留言板

尊敬的读者、作者、审稿人, 关于本刊的投稿、审稿、编辑和出版的任何问题, 您可以本页添加留言。我们将尽快给您答复。谢谢您的支持!

姓名
邮箱
手机号码
标题
留言内容
验证码

肌肉骨骼超声在类风湿关节炎诊疗中的应用

游珊珊 徐钟慧 姜玉新

游珊珊, 徐钟慧, 姜玉新. 肌肉骨骼超声在类风湿关节炎诊疗中的应用[J]. 协和医学杂志, 2017, 8(4-5): 215-220. doi: 10.3969/j.issn.1674-9081.2017.05.005
引用本文: 游珊珊, 徐钟慧, 姜玉新. 肌肉骨骼超声在类风湿关节炎诊疗中的应用[J]. 协和医学杂志, 2017, 8(4-5): 215-220. doi: 10.3969/j.issn.1674-9081.2017.05.005
Shan-shan YOU, Zhong-hui XU, Yu-xin JIANG. Musculoskeletal Ultrasound in the Diagnosis and Treatment of Rheumatoid Arthritis[J]. Medical Journal of Peking Union Medical College Hospital, 2017, 8(4-5): 215-220. doi: 10.3969/j.issn.1674-9081.2017.05.005
Citation: Shan-shan YOU, Zhong-hui XU, Yu-xin JIANG. Musculoskeletal Ultrasound in the Diagnosis and Treatment of Rheumatoid Arthritis[J]. Medical Journal of Peking Union Medical College Hospital, 2017, 8(4-5): 215-220. doi: 10.3969/j.issn.1674-9081.2017.05.005

肌肉骨骼超声在类风湿关节炎诊疗中的应用

doi: 10.3969/j.issn.1674-9081.2017.05.005
详细信息
    通讯作者:

    姜玉新  电话:010-69155491,E-mail:jiangyuxinxh@163.com

  • 中图分类号: R445.1

Musculoskeletal Ultrasound in the Diagnosis and Treatment of Rheumatoid Arthritis

More Information
  • 摘要: 类风湿关节炎是一种常见的自身免疫性疾病, 以受累关节持续性肿胀和压痛为主要表现, 严重者可导致关节畸形和功能丧失。高频超声不仅可清晰分辨出关节及其周围软组织结构, 还能够显示关节滑膜血管从而判断关节炎症程度, 因而在类风湿关节炎诊断和随访治疗中发挥了重要作用。本文对灰阶超声、彩色多普勒超声、超声造影等新技术及超声引导下介入治疗在类风湿关节炎中的应用进行详细介绍。
  • 图  1  灰阶超声显示右侧踝关节外侧滑膜增生,厚度0.26 cm

