Bohndorf K, Schalm J
Clinic for Diagnostic Radiology and Neuroradiology, Zentralklinikum Augsburg, Germany.
Baillieres Clin Rheumatol. 1996 Aug;10(3):399-407. doi: 10.1016/s0950-3579(96)80038-0.
In the light of more modern techniques such as sonography and magnetic resonance imaging, the reader may well ask if plain radiography has still a role in the diagnostic work-up of rheumatoid arthritis. However, in daily routine, the value of diagnostic radiography in support of the clinical and laboratory diagnosis of rheumatoid arthritis is unrivaled. It allows differentiation from other joint diseases, such as osteoarthritis or crystal arthropathies, when the ARA criteria are not conclusive for the diagnosis of rheumatoid arthritis. Further, plain radiography is part of the basic documentation of the disease in measuring disease progression. Therapeutic decisions, such as systemic versus local therapy, and selection of drugs, as well as the form of local therapy, are heavily dependent on radiographs. However, the limitations of radiography in evaluating disease progression have to be recognized. Ultrasonography, as a 'bedside method', and MRI are indispensable adjuncts to radiography, because they are superior in detecting synovitis, early forms of cartilage damage as well as bone reaction such as erosions and cysts. A superior assessment of the degree of synovial changes is also possible with MRI.
鉴于有超声检查和磁共振成像等更现代的技术，读者很可能会问普通X线摄影在类风湿关节炎的诊断检查中是否仍有作用。然而，在日常工作中，诊断性X线摄影在支持类风湿关节炎的临床和实验室诊断方面的价值是无可匹敌的。当美国风湿病学会（ARA）标准对类风湿关节炎的诊断不明确时，它能与其他关节疾病，如骨关节炎或晶体性关节病相鉴别。此外，普通X线摄影是测量疾病进展时疾病基本记录的一部分。治疗决策，如全身治疗与局部治疗、药物选择以及局部治疗的形式，在很大程度上依赖于X线片。然而，必须认识到X线摄影在评估疾病进展方面的局限性。超声检查作为一种“床边检查方法”，以及磁共振成像，是X线摄影不可或缺的辅助手段，因为它们在检测滑膜炎、早期软骨损伤以及诸如侵蚀和囊肿等骨反应方面更具优势。磁共振成像也能够对滑膜变化的程度进行更优评估。
