General Hospital from May 2018 to March 2019 were enrolled. Among them, 34 patients were diagnosed with RA and were included in the RA group; 32 patients were diagnosed with gouty arthritis and were included in the GA group. The imaging features of musculoskeletal ultrasound were compared between the two groups of patients.
A total of 34 patients were included in the RA group, including 17 males and 17 females. A total of 32 patients were included in the GA group, including 14 males and 18 females. There were no significant differences in gender composition, age, and duration of disease between the two groups (>0.05). In the RA group, there were joint bone erosions with a clear boundary in seven cases and with a blurred boundary in 27 cases; synovial hyperplasia was observed in 27 cases, and point-like hyperechoic masses were observed in four cases. In the GA group, there were joint bone erosions with a clear boundary in 27 cases and with a blurred boundary in five cases; synovial hyperplasia was observed in four cases, tophus was observed in 23 cases, point-like hyperechoic masses were observed in 27 cases, and the tram-track sign was observed in 23 cases. The differences in bone erosion boundaries (c2=26.854, <0.01), synovial hyperplasia (c2=29.631, <0.01), tophus (<0.01), point-like hyperechoic mass (c2=33.095, <0.01), and tram-track sign (<0.01) were statistically significant between the two groups of patients. In the RA group, blood flow signaling was Grade 0 in one case, Grade-I in five cases, Grade-II in 14 cases, and Grade-III in 14 cases. In the GA group, blood flow signaling was Grade 0 in 26 cases, Grade-I in three cases, Grade-II in three cases, and Grade-III in zero cases. The difference in the synovial blood flow signaling between the two groups of patients was statistically significant (c2=34.323, <0.01).
MSUS has certain diagnostic value in the differentiation of GA and RA. Moreover, the two conditions have their own ultrasound imaging features.
探讨肌肉骨骼超声（MSUS）在痛风性关节炎（GA）与类风湿关节炎（RA）鉴别诊断中的作用，并分析两种疾病的超声影像学特征。
进行一项回顾性研究。纳入2018年5月至2019年3月在中国人民解放军总医院第一医学中心住院的66例患者。其中，34例被诊断为RA，纳入RA组；32例被诊断为痛风性关节炎，纳入GA组。比较两组患者肌肉骨骼超声的影像学特征。
RA组共纳入34例患者，其中男性17例，女性17例。GA组共纳入32例患者，其中男性14例，女性18例。两组患者在性别构成、年龄及病程方面差异均无统计学意义（>0.05）。RA组中，7例关节骨侵蚀边界清晰，27例边界模糊；27例出现滑膜增生，4例出现点状高回声团块。GA组中，27例关节骨侵蚀边界清晰，5例边界模糊；4例出现滑膜增生，23例出现痛风石，27例出现点状高回声团块，23例出现“双轨征”。两组患者在骨侵蚀边界（c2=26.854，<0.01）、滑膜增生（c2=29.631，<0.01）、痛风石（<0.01）、点状高回声团块（c2=33.095，<0.01）及“双轨征”（<0.01）方面差异均有统计学意义。RA组中，血流信号0级1例，Ⅰ级5例，Ⅱ级14例，Ⅲ级14例。GA组中，血流信号0级26例，Ⅰ级3例，Ⅱ级3例，Ⅲ级0例。两组患者滑膜血流信号差异有统计学意义（c2=34.323，<0.01）。
MSUS在GA与RA的鉴别诊断中具有一定的诊断价值。而且，这两种疾病有各自的超声影像学特征。