    图  2  灰阶超声显示右膝关节髌上囊积液,深0.96 cm

    图  3  能量多普勒超声显示右侧踝关节外侧增生的滑膜出现血流信号,信号强度为2级

  • [1] 中华医学会风湿病学分会.类风湿关节炎诊治指南(草案)[J].中华风湿病学杂志, 2003, 7:250-254. doi:  10.3760/j:issn:1007-7480.2003.04.020
    [2] Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis[J]. Arthritis Rheum, 1988, 31:315-324. doi:  10.1002/art.1780310302
    [3] Dougados M, Devauchelle-Pensec V, Ferlet JF, et al. The ability of synovitis to predict structural damage in rheumatoid arthritis:a comparative study between clinical examination and ultrasound[J]. Ann Rheum Dis, 2013, 72:665-671. doi:  10.1136/annrheumdis-2012-201469
    [4] Nakagomi D, Ikeda K, Okubo A, et al. Ultrasound can improve the accuracy of the 2010 American College of Rheumatology/European League against rheumatism classification criteria for rheumatoid arthritis to predict the requirement for methotrexate treatment[J]. Arthritis Rheum, 2013, 65:890-898. doi:  10.1002/art.37848
    [5] Colebatch AN, Edwards CJ, Ostergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis[J]. Ann Rheum Dis, 2013, 72:804-814. doi:  10.1136/annrheumdis-2012-203158
    [6] Dougados M, Jousse-Joulin S, Mistretta F, et al. Evaluation of several ultrasonography scoring systems for synovitis and comparison to clinical examination:results from a prospective multicentre study of rheumatoid arthritis[J]. Ann Rheum Dis, 2010, 69:828-833. doi:  10.1136/ard.2009.115493
    [7] Szkudlarek M, Court-Payen M, Jacobsen S, et al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis[J]. Arthritis Rheum, 2003, 48:955-962. doi:  10.1002/art.10877
    [8] Dougados M, Jousse-Joulin S, Mistretta F, et al. Evaluation of several ultrasonography scoring systems for synovitis andcomparison to clinical examination:results from a prospective multicentre study of rheumatoid arthritis[J]. Ann Rheum Dis, 2010, 69:828-833. doi:  10.1136/ard.2009.115493
    [9] De Flaviis L, Scaglione P, Nessi R, et al. Ultrasonography of the hand in rheumatoid arthritis[J]. Acta Radiol, 1988, 29:457-460. doi:  10.1177/028418518802900415
    [10] Wakefield RJ, Balint PV, Szkudlarek M, et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology[J]. J Rheumatol, 2005, 32:2485-2487. http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=f2029aec9f4b0081a3a8e220fa69d470
    [11] Hermann KG, Backhaus M, Schneider U, et al. Rheumatoid arthritis of the shoulder joint:comparison of conventional radiography, ultrasound, and dynamic contrast-enhanced magnetic resonance imaging[J]. Arthritis Rheum, 2003, 48:3338-3349. doi:  10.1002/art.11349
    [12] Szkudlarek M, Narvestad E, Klarlund M, et al. Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis:comparison with magnetic resonance imaging, conventional radiography, and clinical examination[J]. Arthritis Rheum, 2004, 50:2103-2112. doi:  10.1002/art.20333
    [13] Wakefield RJ, Gibbon WW, Conaghan PG, et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis:a comparison with conventional radiography[J]. Arthritis Rheum, 2000, 43:2762-2770. doi:  10.1002/1529-0131(200012)43:12<2762::AID-ANR16>3.0.CO;2-#
    [14] Weidekamm C, Koller M, Weber M, et al. Diagnostic value of high-resolution B-mode and doppler sonography for imaging of hand and finger joints in rheumatoid arthritis[J]. Arthritis Rheum, 2003, 48:325-333. doi:  10.1002/art.10784
    [15] Zayat AS, Ellegaard K, Conaghan PG, et al. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis[J]. Ann Rheum Dis, 2015, 74:897-903. doi:  10.1136/annrheumdis-2013-204864
    [16] Bubra PS, Keighley G, Rateesh S, et al. Posterior tibial tendon dysfunction:an overlooked cause of foot deformity[J]. J Family Med Prim Care, 2015, 4:26-29. doi:  10.4103/2249-4863.152245
    [17] Bruyn GA, Hanova P, Iagnocco A, et al. Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability[J]. Ann Rheum Dis, 2014, 73:1929-1934. doi:  10.1136/annrheumdis-2013-203596
    [18] Janta I, Stanciu D, Hinojosa M, et al. Structural damage in rheumatoid arthritis:comparison between tendon damage evaluated by ultrasound and radiographic damage[J]. Rheumatology(Oxford), 2016, 55:1042-1046. doi:  10.1093/rheumatology/kew020
    [19] Witt M, Mueller F, Nigg A, et al. Relevance of grade 1 gray-scale ultrasound findings in wrists and small joints to the assessment of subclinical synovitis in rheumatoid arthritis[J]. Arthritis Rheum, 2013, 65:1694-1701. doi:  10.1002/art.37954
    [20] Newman JS, Laing TJ, McCarthy CJ, et al. Power Doppler sonography of synovitis:assessment of therapeutic response-preliminary observations[J]. Radiology, 1996, 198:582-584. doi:  10.1148/radiology.198.2.8596870
    [21] Schueller-Weidekamm C. Quantification of synovial and erosive changes in rheumatoid arthritis with ultrasound-revisited[J]. Eur J Radiol, 2009, 71:225-231. doi:  10.1016/j.ejrad.2009.02.008
