| Rheumatoid arthritis(RA)is an autoimmune disease,The basic pathological changes are synovitis and pannus formation.Clinically,some patients with RA may suffer from knee joint involvement and leading to a decline in patients’ quality of life.On the basis of inflammation,they are prone to occur early bone and cartilage degeneration,and knee osteoarthritis(KOA).Traditional methods are not suitable for the evaluation of early knee degeneration in RA patients.Musculoskeletal ultrasound(MSKUS)has obvious advantages such as ambulatory monitoring,no radiation and high resolution in clinical examination of knee joints.By detecting the thickness of cartilage(CTH)and morphological changes in the knee joint,we can accurately evaluate the patient’s joints condition.However,the value of MSKUS in the evaluation of early damage about knee joint in RA patients is poorly understood.Objective: To explore the value and significance of MSKUS in the evaluation of knee joint degeneration in RA patients and the influencing factors of knee joint degeneration in RA patients.Methods: from January 2019 to January 2020,54 patients with RA with KOA(named RA with KOA group)and 28 patients with KOA(named KOA group)were collected(including 164 knee joints).At the same time,13 healthy people(including 26 knee joints)with matched gender and age,and normal knee joint ultrasound examination were placed in the normal control group.All of these were 190 knee joints.MSKUS was used to measure the cartilage thickness of medial condyle,lateral condyle and intercondylar groove cartilage of femur,and to observe the thickness of synovium,blood flow in synovium,joint cavity effusion,popliteal cyst,etc.The aim was to evaluate the pathological changes of knee joint.At the same time,the general data,laboratory indexes and complications of the participants were collected,and the relationship between them and knee joint diseases was analyzed.Results:1.There was no significant difference in sex ratio,average age and body mass index between RA with KOA group,KOA group,and normal control group(P > 0.05).2.There was no significant difference of cartilage thickness between RA with KOA group and KOA group(P > 0.05);RA with KOA group and KOA group(1.37 ± 0.35)mm,(1.46 ± 0.40)mm)were less than the normal group(1.56 ± 0.35)mm,the difference was statistically significant(P < 0.05)).The thickness of cartilage in the femoral intercondylar groove of RA combined with KOA group was(1.77 ± 0.40)mm less than that of KOA group and normal control group {(1.98 ± 0.59)mm,(2.06 ± 0.53)mm},the difference was statistically significant(P < 0.05).3.There was no significant difference in the thickness of medial condyle,lateral condyle and intercondylar groove cartilage between RA group and koa group(P > 0.05).4.The thickness of cartilage in the lateral condyle of femur and intercondylar groove of femur which disease courses over 24 months were lower than those in not exceed 24 months group.The difference was statistically significant(P < 0.05).5.Compared with the normal control group {(1.56 ± 0.35)mm and(2.06 ± 0.53)mm},the thickness of the lateral condylar cartilage in the age less than 40 years group,40-60 years group and over 60 years group {(1.32 ± 0.29)mm,(1.42 ± 0.46)mm,(1.29 ± 0.37)mm} decreased significantly,so did about intercondylar groove cartilage {(1.76 ± 0.42)mm,(1.82 ± 0.35)mm,(1.68 ± 0.40)mm}(P < 0.05).6.The proportion of patients with synovium thickening and synovium blood flow positive in RA combined with KOA group was significantly higher than that in KOA group(94.12% vs 3.57%)and(67.7% vs 1.79%)respectively.The osteophyte of knee joint in RA combined with KOA group(26.7%)was significantly lower than that in KOA group(42.86%),the difference was statistically significant(P < 0.05).7.ESR,CRP,RF,anti-CCP antibody in RA with KOA group were significantly higher than those in KOA group and normal group(P < 0.05).8.There was no significant difference in the incidence of metabolic syndrome(MS)among the three groups(χ2 = 0.095,P = 0.758).Conclusions: Early cartilage damages in RA with KOA patients could be detected and evaluated by MSKUS.Meanwhile,synovial thickening,synovial inflammation,osteophyte and other pathological conditions can be accurately diagnosed.Therefore,MSKUS could be used as a routine examination method for the clinical diagnosis of RA with KOA. |
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