| Rheumatoid arthritis(RA) is an autoimmune disease, symptoms are most often involved in synovitis of hand joint and wrist joint.The development of new reliable methods for assessing synovial inflammation and response to treatment in RA is a challenge in daily practice and clinical trials and a relevant research field in rheumatology.Within the last decade, Color doppler or energy doppler technology has become an important means of evaluating the patients with joint inflammation of RA patients, but not yet written into guidelines.In clinic work,condition of RA patients with moderate and severe disease activity is often relapse, requiring combination therapy with a variety of DMARDs,and some patients need small dose of glucocorticoid and biological agents to induced remission.So there urgently need to be reliable monitoring means of evaluating and guiding treatment in the process of disease, in order to maintain long-term disease remittion ease or low disease activity.Therefore to study the efficacy of ultrasound assess RA patients with moderately severe activity has very important clinical using value.Objective: Ultrasound has significance in the study of RA, ultrasonic synovitis is an important factor of disease activity and progress in imaging.Many studies have shown it will be persistent radiological progression even if it had be reached clinical alleviate [1].The main purpose of this study was to evaluate the meaning of musculoskeletal ultrasound in treatment of follow-up patients with the high disease activity RA.We retrospectived RA patients who are moderate and severe disease activity and who had been treated six months ago,and we evaluate the following assumptions:1.Definite correlation of the ultrasound and other clinical activity index, and realize response to disease states by ultrasonic.2. accuracy and objectivity of ultrasound compared with other clinical activity parameter.3.Changes of the clinical and ultrasound index in group treated with corticosteroid therapy and biological agents.Through our study to be further clarify the value and use of ultrasonography in RA daily management.Methods:1 Subjects::Between February 2014 and January 2015, 79 active RA patients were recruited prospectively from the Department of Rheumatology and Immunology of the Second Hospital of Hebei Medical University and among these 35 patients with moderate and severe disease activity went through 6-month therapy with complete clinic data.All patients fulfilled the 2010 revised American College of Rheumatology(ACR) and European League Against Rheumatism(EULAR) classification criteria for RA[2].Subjects were excluded if they had congenital abnormal development of hand joints, injury, complicated with other diseases(systemic lupus erythematosus, sicca syndrome,severe knee osteoarthritis and etc), joint swelling of unknown reason, severe cardiopulmonary disease, pregnancy or breast-feeding, psychosis and etc.Written informed consent was obtained from all the participants.2 Research methods:All the 35 subjects provided a blood sample, underwent a joint ultrasound and completed a set of questionnaires. Clinical data(swollen joint count, tender joint count, DAS 28 score, HAQ), laboratory index(ESR,CRP), ultrasound assessment(Synovial thickness, power doppler, tenosynovitis, bone erosion for 22 joints of bilateral hands by using gray-scale ultrasonography and intraarticular power Doppler signal.)and therapeutic regimen were recorded and analyzed at baseline, 3 months and 6 months.3 Statistical analysis:All the data were analyzed using statistical software SPSS 17.0. Measurement data is represented by x ±s. Comparison between two samples was performed by t-test. Correlations were analyzed by Spearman’s correlation analysis. Comparisons among three groups were performed by analysis of variance. The P values less than 0.05 were considered statistically significant. All the tests were fitted for two-tailed test and test level a is 0.05.Results:1 Fourteen of the 35 RA patients were treated with small dose of glucocorticoid(≤10mg/day) or combined therapy with traditional DMARDs; Six patients received combined therapy of biological agents with MTX. The rest of patients received conventional DMARDs combination therapy. Non-steroidal anti-inflammatory drugs(NSAIDs) were allowed when necessary.2 There were cross-sectional correlations between the US parameters and the DAS28, CRP, ESR and HAQ score. The US joint index of power Doppler signal correlated significantly with the DAS28 and CRP level throughout the study. The correlation coefficients were higher at 6 months than those at baseline and 3 months with the followup. In terms of synovial membrane thickness, scores of synovial membrane thickness of finger and wrist joints have a weakly significant correlation with DAS28 and CRP. There was no obvious correlation between bone erosion and DAS28.But there was a weakly significant correlation between bone erosion and CRP at baseline.In addition, there was a strong correlation between tenosynovitis and disease activity index at different time point,especially CRP.3 There were significantly decreased changes of DAS28, HAQ, VAS, power doppler signal, and tenosynovitis score of after 3 months and 6 months treatment when compared with those of baseline between glucocorticoid and biological group, however, there were no significant statistical difference between those of 3-month and 6-month treatment group(P>0.05).Power doppler signal within the two groups were significantly reduced, and the change between biological agents and the glucocorticoid group at the 6 month was statistically different. The synovial thickness of hand and wrist joints between the two groups had no obvious improvement, and the synovial thickness of wrist joint of biological group improved in 6 month compared with the baseline level. There was obvious improvement in bone erosion in glucocorticoid group at 6 month and biological agents group at 3 and 6 month, and the case in biological agents group was better than that of glucocorticoid group(P < 0.05).4 Power doppler signals and tenosynovitis scores correlated with DAS28 and HAQ scores in glucocorticoid group at 3 month and there was correlation only between power doppler signals and DAS28 and HAQ at 6 month. There was no obvious correlation between DAS28 and HAQ with synovial thickness and bone erosion. In biological group, there were significant positive correlations between energy doppler signal, bone erosion and tenosynovitis scores and DAS28 at 3 month, and only bone erosion correlated with HAQ.At 6 month energy doppler signal and tenosynovitis positively correlated with DAS28, and bone erosion correlated with HAQ as well.Conclusions:1 Regular ultrasound evaluation in RA patients with moderate and severe disease activity could facilitate assessment of disease activity and guidance to clinical treatment, especially to those who have received medications.2 To RA patients with moderate and severe disease activity, small doses of glucocorticoids is not inferior to biological agents in reducing inflammation index, controlling disease activity and inhibiting synovitis, but the biological may be superior in bone erosion.3 Musculoskeletal ultrasound is worth monitoring the RA in clinical promotion as a new imaging. |
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