County Emergency Clinical Hospital Sălaj, Zalău, and Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Iuliu Hațieganu University of Medicine and Pharmacy, and County Emergency Clinical Hospital Cluj, ERN ReCONNET Center, Cluj-Napoca, Romania.
Clin Exp Rheumatol. 2022 Sep;40(9):1686-1692. doi: 10.55563/clinexprheumatol/am4oj4. Epub 2021 Dec 10.
We aimed to investigate the prevalence of US findings in the hand joints and related tendons and explore clinical and laboratory associations in SLE patients of the typical lupus clinic.
One hundred consecutive SLE patients were enrolled in the study. Using B-mode and Doppler US, bilateral wrist, metacarpophalangeal and proximal interphalangeal joints were examined for synovitis and erosions, as well as for signs of hand tenosynovitis.
US detected synovitis (grade 1-3) in 75% and erosive changes in 25% of the cohort. We found that clinical examination underestimated grade ≥2 synovitis by 13%, while US detected SH grade ≥2 in 10% of asymptomatic patients. The overall inflammatory burden, reflected by the US score, was associated with disease activity (respectively with CPR, SELENA-2K, MS-BILAG, and hypocomplementemia), as well as the presence of bone erosions. Rhupus patients had higher inflammatory markers, significantly more synovial hypertrophy, more erosions, more grade 3 tenosynovitis, and were more likely to receive methotrexate (p<0.001) than patients with SLE arthritis, while patients with Jaccoud's arthropathy were more likely to accumulate damage. The dominant hand exhibited more inflammatory changes (respectively synovial hypertrophy grade ≥2) at both the wrist and MCP joints; however, handedness was not associated with structural damage.
In conclusion: 1. joint involvement in SLE is frequent and underacknowledged; 2. the overall inflammatory burden is associated with systemic disease activity and joint damage; (3) destructive arthritis is more likely to occur in the context of concomitant RA or within an "RA-like" subtype of SLE arthropathy; 4. hand dominance is associated with synovitis, but not structural changes; 5. US assessment may help tailor the management of joint involvement, thus preventing joint damage and disability in SLE patients.
我们旨在调查美国手部关节及其相关肌腱的发现率，并探讨典型狼疮诊所中 SLE 患者的临床和实验室关联。
本研究纳入了 100 例连续的 SLE 患者。使用 B 型和多普勒超声，对双侧腕关节、掌指关节和近端指间关节进行滑膜炎和侵蚀以及手部肌腱滑膜炎的检查。
超声检测到 75%的患者存在滑膜炎（1-3 级）和 25%的侵蚀性改变。我们发现，临床检查低估了 13%的 2 级以上滑膜炎，而超声在 10%的无症状患者中检测到 SH 2 级以上。反映在 US 评分中的整体炎症负担与疾病活动（分别与 CRP、SELENA-2K、MS-BILAG 和低补体血症相关）以及骨侵蚀有关。Rhupus 患者的炎症标志物更高，滑膜增生更明显，侵蚀更多，3 级肌腱滑膜炎更多，更有可能接受甲氨蝶呤治疗（p<0.001），而 SLE 关节炎患者则更有可能累积损伤。优势手在腕关节和 MCP 关节均显示出更多的炎症改变（分别为滑膜炎 2 级以上）；然而，手的优势与结构损伤无关。
总之：1. SLE 关节受累频繁且未被充分认识；2. 整体炎症负担与全身性疾病活动和关节损伤相关；3. 在伴有 RA 或“RA 样”SLE 关节病亚型的情况下，破坏性关节炎更有可能发生；4. 手的优势与滑膜炎有关，但与结构变化无关；5. US 评估可能有助于调整关节受累的治疗方案，从而预防 SLE 患者的关节损伤和残疾。
