The Diagnostic Value Of Bilateral Tenosynovitis In Rheumatoid Arthritis

Objective :1.To determine the distribution characteristics of two-handed tenosynovitis in patients with rheumatoid arthritis(RA);2.To evaluate the diagnostic value of bilateral tenosynovitis in RA.Methods:Seventy-six patients with confirmed RA were collected,45 RA patients with both synovitis and tenosynovitis were selected as study group(RA group)and 42 non-ra patients as control group(non-ra group),musculoskeletal ultrasound was used to evaluate the synovium,tendons,and bone cortex of the wrist joint,proximal interphalangeal joints,distal interphalangeal joint,synovial hyperplasia,synovitis,tenosynovitis and bone erosion were scored by the revised semi-quantitative scoring.Record RA patients with clinical characteristics and laboratory indexes,clinical features including course,morning stiffness time,count and tenderness joint swelling of the joints and laboratory indexes including platelet count,erythrocyte sedimentation rate,C-reactive protein,rheumatoid factor,anti-cyclic peptide containing citrulline,and calculate the Disease Activity Score 28-joint and Health assessment questionnaire.Results:1.The scores of synovitis hyperplasia,synovitis,tenosynovitis and bone erosion of both hands in RA group were higher than those in non-ra group(P < 0.05);2.In the RA group,there was a significant positive correlation between the scores of synovitis hyperplasia,synovitis of both hands and swollen joint counts,tender joint counts,platelet,C-reactive protein and disease activity score 28-joint,tenosynovitis and swollen joint counts,C-reactive protein,disease activity score 28-joint(P < 0.05),bone erosion and course,anti-cyclic citrullinated peptide antibodies(P < 0.05);3.In the RAgroup,tenosynovitis of both hands were most likely to occur extensor carpi ulnaris(14.17%)and third flexor tendon(10.53%);4.In receiver operating characteristic curve,synovial hyperplasia,synovitis,tenosynovitis,bone erosion and synovitis with tenosynovitis of RA diagnosis area under curve were 0.632,0.670,0.841,0.641,0.808,the best diagnostic thresholds respectively were 10,4,4,1,10,the threshold value corresponding to the sensitivity of 41.3%,60.9%,56.5%,47.9%,60.9%,and the specific degrees were 95.2%,76.2%,100%,83.3%,92.9%,area under curve of tenosynovitis and tenosynovitis combined with synovitis was significantly greater than synovitis hyperplasia,synovitis and bone erosion(P < 0.05).Conclusion:1.The main manifestations of RA ultrasound are synovial hyperplasia,synovitis,tenosynovitis and bone erosion.2.Tenosynovitis and synovitis of both hands are positively correlated with the number of swollen joint counts and disease activity score 28-joint,which could be used as an indicator to judge RA activity.3.Tenosynovitis of both hands in RA patients is most likely to occur in extensor carpi ulnaris and the third flexor tendon.4.Tenosynovitis has high specificity for RA diagnosis,synovitis has high sensitivity for RA diagnosis,and synovitis combined with tenosynovitis are helpful for RA diagnosis.