Study On The Correlation Betweem Hand And Forefoot Synovitis In Rheumatoid Patients Evaluated By Power Doppler Ultrasound

Objective By examining the hand joints of rheumatoid arthritis(RA)patients with Power doppler ultrasound(PDUS),combined with its clinical indicators,we predicted the factors related to the presence of anterior foot synovitis in RA patients.Methods A study was conducted in 69 patients with rheumatoid arthritis from May 2021 to May 2022,including 690 cases of metacarpophalangeal joint,690 cases of proximal interphalangeal joint,138 cases of wrist joint,and 690 cases of metatarsophalangeal joint.Twodimensional and PDUS examinations were performed on all patients,and clinical indicators were collected.Sixty-nine patients were divided into forefoot synovitis group(n = 19)and non-forefoot synovitis group(n = 50)according to whether the synovitis of the metatarsophalangeal joint was thickened by two-dimensional ultrasound.The differences in clinical indicators and ultrasound results between the two groups were compared,and the correlation between PDUS score of hand and metatarsophalangeal joint synovitis was analyzed,and the related factors of forefoot synovitis were predicted.Results(1)Sixty-nine patients were included,28 joint swelling numbers(SJC)(t=3.095,P=0.003),DAS-28 scores(t=2.231,P=0.030)in the forefoot synovitis group.The total PDUS score of hands(Z=-5.435,P<0.001)was significantly higher than that of non-anterior foot synovitis group,and the difference was statistically significant(P<0.05);(2)In the forefoot synovitis group,there was a low correlation between the number of PDUS signal positive joints and SJC(0-28)(r=0.466,P<0.05).There was a low correlation with DAS-28 score(r=0.474,P<0.05),and a significant correlation with the total score of PDUS in the hand(r=0.529,P<0.05).;(3)Univariate regression analysis of 28 joint swelling(SCJ)(P=0.006,OR=1.385,95%CI:1.098-1.747)and 28 joint tenderness count(TCJ)(P=0.073,OR=1.155,95%CI:0.987-1.352),DAS-28 score(P=0.046,OR=2.050,95CI%:1.011-4.155),total PDUS score of hand(P=0.001,OR=2.306,95CI%:1.424-3.734)and the number of PDUS-positive joints in the hand(P < 0.001,OR=2.997,95CI%:1.689-5.317)were risk factors for synovitis of the foot.Multivariate regression analysis showed that only the total PDUS score of the hand was an independent risk factor for anterior synovitis(P=0.013,OR=2.428,95CI%:1.210-4.781),and the difference was statistically significant(P<0.05);(4)Receiver operating characteristic curve(ROC)of PDUS score of hands in RA patients suggested that the total PDUS score of hands > 5 was associated with metatarsophalangeal joint synovitis,with sensitivity of 90% and specificity of 78%,suggesting a correlation between total PDUS score of hands and metatarsophalangeal joint synovitis.Conclusion The total PDUS score of the hand has imaging value in indicating the presence of metatarsophalangeal joint synovitis in patients with rheumatoid arthritis.