The Study Of The Ultrasound In The Dignosis Of Rheumatoid Arthritis Knee Joint’s Lesions

Objective1.To explore the value of high frequency color Doppler ultrasound to reveal the normal structure of knee joints and arthropathy of the knee joint’s lesions in patients with rheumatoid arthritis (RA)2. Comparing the sonography with the images of MRI,we discuss the value of sonography to reveal arthropathy of the knee joint, also summarize the characteristics of sonogram to evaluate its diagnostic values.3. To explore the correlation between manifestations of high frequency color Doppler ultrasound and laboratory examination of knee joint’s lesions in patients with RA.Methods58knee joints of rheumatoid arthritis in40patients were studied. All patients met criteria for the new diagnostic USA Rheumatism Association and the European League Against Rheumatism in2009. The damaged knee joints are swelling, pain, serious with limited activity. Among these patients, we choose30knee joints underwent magnetic resonance imaging. MRI is as the gold standard, All patients underwent examination for erythrocyte sedimantation rate and C-reactive protein.60knee joints in30health adults were studied. There was no history of joint swelling and pain, no dysplasia. Male5cases, female25cases, age44to55years old.The ultrasound is performed with the patient resting in a sitting or supine position, multi-position and multi-section examination. We use Hitachi Hivision Preirus high frequency color Doppler,the frequency of probe is5-13MHZ. We observed suprapatellar pouch effusion, synovial membrane, articular cartilage, bone and periarticular of the knee joints.We checked the ultrasonography characteristics and Doppler signal.We analyzed the correlation between the synovial thickness, suprapatellar pouch effusion and erythrocyte sedimantation rate(ESR),C-reactive protein(CRP).All MRI images were performed by a3.0Tesla magnet(Sonata SIMENS). Results1Ultrasonographic features of normal knee joints:ultrasonography shows the organizational structure around the joints and joints neat, clear layer. Tendon fiber is medium echo. Longitudinal shape is rule. Cross section is circular or oval. The lower femoral cartilage echo is low, boundaries clear. Cortex of the bone is continuous, smooth and high echo. Synovium is linear high echo. And most of the synovium is not clear.2Ultrasonographic features of knee joints in patients with RA. Knee effusion was demonstrated in58knee joints, irregularly. Synovial hypertrophy of the knee joint was detected by grey ultrasound in47knee joints. Synovial vessels were detected by color Doppler in23knee joints of patients. Damage of articular cartilage were detected by real-time high-frequency US in36knee joints. Bone erosions were found in19knee joints. The ultrasound is sensitive in displaying the popliteal cyst, and we detected24poplital cysts. A significant positive correlation was detected among synovial thickness and ESR,CRP. Also there is correlation among knee effusion and ESR,CRP.A significant difference in synovial thickening and effusion detected by US between knees affected by RA and those of controls (P<0.05). There was no significant difference between ultrasound and magnetic resonance in detecting the suprapatella bursa effusion, synovial hyperplasia, cartilage injury and popliteal cyst.Conclusion1. The high frequency ultrasound can clearly show the knee joints disease of rheumatoid arthritis including capsule on patellar effusion, patellar pouch synovial thickening, thinning of the lower femur articular cartilage, bone cortex interruption, popliteal fossa cyst formation,etc.2. The synovial thickness, knee effusion are positive relavant with ESR,CRP, therefore they can offer evidence for the diagnosis of RA.