彩色脉冲多普勒超声对类风湿关节炎活动期的评估

目的应用彩色脉冲多普勒超声,对类风湿关节炎（RA）患者的手、腕、掌指关节和尺桡面的关节滑膜囊内血液供应情况和血流频谱进行检测评估。方法对30例类风湿患者,分成活动期和非活动期两组的300个掌指关节（MCP）60个尺桡面（URS）进行检测,并测量所有血流的阻力指数（RI）和搏动指数（PI）。结果16例患者有62个MCP检测到血流信号,20例患者中有29个URS探测到血流信号。应用彩色脉冲多普勒超声评估RA活动期的敏感性,特异性,阳性预测值和阴性预测值分别为94%,64%,81%和88%。且血流信号数目与RI间存在负相关,血流信号数目越多,RI值越低。结论应用彩色脉冲多普勒评估RA是否为活动期,是一种安全、可靠、敏感度高的检测方法。     

A Pilot Study of Potassium Supplementation in the Treatment of Hypokalemic Patients With Rheumatoid Arthritis: A Randomized, Double-Blinded, Placebo-Controlled Trial

Patients with rheumatoid arthritis (RA) have been described as having significantly low serum potassium concentrations than that in healthy subjects. We assessed the therapeutic efficacy and tolerability of oral potassium supplement dissolved in grape juice in female hypokalemic patients with active RA. Thirty-two hypokalemic patients with active RA were investigated in a parallel, randomized design. In addition to their usual medication, the control group received placebo and the intervention group received 6000 mg chloride potassium dissolved in grape juice on 28 consecutive days. The primary outcome parameter was the change of pain on a visual analog scale (VAS). The American College of Rheumatology (ACR) percent response criteria and Disease Activity Score 28 (DAS28, 28-joint count) and the European League Against Rheumatism (EULAR) moderate response were assessed. Mean age was 48.6 ± 6 years. In the potassium group, 43.75% (7/16) of the patients met the criteria of 33% lower pain intensity compared with 6.25% (1/16) in the placebo group (P < .02) at day 28. Also, 31.25% (5/16) of the patients in the intervention group achieved moderate responses, according to the EULAR criteria. The corresponding percentage for patients receiving placebo was 6.25% (1/16) (P < .05). Potassium supplements appeared to decrease pain intensity.

Perspective

This article reports a trial evaluating the effect of potassium supplementation in the treatment of pain in hypokalemic patients with rheumatoid arthritis. The elevated serum cortisol and potassium values in the treatment group correlate negatively with patient's assessment of pain intensity, reflecting an anti-pain effect for potassium supplementation.     

超声与磁共振对类风湿关节炎腕手关节病变诊断价值的比较简

目的探讨类风湿关节炎腕手部关节病变的超声和磁共振病变分布特征并比较二者的诊断价值。方法对11例类风湿关节炎患者进行腕手部超声和磁共振检查,计算两种影像方法对腕手部关节滑膜炎、骨质侵蚀和肌腱病变的检出率,以磁共振为金标准评价超声对腕手部关节各种病变的诊断效力。结果共评价腕手部103个关节和112个肌腱区域。超声和磁共振对腕手部关节滑膜炎、骨质侵蚀、肌腱病变的检出率分别为59．2％、11．7％、18．8％和62．1％、14．6％、32．1％。腕关节三种病变检出率均高于掌指关节和指间关节。腕部伸肌腱病变检出率高于屈肌腱,掌指关节屈肌腱病变检出率高于伸肌腱。与磁共振相比,超声对腕手部关节滑膜炎、骨质侵蚀、肌腱病变的诊断敏感性为92．2％、73．3％、59．5％,特异性为94．9％、97．7％、98．6％,阳性预测值为96．7％、84．6％、96．2％,阴性预测值为88．1％、95．6％、80．2％。结论类风湿关节炎腕部受累较掌指关节和近端指问关节常见,腕部伸肌腱病变较屈肌腱病变常见,掌指关节处屈肌腱病变较伸肌腱病变常见。以磁共振为对照,超声检查对腕关节各种病变诊断准确率较高,对掌指关节处伸肌腱病变诊断敏感性较低。     

Gender-Specific Effects of Depression on Functional Disability in Rheumatoid Arthritis: A Prospective Study

We examined the prospective impact of depression on objective ratings of disability as a function of gender in a sample of persons with rheumatoid arthritis. Forty-two individuals from an outpatient rheumatology clinic completed measures of depression, disability, and pain over the course of 1 year. A physician's assistant completed objective measures of functional disability following a routine physical examination. Results demonstrated a significant main effect for gender on Time 2 objective ratings of disability (after controlling for disease variables and self-report indices of pain and disability), indicating that physician assistants rated female participants as more disabled than male participants. Importantly, the interaction of gender and Time 1 depression contributed significant variance to Time 2 disability. Findings suggest that women, relative to men, may experience greater declines in functional capacity over time, independent of self-perceptions of pain and disability, and that depression plays a significant role in this process. Discussion focuses on treatment considerations for health care teams, with particular focus on women's adjustment of to RA.     

