Research Of Different Ultrasound Examination Assessment Criteria In Rheumatoid Arthritis Diagnosis

Objective:Discussion the value of different ultrasound examination assessment criteria applied to the 2010 ACR/EULAR RA classification criteria for early RA diagnosis.Method:1.Patients who are 18-60 years old that are with joint pain complaint and suspected RA in Department of Rheumatic immunology of Hunan Provincial People’s Hospital(outpatient or inpatient),from September2014 to September 2015.2.All patients are detailed questioning history parallel physical examination,recording the affected joint,rheumatoid nodules medical history and are tested of a full immunity, a full set of lupus, rheumatoid complete set(including RF, anti-ccp), inflammatory markers CRP, ESR.3.All patients were tested by ultrasound of 38 joints, recording synovial thickness, levels of synovitis and the presence of bone destruction, joint effusions.4.All patients were classified to ACR 1987 and 2010 ACR/EULAR classification standard According to the datas.5.Reference to the 2010 ACR/EULAR classification criteria for the development of specifications for patients with DMARDs treatment or(and) the diagnosis of RA as a diagnostic of the "gold standard" for the diagnosis of RA.The sensitivity and specificity of different classification criteria are calculated. The value of each joint statistical independentpredictors of rheumatoid arthritis.6.Statistical processed.Compare the differences between different classification criterias.Result:1.54 cases with complete medical records were collected,the final diagnosis of RA 37 cases.2.Different criteria of GSUS≥1,GSUS≥2,GSUS≥2/PDUS(+) and the clinical examination positive rate of "comparison joint",all jionts for GSUS≥1,The proximal interphalangeal joint, metatarsophalangeal joint for GSUS≥2,metatarsophalangeal joint for GSUS≥2/PDUS(+) And the total detection for GSUS≥1,GSUS≥2 are higher than that of clinical examination.The difference was statistically significant(P < 0.05).3.Statistical results show ACR 1987 criteria were detected in 18 cases,2010 clinical criteria were detected in 27 cases, 2010GSUS≥1 standard were detected in 39 cases,2010 R GSUS≥2 were detected in 27 cases, 21 cases were detected by standard of 2010 GSUS≥2/PDUS(+).4.The 2010 Ultrasound criterias sensitivity was higher than that of clinical criteria, and the 2010 ≥GS has the highest sensitivity and the lowest for ACR 1987,specificity of 2010 GS≥2, 2010 GS≥2/PDUS(+)are the highest and the lowest for 2010 GS≥1.The diagnosis rate of 2010GS≥1, 2010 GS≥2 is the highest and lowest for ACR 1987,the of highest Youden index and Kappa value were 2010 GS≥2,the reliability of the diagnosis(AUC) 2010 GS≥2 is the highest.Conclusion:1.Different ultrasonic evaluation criteria can detect subclinical synovitis that the clinical examination can not find in multiple joints.Where GS≥1,GS ≥ 2 of all joints of the proximal interphalangeal joint and metatarsophalangeal joint, GSUS ≥ 2/PDUS(+) metatarsophalangeal joint high detection rate.2. Ultrasound different assessment criteria provide synovitis evidence for application in the 2010 ACR / EULAR classification criteria for classification after the criteria for the diagnosis of effectiveness were higher than that of ACR 1987 criteria and ACR / EULAR 2010 clinical criteria. The diagnostic efficiency of GS≥2 of synovitis is the highest.