Application Of Musculoskeletal Ultrasonography Combined With Laboratory Examination In The Assessment Of Rheumatoid Arthritis Activity

Objective:To explore the accuracy of musculoskeletal ultrasonography(MSUS)combined with laboratory tests in evaluating active rheumatoid arthritis(RA),and to provide reference for clinical identification of active RA.Methods:From October 2018 to April 2022,55 patients with RA who were hospitalized in the Department of Rheumatology and Immunology,Yichun City People’s Hospital and 55 healthy people during the same period were selected.The RA patients were set as the research group,and they were divided into three subgroups: remission group,mild-moderate activity group,and severe activity group according to the 28 joint disease activity score(DAS28);healthy subjects were set as the reference group.Both the study group and the reference group received erythrocyte sedimentation rate(ESR),C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)levels(ESR is plasma detection,CRP,IL-6.TNF-α is a serum test),and the patients in the research group and the healthy subjects in the reference group received MSUS examination on this basis.The differences in the levels of ESR,CRP,IL-6,and TNF-α in different subgroups of the study group and the reference group were observed;the MSUS examination results of patients in different subgroups of the study group were observed,and the synovial hyperplasia,tendon/tenosynovitis,bone erosion,joint The detection rate of effusion was compared,and the two-dimensional gray-scale ultrasonography(GSUS)score,power Doppler ultrasonography(PDUS)score,and musculoskeletal ultrasonography(MSUS)total score were compared in each subgroup;ESR,CRP,IL-6.The value of TNF-α,MSUS and MSUS combined laboratory tests in predicting active RA..Results:(1)The levels of ESR,CRP,IL-6 and TNF-α in each subgroup of the study group were higher than those of the reference group,and the difference was statistically significant(P<0.05).There were statistically significant differences in all items(P<0.05).(2)The detection rates of synovial hyperplasia and bone erosion in each subgroup in the study group were higher than those in the reference group(P<0.05),and the difference between any two groups was statistically significant(P<0.05).The detection rates of tendon/tenosynovitis and joint effusion in each subgroup of the group were higher than those in the reference group(P<0.05),and the detection rates of tendon/tenosynovitis and joint effusion in the severe activity group were higher than those in the mild-to-moderate activity group(P<0.05).).The GSUS score,PDUS score,and MSUS total score of each subgroup in the study group were higher than those in the reference group(P<0.05),and the difference between any two groups was statistically significant(P<0.05).(3)ROC curve analysis showed that the AUC of MSUS for predicting active RA was 0.793,which was higher than various laboratory tests,but lower than MSUS combined with ESR,CRP,IL-6,and TNF-α tests;various laboratory tests Among the indicators,IL-6 has the highest predictive value,with AUC of 0.691,but lower than that of MSUS and MSUS combined laboratory tests;followed by CRP,ESR,and TNF-α,with AUC of 0.657,0.642,and 0.518,respectively;MSUS combined experiment The AUC predicted by laboratory examination was 0.915,which was higher than various laboratory examination indicators and single MSUS examination.The sensitivity and specificity of predicting active RA were 97.30% and 83.33%.Conclusion:MSUS combined with blood ESR,CRP,IL-6 and TNF-α tests can improve the accuracy of predicting active RA.