Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Advanced Medicine for Rheumatic Diseases, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Mod Rheumatol. 2022 Jan 5;32(1):127-135. doi: 10.1080/14397595.2021.1912905.
We aimed to clarify the clinical implication of ultrasound (US)-detected foot joint inflammation in tightly controlled patients with rheumatoid arthritis (RA).
We evaluated bilateral foot joints (second to fifth metatarsophalangeal joints of forefoot; tarsometatarsal, cuneonavicular and midtarsal joints of midfoot) of 430 RA patients for synovitis using Power Doppler (PD) imaging by US. We made a cross-sectional and a 3-year longitudinal analysis about the associations of US-detected synovitis with clinical, laboratory and radiographic data as well as foot-specific outcomes using a self-administered foot evaluation questionnaire (SAFE-Q).
The US-detected foot synovitis was seen in 28% of patients. The US-detected synovitis was closely related to 28 joint-disease activity score (DAS28) more in the forefoot than in the midfoot, while related to joint destruction in both. Multiple regression analyses showed significant associations between midfoot PD positivity and SAFE-Q in the remission group. SAFE-Q was worsened after the 3-year interval, but PD positivity at baseline did not contribute to the changes. On the other hand, destruction of the joints with US-detected synovitis significantly progressed in 3 years than with not.
US-detected synovitis on foot joints were related to systemic inflammation, clinical symptoms, and future joint destruction with region specificity.
我们旨在阐明在类风湿关节炎（RA）患者中，超声（US）检测到的足部关节炎症的临床意义。
我们使用超声的能量多普勒（PD）成像评估了 430 名 RA 患者的双侧足部关节（前足的第二至第五跖趾关节；中足的跗跖、楔骨和中跗关节）的滑膜炎。我们进行了横断面和 3 年纵向分析，探讨了 US 检测到的滑膜炎与临床、实验室和放射学数据以及使用自我管理足部评估问卷（SAFE-Q）的足部特定结局之间的关联。
28%的患者存在 US 检测到的足部滑膜炎。与中足相比，US 检测到的前足滑膜炎与 28 关节疾病活动评分（DAS28）的相关性更密切，而与关节破坏的相关性在两者中均存在。多变量回归分析显示，在缓解组中，中足 PD 阳性与 SAFE-Q 之间存在显著关联。在 3 年的随访中，SAFE-Q 恶化，但基线时 PD 阳性并不导致其变化。另一方面，与未出现滑膜炎的关节相比，出现滑膜炎的关节在 3 年内的破坏明显进展。
足部关节的 US 检测到的滑膜炎与全身炎症、临床症状以及未来的关节破坏有关，且具有区域特异性。
