Brix Lau, Hedemann-Nielsen Agnete, Medrud Lise, Fredberg Ulrich, Ellingsen Torkell
Department of Radiology, University Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark.
Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Rheumatol Int. 2024 Dec 14;45(1):1. doi: 10.1007/s00296-024-05762-7.
To describe agreement in detection of joint swelling as the mandatory key of the diagnostic algorithm used in rheumatoid arthritis (RA). This was done by comparing clinical examinations, ultrasonography (US), Magnetic Resonance Imaging (MRI) and patient self-evaluation of the joints in the wrist and fingers (metacarpophalangeal joints (MCP) and proximal interphalangeal joints (PIP)) in an early untreated RA cohort.
14 patients (8 women and 6 men, mean age ± standard deviation: 54.9 ± 14.5 years, range: 34-81 years) with symptom duration of less than six months, steroid and DMARD naïve at the time of examination and no previous history of arthritis were included in the study. US techniques included B mode and Color Doppler while MRI included a variety of imaging sequences (STIR, T1W TSE and T1W VIBE).
Overall, there was good agreement between clinical evaluation, evaluation by US, by MRI or patients' own evaluation of joint swelling. Patient self-evaluation converged with the clinical evaluation in 12 cases (86%).
Agreement was good among the applied imaging modalities and patient self-evaluation when compared to the clinical evaluations. Adding MRI to the US examination did not provide further diagnostic information.
描述类风湿关节炎（RA）诊断算法中作为关键要素的关节肿胀检测的一致性。通过比较早期未治疗的RA队列中手腕和手指关节（掌指关节（MCP）和近端指间关节（PIP））的临床检查、超声检查（US）、磁共振成像（MRI）以及患者自身对关节的评估来实现这一目的。
14例患者（8例女性，6例男性，平均年龄±标准差：54.9±14.5岁，范围：34 - 81岁）纳入研究，其症状持续时间少于6个月，检查时未使用过类固醇和改善病情抗风湿药（DMARD），且既往无关节炎病史。超声检查技术包括B模式和彩色多普勒，而磁共振成像包括多种成像序列（短TI反转恢复序列（STIR）、快速自旋回波T1加权序列（T1W TSE）和容积内插屏气检查序列（T1W VIBE））。
总体而言，临床评估、超声评估、磁共振成像评估或患者自身对关节肿胀的评估之间具有良好的一致性。患者自身评估与临床评估在12例（86%）中一致。
与临床评估相比，所应用的成像方式与患者自身评估之间具有良好的一致性。在超声检查中增加磁共振成像并未提供更多诊断信息。
