微小附着点炎可区分类风湿关节炎和银屑病关节炎：一项关于手部关节和微小附着点的全面超声对比研究
Mini-enthesitis can differentiate rheumatoid arthritis from psoriatic arthritis: A comprehensive comparative ultrasound study of the joints and mini-entheses of the hands.
作者信息
Sapundzhieva Tanya, Sapundzhiev Lyubomir, Batalov Anastas
机构信息
Department of Internal Diseases, Medical University of Plovdiv, Medical Faculty, Plovdiv, Bulgaria.
Department of Rheumatology, University Hospital 'Pulmed', Plovdiv, Bulgaria.
出版信息
Arch Rheumatol. 2025 Mar 17;40(1):28-41. doi: 10.46497/ArchRheumatol.2025.10780. eCollection 2025 Mar.
OBJECTIVES
This study aimed to explore whether hand ultrasonography (USG) could differentiate between rheumatoid arthritis (RA) and psoriatic arthritis (PsA) patients.
PATIENTS AND METHODS
A comprehensive USG of 35 PsA patients (13 males, 22 females; mean age: 60.9±8.4 years; range, 53 to 69 years), 30 RA patients (10 males, 20 females; mean age: 58.4±10.0 years; range, 50 to 61 years), and 20 healthy controls (5 males, 15 females; mean age: 55.6±5.8 years; range, 50 to 61 years) was performed with assessments of the wrist, tendons, mini-entheses, and joints of the second and third finger, both on gray scale and power Doppler USG.
RESULTS
Two hundred forty-five joints of PsA patients, 210 joints of RA patients, and 120 joints of healthy controls were assessed by USG. Wrist joint synovitis and tenosynovitis of the extensor digitorum communis and extensor carpi ulnaris tendon were significantly more common in RA patients compared to PsA patients (p<0.001), detected in 93.30%, 63.30%, and 73.30% versus 57.10%, 14.30%, and 2.90%, respectively. The incidence of tenosynovitis of the flexor tendons at the wrist level was significantly higher in RA patients (p=0.003), detected in 36.70% versus 14.30%. Paratenonitis of the finger extensor tendon at the metacarpophalangeal joints was significantly more prevalent in PsA patients, detected in 85.70% versus 3.30% (p<0.001). Central slip enthesitis at the proximal interphalangeal joint and enthesitis of the distal slip of the extensor tendon at the second and third distal phalanx were exclusively found in PsA patients, occurring in 45.70%, 91.40%, and 71.30%, respectively (p<0.001). Flexor tenosynovitis and pseudotenosynovitis were significantly more prevalent in PsA patients (65.70% and 57.10%, respectively) compared to RA patients (16.70% and 0.00%, respectively; p<0.001). PsA patients had significantly higher thickness of the A1 pulley compared to RA patients (p<0.001).
CONCLUSION
Mini-enthesitis is a hallmark USG finding in PsA.
目的
本研究旨在探讨手部超声检查（USG）能否区分类风湿关节炎（RA）患者和银屑病关节炎（PsA）患者。
患者与方法
对35例PsA患者（13例男性，22例女性；平均年龄：60.9±8.4岁；范围53至69岁）、30例RA患者（10例男性，20例女性；平均年龄：58.4±10.0岁；范围50至61岁）和20例健康对照者（5例男性，15例女性；平均年龄：55.6±5.8岁；范围50至61岁）进行全面的超声检查，对腕关节、肌腱、微小附着点以及第二和第三指关节进行灰阶和能量多普勒超声评估。
结果
通过超声检查评估了PsA患者的245个关节、RA患者的210个关节和健康对照者的120个关节。与PsA患者相比，RA患者的腕关节滑膜炎以及指总伸肌和尺侧腕伸肌腱腱鞘炎更为常见（p<0.001），分别为93.30%、63.30%和73.30%，而PsA患者分别为57.10%、14.30%和2.90%。RA患者腕部屈肌腱腱鞘炎的发生率显著更高（p=0.003），分别为36.70%和14.30%。PsA患者掌指关节处指伸肌腱周围炎更为普遍，分别为85.70%和3.30%（p<0.001）。近端指间关节中央束附着点炎以及第二和第三远节指骨伸肌腱远侧附着点炎仅在PsA患者中发现，分别为45.70%、91.40%和71.30%（p<0.001）。与RA患者相比，PsA患者的屈肌腱腱鞘炎和假腱鞘炎更为普遍（分别为65.70%和57.10%），而RA患者分别为16.70%和0.00%（p<0.001）。PsA患者的A1滑车厚度显著高于RA患者（p<0.001）。
结论
微小附着点炎是PsA超声检查的标志性表现。
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