| Purpose:To study the role of ultrasound in the diagnosis of in patients with rheumatoid arthritis (rheumatoid arthritis, RA).Method:Choose 30 patients treated in Shandong Provincial Hospital Affiliated to Shandong University from October 2010 to March 2011. All of the patients were rated no less than 6 according to ACR/EULAR 2009 diagnostic criteria for rheumatoid arthritis, and were consistent with American College of Rheumatology 1987 revised the RA classification criteria. All the 30 cases had been diagnosed excluded other connective tissue diseases. There were also 2 cases of patients with reactive arthritis, and 1 case with psoriatic arthritis; all the above 3cases were excluded other connective tissue diseases. For the normal control group,17 healthy people participated, all of them having no joint swelling, pain history, non-rheumatoid arthritis and other connective tissue disease history.Ultrasound scanner using the Vingmed Ultrasound scanner of GE, USA, choose the low blood flow rate of musculoskeletal conditions, the probe selected for Vivid 7/Vivid Dimension, bandwidth adjustment for the 11.3MHz/13Mhz, gain adjustment for the noise signal does not produce the greatest sensitivity. Joints were observed, including wrist, knee and ankle joints for both sides. Both patients group and normal control group were observed in supine position. Observations include:two-dimensional ultrasound, the observed range of joints and the thickness of the dark zone, with or without synovial hypertrophy, thickening of the synovial membrane morphology; color Doppler ultrasound (color Doppler flow imaging, CDFI), the observation of intra-articular distribution of blood flow and the quantities of blood flow signals.Asked in detail about patient's condition, clinical signs and symptoms, records of patients with bilateral proximal interphalangeal joints, metacarpophalangeal joints, wrist, elbow, shoulder, knee and other joints of a total of 28 tender joint counts (tender joint count, TJC28), swollen joint count (swollen joint count, SJC28) and patient health status assessment (global health, GH). Record the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) value of patients, and calculate the patients' ACR/EULAR 2009 score.Using x±s describe measurement data, using t test for statistical analysis, using Chi-square analysis to describe classifying data, take P<0.05 as statistical significant difference.Results:Synovial thickening were found in 39 wrist,6 knee, and 4 ankle joints of the 30 RA cases; no synovial thickening were found in all the 17 cases of normal control group.60 wrists detected in 30 RA cases, the synovial thickness being 1.8～7.8mm, with the average of 4.15±1.61mm; 34 wrists detected in 17 normal control cases, the synovial thickness being 1.2～1.9mm, with the average of 1.44±0.21mm, P<0.01, the difference had statistical significance. Abnormal blood flow signals of wrist in 30 RA cases being 0 to 3, with an average level of 1.3±0.11; wrist blood flow signal level in normal control group being 0, P<0.01, the difference had statistical significance. Between 30 RA cases,2 ReA cases, and 1 PsA case, either synovial thickness or abnormal blood flow signals had no significant differences.The 30 RA cases were divided into 3 subgroups according to erythrocyte sedimentation rate, and divided into difference sections according to the synovial thickness, and abnormal blood flow signal level of the wrist joints. It can be seen as the ESR increased, the synovial thickening increased, P<0.05, the difference being statistically significant; as the ESR increased, P<0.01, the differences being statistically significant.The 30 RA cases were divided into 3 subgroups according to C-reactive protein, and divided into difference sections according to the synovial thickness, and abnormal blood flow signal level of the wrist joints. It can be seen as the CRP increased, the increasing of synovial thickening was not obvious, P> 0.05, the difference being no statistically significant; as CRP increased, the abnormal blood flow signal level increased correspondingly, P<0.05, the difference being statistically significant.The 30 RA cases were divided into 3 subgroups according to DAS28 score, and divided into difference sections according to the synovial thickness, and abnormal blood flow signal level of the wrist joints. It can be seen as the DAS28 score increased, the increasing of synovial thickening was not obvious, P> 0.05, the difference being no statistically significant; as DAS28 score increased, the abnormal blood flow signal level increased correspondingly, P<0.05, the difference being statistically significant.Conclusion:This study initially confirmed the potential value of ultrasound liked synovial thickness rating system and synovial blood flow rating system in the assessment of disease activity of rheumatoid arthritis. Ultrasonography is more sensitive, reliable than physical examination, and much cheaper and easier to promote than enhanced MRI, etc.. It can be seen that synovial blood flow rating is more valuable than synovial thickness rating in the early diagnosis of RA, which can be used to grade disease activity in patients with RA. However, to determine if ultrasound grading better than other methods, and find the best joint combination, remains to a large sample longitudinal study. In addition, it needs further study and discussion for specifing standardized equipment and standardized operations for ultrasound examination of the joints, and identifing different classifications methods of different joint with synovitis. |
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