A Cohort Study Of Ultrasound Semi-quantitative Scoring In The Diagnosis Of Seronegative Rheumatoid

Objective: To investigate the value of ultrasound semi-quantitative scoring in the diagnosis of seronegative rheumatoid arthritis.Methods: Ultrasonography was performed in 30 hand joints of 411 patients with suspected RA with complaints of hand joint pain,focusing on the assessment of SH,PD,BE,tenosynovitis,and tendonitis,with a follow-up of 3-6 months,using the 2010 ACR/EULAR diagnostic criteria for RA or the effective treatment with DMARDs as the judgment criteria,and comparing SNRA,SPRA,and non-RA in terms of clinical manifestations,The sensitivity and specificity of the ultrasound semi-quantitative score for the diagnosis of SNRA in case of negative serology were also tested.Results: 1.A total of 411 cases were included in this study,including 131(31.87%),165(40.15%),and 115(27.98%)cases in each of the SNRA,SPRA,and non-RA groups.2.The length of diagnosis and the number of BE3 levels were greater in SNRA patients than in SPRA patients(P<0.05),and the CRP,ESR,SH1/2/3 levels,PD1/2/3grade,BE1/2 grade,the number of cases of tendinitis and tenosynovitis were not significantly different from those of SPRA patients(P≥0.05).3.The number of joints involved,CRP,ESR,SH2/3 grade,PD1/2/3 grade,BE2/3 grade were greater in SNRA patients than in non-RA patients(P<0.05),and the mean age,SH1 grade,PD1 grade,and The number of BE1 grade was smaller than that of non-RA patients(P<0.05),and the number of cases of SH2 grade,tendinitis,and tenosynovitis in SNRA patients was not significantly different from that of non-RA patients(P≥0.05).4.When serology was negative,when the highest scored joint met either PD grade ≥ 2 or BE grade ≥ 2,it was both highly sensitive(92.36%)and highly specific for the diagnosis of RA(Subclinical synovitis was detected in 5.78(59.54%)SNRA patients,81(49.09%)SPRA patients,and 51(44.35%)non-RA patients.The number of joints involved in clinical assessment was greater than 10 in 13.74%,14.55%,and 7.83% of SNRA,SPRA,and non-RA patients,and the number of joints involved in ultrasound assessment was greater than 10 in 33.59%,32.73%,and 12.70% of SNRA,SPRA,and non-RA patients,and the number of joints involved in ultrasound assessment was greater than The number of joints involved in ultrasound assessment was greater than that in clinical assessment in SNRA and SPRA patients(P<0.05),and there was no significant difference between the number of joints involved in ultrasound assessment and that in clinical assessment in non-RA patients(P≥ 0.05).Conclusion:1.Ultrasound semi-quantitative scores are important in the early diagnosis of SNRA patients,and the best balance of high sensitivity(92.36%)and high specificity(88.70%)for the diagnosis of SNRA is achieved when the joint with the highest score meets either "PD classification ≥2 or BE classification ≥2".2.Patients with SNRA and SPRA have similar clinical and ultrasound presentations,but some SNRA patients have severe bone destruction "early in the course of the disease",a greater proportion than SPRA patients.3.Patients with SNRA and non-RA patients have similar clinical presentations,but different ultrasound presentations,and can be distinguished from each other using ultrasound semi-quantitative scores.4.Ultrasound can detect subclinical synovitis and provide a basis for early diagnosis of RA.