超声在鉴别诊断RA与PsA中的应用价值

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Ann Rheum Dis. 2011;70(6):1111-4.   Differential diagnosis between rheumatoid arthritis and psoriatic arthritis: the value of ultrasound findings at metacarpophalangeal joints level.   Gutierrez M, Filippucci E, Salaffi F, Di Geso L, Grassi W.   Source Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy. dr.gmarwin@gmail.com   Abstract   OBJECTIVE: To investigate the potential of ultrasound (US) in the differential diagnosis between rheumatoid arthritis (RA) and psoriatic arthritis (PsA) at metacarpophalangeal (MCP) joints level. METHODS: 18 RA patients and 20 PsA patients with clinical involvement of MCP joints were included. All US examinations were performed by two rheumatologists investigating: presence of joint cavity widening (JCW), synovial fluid and/or synovial hypertrophy, peritenon extensor tendon inflammation (PTI) and intra-articular or peri-tendinous power Doppler (PD) signal. RESULTS: A total of 83 MCP joints in 18 RA patients were assessed. In all of these the authors found different degrees of JCW. 15 of 83 (18%) MCP joints showed synovial fluid, whereas 68 of 83 (82%) MCP joints showed synovial hypertrophy. In 72 of 83 (86.7%) MCP joints intra-articular PD was detected. No PTI pattern was found in these patients. In PsA patients, a total of 82 MCP joints in 20 patients were assessed. 54 of 82 (65.8%) MCP joints showed PTI pattern (p = 0.001). In 50 of these 54 (92.5%) MCP joints extra-articular PD signal was detected (p = 0.001). 28 of 82 (34.1%) MCP joints showed different degrees of JCW. 6 of 28 (21.4%) MCP joints presented synovial fluid, whereas 22 of 28 (78.5%) MCP joints showed synovial hypertrophy. In 8 of 82 (9.7%) MCP joints the JCW and PTI patterns were found contemporaneously. CONCLUSIONS: Preliminary results demonstrate that PTI pattern is a higher characteristic of PsA, which suggests a potential role of US in the differential diagnosis between RA and PsA at MCP joints level.   PMID: 21406459

超声在鉴别诊断RA与PsA中的应用价值   Gutierrez M, et al. Ann Rheum Dis.2011; 70:1111-4.   目的：利用超声检查掌指关节(MCP)以探讨超声在鉴别诊断类风湿关节炎（RA）和银屑病性关节炎（PsA）中的应用潜力。   方法：纳入MCP受累的18例RA患者和20例PsA患者。由2名风湿病学医师操作所有的超声检查。检测参数包括：关节腔隙增宽(JCW)，关节腔积液和/或滑膜增厚，伸肌腱腱鞘炎(PTI)，关节内或肌腱周围强力多普勒（PD）信号。   结果：共评估了18例RA病人的83个MCP。研究者发现不同程度的JCW。15/83（18％）个MCP有积液，68/83（82％）个MCP有滑膜肥厚。在72/83（86.7％）个MCP关节腔内检测到PD信号。在这些患者中未发现PTI分布模式。20例PsA患者共评估82个MCP。54/82（65.8％）个MCP关节有PTI受累模式（P = 0.001）。 50/54（92.5％）个MCP检测到关节外PD信号（P = 0.001）。 28/82（34.1％）个MCP关节表现出不同程度的JCW。 6/28（21.4％）个MCP有积液，而22/28（78.5％）个MCP出现滑膜肥厚。 8/82（9.7％）个MCP被发现同时存在JCW和PTI模式。   结论：初步研究证明PsA病人更多表现PTI模式，这提示利用超声检测MCP可能有助于鉴别RA与PsA。