| Objective: In order to further discuss the clinic value of ultrasound and provide bases for early diagnose, disease evaluation, therapy monitoring and prognosis, the changes for ultrasound imaging of hand joints before and after treatment for patients with Rheumatoid Arthritis(RA) by high frequency color Doppler ultrasound imaging technology is observed. The relevance of it with other imaging inspection and clinic indicators are also analyzed.Material and methods: 30 resident patients that are diagnosed as RA from Aug 2013 to March 2014 in Department of Rheumatology of People’s hospital in Xinjiang Uygur Autonomous Region are selected. Screening criteria meets the classification and diagnostic criteria for RA of American College of Rheumatology(ACR) in 1987. 30 RA patients are divided into before-treatment and after-treatment group by self control method. In order to inspect whether there’s any thickening of synovial membrane, arthoedema, tendon fatigued, roughness of bones or injuries of sclerotin, X ray and ultrasound inspections are performed for proximal Interphalangeal(PIP) for both hands(1-5), Matacarpophalangeal(MCP) and both wrist joints both before the therapy and 3 months after therapy. Blood flow in synovial membrane is observed by color Doppler flow imaging(CDFI), disease activity score with 28 joints(DAS 28), health assessment questionnaire(HAQ scoring), visual analogue scale(VAS), evaluation of patients and doctors on disease, morning stiffness time, cyclic citrullinated peptide(Anti-CCP), rheumatoid factor(RF), erythrocyte sedimentation rate(ESR), C-reaction protein(CRP) and platelet(PLT) counts are recorded. In order to analyze the relevance of results with imaging diagnostic results, magnetic resonance imaging is performed at the same time. Measurement data are expressed in the form of x ± s. T test using paired data is performed for the thickness of synovial membrane before and after the therapy. χ2 test using paired data is performed for classification of blood flow and imaging. The relevance between thickness of synovial membrane and CRP, ESR, Anti-CCP & RF are analyzed by Sperason relevance analysis.Results: 1. Indicator for clinic examination and laboratory from 30 RA patients are decreased after normalized anti-rheumatism therapy. Significant differences are found.(P<0.01) 2. Changes of ultrasound images for hand joints of RA patients: 2.1. 28 cases of synovial membrane thickness(289 joints) are found by ultrasound inspection before therapy. Average for the thickness is(4.51±1.97)mm. Average for the thickness of synovial membrane after therapy is(2.85±1.35)mm. Significant difference could be found.(t=61.4, P<0.01) 2.2. Arthroedema are found in 205 joints from 21 patients before therapy. 32 wrist joints(positive joint 53.3 %), 148 metacarpophalangeal joints(positive joints 49.3 %), 25 interphalangeal joint(positive joints 12.1 %) are included. The amount of arthroedema is reduced in 4 patients. The amount of hydrops articuliis reduced in 8 patients. No changes is found in 9 patients. 2.3. The observation of blood flow signature in synovial membrane by CDFI is performed. According to results by semi-quantitative classification, 6 class 0, 10 class I, 8 class II, 6 class III before therapy and 8 class 0, 12 class I, 7 class II, 3 class III are found. 2.4. X ray, B-ultrasonic wave and MRI are performed for both hands in 16 RA patients of 30 patients. No significant difference could be found in detection rate of synovitis between ultrasound and MRI could be found.(χ2=0.01, P>0.05) However, significance in detection rate of bone erosion between ultrasound and MRI could be found.(χ2 = 3.51, P<0.05) Furthermore, same positive detection rate is found in ultrasound and MRI. Positive relationship in the result could be found. Correlation coefficient is 0.41.Conclusion: The changes of synovial membrane in RA could be directly determined and clearly displayed by high frequency color Doppler ultrasound imaging technology. No wound, little cost and no radiation are advantages of high frequency ultrasound. The efficiency of therapy and evaluation of disease could be observed dynamically. Inspection by ultrasound and MRI of joints are better than traditional X ray inspection in the field of inspection for small joints disease in RA patients. There’s important value of early synovitis and bone erosion on evaluation of activity of RA and prediction of progress $ prognosis of disease. |
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