Caprotti P, Campani R, Bottinelli O, Genovese E, Caprotti C
Istituto di Radiologia, Università, IRCCS Policlinico S. Matteo, Pavia.
Radiol Med. 1993 May;85(5 Suppl 1):237-46.
The role of US was investigated in the study of rheumatoid arthritis, since the method depicts the changes in the periskeletal soft tissues--i.e., where the disorder preferably locates in both its early and late phases. A hundred and fifty-eight patients affected with rheumatoid arthritis according to American Rheumatism Association criteria were examined: the hand (wrist, carpus, metacarpus and fingers), the knee and the foot (metatarsus and toes) were studied in all patients. The study population was divided into two groups according to the time of onset of the disease: in 82 of them (52%) the onset of symptoms dated back to less than a year, while 76 of them (48%) had been suffering for over a year. US appears as the most accurate method to study the early phases of rheumatoid arthritis, for it makes early diagnosis possible, thus allowing the correct treatment to be chosen and preventing the disease from causing the irreversible lesions which progressively disable the patient. In the early phases of rheumatoid arthritis, US detects the exudative effects of synovial inflammation in periskeletal soft tissues. Joint effusions and synovial pannus are also depicted by US, as well as the thickening of tendon sheaths and tendon ruptures and rheumatoid nodules. In the late phases of rheumatoid arthritis, US supports conventional radiology, the latter remaining the irreplaceable method of choice to demonstrate skeletal lesions. Nonetheless, in such phases US yields further information on periarticular soft tissue involvement which no other method would make available--e.g., the presence of effusions, bulgings, synovial pannus, joint cartilage erosions, damaged tendons and sheaths, hypoplasia of the muscles ending on the involved joint and finally periarticular changes. Finally, US proves of great value in the early demonstration of reactivating phases, with unquestionable prognostic advantages.
本研究调查了超声（US）在类风湿关节炎研究中的作用，因为该方法能够描绘骨骼周围软组织的变化，即该疾病在早期和晚期更易发生病变的部位。按照美国风湿病协会标准，对158例类风湿关节炎患者进行了检查：所有患者均对其手部（腕关节、腕骨、掌骨和手指）、膝关节和足部（跖骨和脚趾）进行了研究。根据疾病发病时间，将研究人群分为两组：其中82例（52%）症状出现时间不到一年，而另外76例（48%）患病时间超过一年。超声似乎是研究类风湿关节炎早期阶段最准确的方法，因为它能够实现早期诊断，从而有助于选择正确的治疗方法，并防止疾病造成不可逆转的损害，使患者逐渐丧失活动能力。在类风湿关节炎的早期阶段，超声可检测到骨骼周围软组织中滑膜炎症的渗出效应。超声还能显示关节积液、滑膜血管翳，以及腱鞘增厚、肌腱断裂和类风湿结节。在类风湿关节炎的晚期阶段，超声辅助传统放射学检查，而传统放射学检查仍是显示骨骼病变不可替代的首选方法。尽管如此，在这一阶段，超声可提供关于关节周围软组织受累情况的更多信息，而其他方法无法做到这一点，例如积液、肿胀、滑膜血管翳、关节软骨侵蚀、受损肌腱和腱鞘、受累关节处肌肉发育不全，以及最终的关节周围变化。最后，超声在早期显示病情复发阶段具有重要价值，具有明确的预后优势。
