Lu Yueh-Chien, Chen Ying-Chou
Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang GungUniversity College of Medicine, Kaohsiung, 833, Taiwan.
Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, 833, Taiwan.
Clin Rheumatol. 2025 Aug 6. doi: 10.1007/s10067-025-07625-3.
Musculoskeletal ultrasound (MSUS) assessment of disease activity is a valuable tool for guiding therapeutic decisions within a treat-to-target strategy. This study aimed to assess synovitis activity in the wrist joint at different levels using ultrasonography (US) in patients with rheumatoid arthritis (RA).
Gray scale synovial hypertrophy (SH) and power Doppler (PD) ultrasound were performed on the dorsal radio-scaphoid, inter-carpal, and radio-ulnar joints of the dominant wrist. A one-way ANOVA with multiple comparisons was conducted for each joint.
A total of 38 patients with RA and wrist joint involvement underwent a standardized PD examination assessing three positions in the wrist. The mean synovial hypertrophy (SH) was 1.08 ± 0.487 at the radio-carpal joints, 1.08 ± 0.487 at the inter-carpal joints, and 0.45 ± 0.602 at the radio-ulnar joints, with significantly higher values at the radio-carpal and inter-carpal joints compared to the radio-ulnar joints. The mean power Doppler (PD) was 0.08 ± 0.273 at the radio-carpal joints, 0.79 ± 0.577 at the inter-carpal joints, and 0.16 ± 0.437 at the radio-ulnar joints, with significantly higher values at the inter-carpal joints. Overall, the inter-carpal joint demonstrated greater sensitivity than the other joints.
Ultrasound assessment of wrist joints should include intercarpal joints, as they frequently show increased power Doppler activity, indicating higher inflammatory activity. Key Points • The intercarpal joint is the most important component of the wrist for detecting ultrasound activity in clinical practice, particularly in patients with low disease activity in RA patients. • Musculoskeletal ultrasound (MSUS) assessment of disease activity may serve as a valuable tool for guiding therapeutic decisions within a treat-to-target strategy. Further studies are needed to optimize ultrasound evaluation and validate its measurements for clinical use.
肌肉骨骼超声（MSUS）对疾病活动度的评估是在达标治疗策略中指导治疗决策的一项重要工具。本研究旨在使用超声检查（US）评估类风湿关节炎（RA）患者不同水平腕关节的滑膜炎活动度。
对优势手腕的桡舟背侧、腕骨间和桡尺关节进行灰阶滑膜肥厚（SH）和能量多普勒（PD）超声检查。对每个关节进行单因素方差分析及多重比较。
共有38例累及腕关节的RA患者接受了评估腕部三个位置的标准化PD检查。桡腕关节的平均滑膜肥厚（SH）为1.08±0.487，腕骨间关节为1.08±0.487，桡尺关节为0.45±0.602，桡腕关节和腕骨间关节的值显著高于桡尺关节。桡腕关节的平均能量多普勒（PD）为0.08±0.273，腕骨间关节为0.79±0.577，桡尺关节为0.16±0.437，腕骨间关节的值显著更高。总体而言，腕骨间关节比其他关节表现出更高的敏感性。
腕关节的超声评估应包括腕骨间关节，因为它们常显示能量多普勒活动增加，提示炎症活动度更高。要点 • 在临床实践中，腕骨间关节是检测超声活动度时腕关节最重要的组成部分，尤其是在疾病活动度较低的RA患者中。 • 肌肉骨骼超声（MSUS）对疾病活动度的评估可能是在达标治疗策略中指导治疗决策的一项重要工具。需要进一步研究以优化超声评估并验证其测量结果在临床中的应用。