    [22] Kamishima T, Sagawa A, Tanimura K, et al. Semi-quantitative analysis of rheumatoid finger joint synovitis using power Doppler ultrasonography:when to perform follow-up study after treatment consisting mainly of antitumor necrosis factor alpha agent[J]. Skeletal Radiol, 2010, 39:457-465. doi:  10.1007/s00256-009-0824-5
    [23] Snekhalatha U, Muthubhairavi V, Anburajan M, et al. Ultrasound Color Doppler Image Segmentation and Feature Extraction in MCP and Wrist Region in Evaluation of Rheumatoid Arthritis[J]. J Med Syst, 2016, 40:197. doi:  10.1007/s10916-016-0552-z
    [24] Kawashiri SY, Suzuki T, Nakashima Y, et al. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis:power Doppler subclinical synovitis is associated with bone erosion[J]. Rheumatology(Oxford), 2014, 53:562-569. doi:  10.1093/rheumatology/ket405
    [25] Minowa K, Ogasawara M, Murayama G, et al. Predictive grade of ultrasound synovitis for diagnosing rheumatoid arthritis in clinical practice and the possible difference between patients with and without seropositivity[J]. Mod Rheumatol, 2016, 26:188-193. doi:  10.3109/14397595.2015.1069457
    [26] Mian AN, Chaabo K, Wajed J, et al. Rheumatoid arthritis patients with fibromyalgic clinical features have significantly less synovitis as defined by power Doppler ultrasound[J]. BMC Musculoskelet Disord, 2016, 17:404. doi:  10.1186/s12891-016-1258-6
    [27] Naredo E, Valor L, De la Torre I, et al. Predictive value of Doppler ultrasound-detected synovitis in relation to failed tapering of biologic therapy in patients with rheumatoid arthritis[J]. Rheumatology(Oxford), 2015, 54:1408-1414. doi:  10.1093/rheumatology/kev006
    [28] 李强, 朱平, 赵雯, 等.类风湿关节炎临床缓解与超声影像学缓解的比较研究[J].中华风湿病学杂志, 2013, 17:293-297. doi:  10.3760/cma.j.issn.1007-7480.2013.05.002
    [29] Janta I, Valor L, De la Torre I, et al. Ultrasound-detected activity in rheumatoid arthritis on methotrexate therapy:Which joints and tendons should be assessed to predict unstable remission?[J]. Rheumatol Int, 2016, 36:387-396. doi:  10.1007/s00296-015-3409-8
    [30] Sreerangaiah D, Grayer M, Fisher BA, et al. Quantitative power Doppler ultrasound measures of peripheral joint synovitis in poor prognosis early rheumatoid arthritis predict radiographic progression[J]. Rheumatology(Oxford), 2016, 55:89-93. doi:  10.1093/rheumatology/kev305
    [31] Zufferey P, Rebell C, Benaim C, et al. Ultrasound can be useful to predict an evolution towards rheumatoid arthritis in patients with inflammatory polyarthralgia without anticitrullinated antibodies[J]. Joint Bone Spine, 2017, 84:299-303. doi:  10.1016/j.jbspin.2016.05.011
    [32] Gibbon WW, Wakefield RJ. Ultrasound in inflammatory disease[J]. Radiol Clin North Am, 1999, 37:633-651. doi:  10.1016/S0033-8389(05)70120-2
    [33] Klauser A, Demharter J, De Marchi A, et al. Contrast enhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis:results from the IACUS study group[J]. Eur Radiol, 2005, 15:2404-2410. doi:  10.1007/s00330-005-2884-9
    [34] Klauser AS, Franz M, Arora R, et al. Detection of vascularity in wrist tenosynovitis:power doppler ultrasound compared with contrast-enhanced grey-scale ultrasound[J]. Arthritis Res Ther, 2010, 12:R209. doi:  10.1186/ar3185
    [35] Klauser AS, Franz M, Bellmann WR, et al. Contrast-enhanced ultrasonography for the detection of joint vascularity in arthritis-subjective grading versus computer-aided objective quantification[J]. Ultraschall Med, 2011, 32(Suppl 2):E31-E37. https://www.ncbi.nlm.nih.gov/pubmed/21894599
    [36] Cardinal E, Chhem RK, Beauregard CG. Ultrasound-guided interventional procedures in the musculoskeletal system[J]. Radiol Clin North Am, 1998, 36:597-604. doi:  10.1016/S0033-8389(05)70048-8
    [37] Grassi W, Farina A, Filippucci E, et al. Sonographically guided procedures in rheumatology[J]. Semin Arthritis Rheum, 2001, 30:347-353. doi:  10.1053/sarh.2001.19822
    [38] Babaei-Ghazani A, Eftekharsadat B. Ultrasound guided injection of resistant extra-articular shoulder and elbow cysts in rheumatoid arthritis:A case report[J]. J Back Musculoskelet Rehabil, 2016, 29:381-385. doi:  10.3233/BMR-150625
    [39] Ammitzbøll-Danielsen M, østergaard M, Fana V, et al. Intramuscular versus ultrasound-guided intratenosynovial glucocorticoid injection for tenosynovitis in patients with rheumatoid arthritis:a randomised, double-blind, controlled study[J]. Ann Rheum Dis, 2017, 76:666-672. doi:  10.1136/annrheumdis-2016-209840
    [40] Kelly S, Humby F, Filer A, et al. Ultrasound-guided synovial biopsy:a safe, well-tolerated and reliable technique for obtaining high-quality synovial tissue from both large and small joints in early arthritis patients[J]. Ann Rheum Dis, 2015, 74:611-617. https://ard.bmj.com/content/annrheumdis/74/3/611.full.pdf
  • 加载中
图(3)
计量
  • 文章访问数:  33
  • HTML全文浏览量:  10
  • PDF下载量:  7
  • 被引次数: 0
出版历程
  • 收稿日期:  2017-06-26
  • 刊出日期:  2017-09-30

目录

    /

    返回文章
    返回

    【温馨提醒】近日,《协和医学杂志》编辑部接到作者反映,有多名不法人员冒充期刊编辑发送见刊通知,鼓动作者添加微信,从而骗取版面费的行为。特提醒您,本刊与作者联系的方式均为邮件通知或电话,稿件进度通知邮箱为:mjpumch@126.com,编辑部电话为:010-69154261,请提高警惕,谨防上当受骗!如有任何疑问,请致电编辑部核实。谢谢!