Musculoskeletal Ultrasonography With Rheumatoid Arthritis And Cold Heat Blockage Blockage Correlation Between Syndromes

Objective:To provide objective diagnostic evidences for traditional Chinese medical (TCM) syndrome types of rheumatoid arthritis (RA), the correlation between musculoskeletal ultrasound (MSUS) changes and the clinical manifestations and laboratory indices of the dampness-heat impeding syndrome and the cold-dampness impeding syndrome of RA will be analyzed and explored.Methods:Inpatients and outpatients of RA in rheumatism department of Dongfang hospital affiliated to Beijing university of Chinese medicine between March2013and March2014, who with the dampness-heat impeding syndrome or the cold-dampness impeding syndrome were collected. Case report form (CRF) were made and clinical symptoms of RA patients were recorded; Laboratory indices including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-cyclic citrullinated (anti-CCP) antibody, rheumatoid factor (RF), D-dimer, immunoglobulin (IgG、IgM、IgA) and blood routines (white blood cell, red blood cell, hemoglobin and platelet) were tested by conventional methods, the disease activity scores28(DAS28) and syndromes quantitative scores of TCM were calculated. MSUS was applied to detect the thickness of synovial hyperplasia, joint effusion thickness, blood flow signal classification, tendinitis/tenosynovitis and bone erosion, which changed in the small joints of the hands (wrist, metacarpophalangeal joints and proximal interphalangeal joints) of RA patients.The differentiation between the dampness-heat impeding syndrome and the cold-dampness impeding syndrome of RA in the joints changes observed with MSUS and related laboratory indices was analyzed. And the correlations of the joints changes observed with MSUS and laboratory indices above also were analyzed.Results:(1) The baseline data:45case of RA patients (129joints and the wrist count as a small joint) were collected.There is no statistical significance between dampness-heat and cold-dampness impeding pattern in gender,age, duration of disease and the affected joints (P>0.05)(2) The comparison of dampness-heat and cold-dampness impeding pattern in MSUS: The doppler blood flow signal classification has a significant difference between RA two syndrome types in TCM(P<0.05), while the thickness of synovial hyperplasia, joint effusion, bone erosion and the incidence rate of synovial hyperplasia, joint effusion, tendonitis/tenosynovitis, bone erosion are not statistically significant between them (P>0.05).Draw the ROC curve of doppler blood flow signal classification when define the dampness-heat impeding syndrome as a positive event, and the AUC is0.594. There is no statistical significance between dampness-heat and cold-dampness impeding pattern of duration of disease<lyear and>lyearin MSUS changes (P>0.05).The wrist is given priority to affected joints in the two types of pattern,and There is no statistical significance between them (P>0.05)(3)The comparison of laboratory indices:There was no statistical significance between dampness-heat and cold-dampness impeding pattern in blood routines (white blood cell, N%, red blood cell, hemoglobin and platelet), ESR, CRP, immunoglobulin (IgG、IgM. IgA), RF, anti-CCP antibody, DAS28and syndromes quantitative scores of TCM (P>0.05). The positive rate of RF and anti-CCP antibody between the two syndromes are not statistically significant (P>0.05).There is a certain correlation between duration of disease and the thickness of bone erosion (P<0.05, r=0.344)(4) The correlation analysis between changes observed with MSUS and laboratory indices:There is a certain correlation between platelets and the thickness of synovial hyperplasia and joint effusion(P<0.05, r=0.465). There is a certain correlation between CRP and the thickness of synovial hyperplasia and the thickness of synovial hyperplasia, joint effusion, bone erosion(P<0.05), and the correlation coefficient are0.481,0.455respectively. There is a certain correlation between immunoglobulin M and the thickness of synovial hyperplasia and joint effusion (P<0.05, r=0.573).There is no significant correlation between the joints changes observed with MSUS and age, blood routines (white blood cell, N%, red blood cell, hemoglobin), ESR, immunoglobulin (IgG、IgA), RF, anti-CCP antibody, DAS28and syndromes quantitative scores of TCM (P>0.05)Conclusion:1There is no statistical significance between dampness-heat and cold-dampness impeding pattern in gender, age,duration of disease and the affected joints.2There are some different performance of the doppler blood flow signal classification in both of the two types syndrome. The blood flow signal classification may contribute to the diagnosis of dampness-heat impeding pattern.3There is a certain correlation between the joints changes observed with MSUS and duration of disease, PLT, CRP, IgM of RA patients.