Comparative Study Of Musculoskeletal Ultrasound Score And RAMRIS In The Diagnosis Of Rheumatoid Arthritis

Objective:By comparing with magnetic resonance imaging and its rheumatoid arthritis magnetic resonance scoring system(RAMRIS),the dissertation aims to investigate the clinical significance of musculoskeletal ultrasound(MSUS)and its scoring system in the diagnosis of the joint lesions of rheumatoid arthritis(RA)and the evaluation of disease activity in RA.Methods:Data of patients diagnosed with RA for the first time from January of 2016 to December of 2018 were collected from the department of Rheumatology,affiliated hospital of guilin medical university.The wrist joints,metacarpophalangeal joints and proximal interphalangeal joints of both hands of the 53 patients with RA were examined by MSUS and magnetic resonance imaging(MRI).At the same time,Synovitis/synovial hyperplasia,tendon/tenosynovitis,bone erosion,blood flow signal and bone marrow edema were observed,and MSUS and MRI scores were performed on the corresponding RA lesions.Meanwhile,the clinical indexes such as the swollen joint counts(SJC),tender joint counts(TJC),and the serological indexes(such as ESR,hs-CRP)were recorded;and the 28 joint disease activity score(DAS28)was calculated.Results:(1)Among the 53 patients,the number of cases of synovitis detected by MSUS and MRI was equal,which were 45 cases(χ~2=0,P=1.000),and the number of cases of tendon/tenosynovitis was roughly the same(χ~2=0.038,P=0.845),the differences were no statistically significant(P>0.05).But,in bone erosion,the detection rates by MRI was higher than that by MSUS(χ~2=9.600,P=0.001),the differences between MSUS and MRI were statistically significant(P<0.05).(2)A total of 1166 joints of both hands were evaluated in 53 patients,260 joints(22.30%)had been detected with synovitis by MSUS,209 joints(17.92%)had been detected with synovitis by MRI,and the detection rate of MSUS was higher than that of MRI.While in the aspect of tendon/tenositis and bone erosion,the detection rate of MRI was higher than that of MSUS,and the differences between MSUS and MRI were statistically significant in above-mentioned three joint lesions detected(P<0.05).(3)The differences were statistically significant between MSUS and MRI in synovitis score and bone erosion score(P<0.05),but the differences were no statistically significant between MSUS and MRI in tendon/tenosynovitis score and total score(P>0.05).(4)The GSUS score of synovitis was positively correlated with DAS28,ESR and hs-CRP(r>0,P<0.05),the PDUS score of synovitis was weak correlated with DAS28(r=0.320,P<0.05),and there was no correlation between the PDUS score of synovitis and ESR&hs-CRP(P>0.05);The total score of MSUS was positively correlated with DAS28,ESR and hs-CRP(r>0,P<0.05).The bone erosion score,bone marrow edema score and RAMRIS total score in RAMRIS were positively correlated with DAS28,ESR and hs-CRP(r>0,P<0.05).Conclusions:(1)MSUS is as sensitive as MRI in the diagnosis of both-wrist synovitis;(2)The two scoring system of MSUS and RAMRIS is consistent as a whole in the diagnosis of wrist lesions of both hands;(3)MSUS score can not only be used for the diagnosis of RA,but also as an indicator of RA disease activity;(4)There still exist certain limitations in assessing the systematic joint inflammation of RA patients by detecting the wrist joints of both hands with only MSUS score.