The Clinical Value Of Musculoskeletal Ultrasound And Its Semi-quantitative Scoring System In The Diagnosis Of Rheumatoid Arthritis Arthropathy

BackgroundRheumatoid arthritis(RA) is a clinical multiple degeneration of bones and joints.As the disease progresses,it can affect multiple systems and organs throughout the body,seriously affecting the quality of life of patients.Early diagnosis is of great significance to the prevention and treatment of RA.Imaging examination occupies an important position.Magnetic resonance imaging(MRI)and its scoring system are highly sensitive to early RA,but they are expensive and poor in practicality.Musculoskeletal ultrasound(MSUS)is a new imaging method,and its application value in the diagnosis of RA has received a lot of attention,and its specific application value needs to be confirmed by further studies.ObjectiveTo explore the clinical value of MSUS and its semi-quantitative scoring system in the diagnosis of rheumatoid arthritis joint disease.MethodThe 45 patients with highly suspected early RA who underwent arthroscopy in our hospital from January 2017 to December 2018 were selected as the research objects.All patients underwent MSUS and MRI examinations two wrist joints,and semi-quantitative scoring analysis was performed.Using arthroscopy as the gold standard,analyze the value of MSUS and MRI in the diagnosis of RA lesions and pathological changes(articular effusion,synovitis,bone erosion,tendon/tenosynovitis),and compare the diagnostic sensitivity,specificity,and positive predictive value,Negative predictive value,accuracy,Youden index;statistical MSUS,MRI semi-quantitative scores for comparative analysis;Spearman rank correlation describes the two scoring systems and RA lesion activity related indicators(erythrocyte sedimentation rate,hs-CRP,DAS28)Correlation.Result(1)Arthroscopy results showed that 32 of the 45 patients had RA,of which 24 patients had ≥2 pathological changes at the same time,14 cases of joint effusion,23 cases of synovitis,14 cases of bone erosion,11 cases of tendons / Tenosynovitis.(2)MSUS examination showed that 30 patients had RA lesions,including 15 cases of joint effusion,23 cases of synovitis,12 cases of bone erosion,and 11 cases of tendon/tenosynovitis.(3)MRI examination showed that 31 patients had RA lesions,including 14 cases of joint effusion,23 cases of synovitis,13 cases of bone erosion,and 11 cases of tendon/tenosynovitis.(4)Sensitivity,specificity,positive predictive value,negative predictive value,accuracy,Youden index(87.50%,84.62%,93.33%,73.33%,86.67%,0.7212)and MRI(93.75)of MUS in the diagnosis of RA lesions %,92.31%,96.77%,85.71%,93.33%,0.8606)were similar(P>0.05).The coincidence rate of MSUS in diagnosing joint effusion,synovitis,bone erosion,tendon/tenosynovitis(92.86%,100.00%,85.71%,90.91%)is similar to MRI(92.86%,95.65%,92.86%,100.00%),(P>0.05).The overall specificity,positive predictive value,Youden index(92.31%,98.31%,0.8586)of MSUS in the diagnosis of RA pathological changes are slightly higher than MRI(84.62%,96.72%,0.7978),sensitivity,negative predictive value(93.55%,75.00%)was slightly lower than MRI(95.16%,78.57%),and the diagnostic accuracy was the same as MRI(both 93.33%),and the difference was not statistically significant(P>0.05).(5)In the semi-quantitative MSUS score,the synovitis score was higher than the MRI score,and the bone erosion score was lower than the MRI score.The difference was statistically significant(P<0.05);but the tendon/tenosynovitis score and total score were similar to the MRI score(P>0.05).(6)Synovitis GSUS score and erythrocyte sedimentation rate,hs-CRP,DAS28 in MUS examination showed a positive correlation(P<0.05);synovitis PDUS score and DAS28 showed a positive correlation(P<0.05);joint effusion The score was positively correlated with hs-CRP and DAS28(P<0.05);the total score of MSUS was positively correlated with erythrocyte sedimentation rate,hs-CRP and DAS28(P<0.05).Synovitis score and hs-CRP in MRI score showed a positive correlation(P<0.05);bone erosion score,bone marrow edema score,and total score all showed positive correlation with erythrocyte sedimentation rate,hs-CRP,DAS28(P<0.05).ConclusionThe diagnostic value of MSUS examination for RA lesions and pathological changes is similar to MRI,and the MSUS semi-quantitative score is closely related to RA disease activity.This correlation is more consistent with the relationship between MRI scoring system and RA disease activity.Therefore,MSUS and its semi-quantitative scoring system can be used as an effective method for the diagnosis of RA.