Application Value Of High Frequency Ultrasound In The Treatment Evaluation Of Rheumatoid Arthritis

Objective:To explore the value of high frequency ultrasound in the evaluation of the treatment response of rheumatoid arthritis.Methods:47 treatment-naive RA（Rheumatoid arthritis）patients were selected in the department of rheumatology in The Faffiliated Hospital of Guangxi Medical University from March 2018 to October 2019.These patients were evaluated by high-frequency ultrasound for synovial thickness,synovial doppler blood flow signals within the energy,joint effusion and bone erosion in each joint before and after treatment respectively.The clinical disease activity score 28（DAS28）and relevant laboratory indicators such as erythrocyte Sedimentation rate（ESR）,C reactive protein（CRP）,anti-cyclic citrullinated peptide antibody（anti-CCP）and rheumatoid factor（RF）were also collected.The changes of ultrasonic examination,laboratory test and clinical DAS28scores of RA patients before and after treatment were analyzed to evaluated the therapeutic effect.The correlation between laboratory index and ultrasonic index was analyzed.What’s more,47 patients were divided into good response（ΔDAS28>1.2）and poor response（ΔDAS28≤1.2）.The ultrasound changes of two groups were compared to explore prognosis indicators of different treatment responses.Results:The synovial thickness of bilateral carpal joint,bilateral knee joint,left 1st-5th metacarpophalangeal joint,right 1st-2nd metacarpophalangeal joint and right 4th-5th metacarpophalangeal joint decreased significantly after treatment(P_Lwrist<0.001、P_{R wrist}<0.001、P_LKnee<0.001、P_{R Knee}<0.001、P_LMCP1<0.001、P_LMCP2=0.001、P_LMCP3<0.001、P_LMCP4=0.002、P_LMCP5=0.001、P_RMCP1<0.001、P_RMCP2<0.001、P_RMCP4<0.001、P_RMCP5=0.007).Bilateral knee joint effusion significantly decreased after treatment(P_{L Knee}=0.001、P_{R Knee}=0.001).Blood flow signals in bilateral carpal joint,bilateral metacarpophalangeal joint,bilateral 2-3 proximal interphalangeal joint and bilateral knee joint synovium significantly decreased after treatment(P_{total blood flow score}<0.001).The synovial thickness of the right third metacarpophalangeal joint and the bilateral 2nd and3rd proximal interphalangeal joint did not decrease significantly after treatment(P_RMCP3=0.06、P_LPIP2=0.248、P_LPIP3=0.423、P_RPIP2=0.474、P_RPIP3=0.326).The bone erosion of bilateral carpal joint,bilateral metacarpophalangeal joint,bilateral 2-3proximal interphalangeal joint and bilateral knee joint showed no significant improvement after treatment(P_{total score of bone erosion}=0.604).there was a significant positive correlation between CRP and synovial thickness of wrist joint（P=0.019,r=0.341）.There was a significant positive correlation between CRP and the total score of blood flow of all joints（P=0.033,r=0.312）.The synovial thickness of the proximal interphalangeal joint of the patients with good response to treatment was significantly greater than that of the group with poor response(P_{total synovial thickness of PIP}=0.025),and the carpal bone erosion score of the patients with good response to treatment was significantly lower than that of the group with poor response(P_{total score of wrist bone erosion}=0.047).Conclusions:High frequency ultrasound can directly and accurately reflect the changes of synovial thickness,blood flow,joint effusion,cartilage and bone erosion,which is of great reference value for the evaluation of curative effect in patients with RA.The synovium thickness of the proximal interphalangeal joint and the bone erosion score of the wrist joint have certain clinical value in predicting the therapeutic response of RA.