Association of Changes in Anticitrullinated Protein Antibody Levels With Resource Use and Disease Activity Measures in Rheumatoid Arthritis Patients a US Observational Cohort

PurposeAnticitrullinated protein antibody (ACPA) concentration, beyond ACPA positivity, is indicative of more aggressive radiographic progression in patients with rheumatoid arthritis (RA). However, there is limited information on the association of changes in ACPA with resource use measures and/or disease activity measures. We evaluate associations between changes in levels of ACPA and outcomes, including durable medical equipment (DME) use, hospitalizations, and disease activity, in patients with established RA.MethodsPatients from the Brigham and Women's Hospital Rheumatoid Arthritis Sequential Study who had ACPA measurements at baseline and month 12 were included. Changes in ACPA levels from baseline to month 12 were categorized as a decrease (<−10%), no change (−10% to +10%), or increase (>+10%). DME use and hospitalizations were assessed twice yearly using patient questionnaires; disease activity was assessed annually. Binary multivariate logistic regression was used to analyze the association between changes in ACPA levels and DME use and hospitalizations; linear regression was used to assess the association with disease activity.FindingsOf 840 patients included in the analysis, 291 (34.6%), 266 (31.7%), and 283 (33.7%) had a decrease, no change, or increase in ACPA levels, respectively. A decrease in ACPA levels was associated with a reduction in DME use (adjusted odds ratio [aOR] = 0.64; 95% CI, 0.44–0.93; P = 0.02) and hospitalizations (aOR = 0.62; 95% CI, 0.41–0.95; P = 0.03) versus no change or increase. Adjusted mean changes in disease activity score in 28 joints (C-reactive protein), total and swollen joint counts, and pain scores were significantly greater in patients with decreased ACPA levels versus those with no change or increase (P < 0.05).ImplicationsAmong patients with RA, reductions in ACPA levels of >10% were associated with reductions in DME use, hospitalizations, and disease activity. ClinicalTrials.gov identifier: NCT01793103.     

Relative Contributions of Attributional Style and Arthritis Helplessness to Depression in Rheumatoid Arthritis: A Longitudinal Investigation

We examined the relative efficacy of disease-specific and disease-unrelated appraisals of helplessness in predicting depression in rheumatoid arthritis over the course of 1 year. Forty-two individuals from an outpatient rheumatology clinic completed measures of depression, disease-unrelated causal attributions, arthritis-specific helplessness, pain, and disability. Results revealed that disease-unrelated causal attributions, assessed at Time 1 contributed significant variance to depression assessed at Time 2, after controlling for initial levels of depression and concurrent disease status variables. Arthritis-specific helplessness did not relate to subsequent levels of depression. In general, our findings indicated that causal attributions for disease-unrelated events were more reliable predictors of depression in rheumatoid arthritis than was arthritis-specific helplessness. Discussion of the implications of our findings for future research follows from the results.     

Distal Forearm Fracture Open Reduction–Internal Fixation: Sonographic Detection of Hardware Malalignment and Associated Tendon Injuries Missed by Radiography

Tendon injury is a known complication of distal radius fracture plate and screw fixation. Targeted musculoskeletal sonography is uniquely capable of assessing both tendon integrity and hardware abnormalities not recognized on radiographs. Each of the 3 patients described presented with pain after an open reduction–internal fixation following a distal forearm fracture. In each patient, radiographic findings, specifically the hardware position, were interpreted as normal. Important radiographically occult observations were subsequently made with sonography, including 3 proud screws and tendon injuries, all of which required surgical treatment. This case series demonstrates the clinical utility of musculoskeletal sonography in symptomatic patients after distal radius open reduction–internal fixation with negative radiographic findings. In our practice, sonography has been the most useful modality for precluding missing or delaying the diagnosis and treatment of these hardware complications. We advocate its use as an adjunct in any department performing musculoskeletal imaging.     

超微血流成像及能量多普勒超声在类风湿关节炎临床缓解期的应用价值

摘要：目的：探讨超微血流成像（SMI）及能量多普勒超声（PDUS）在类风湿关节炎（RA）临床缓解期的应用价值。方法：对40例RA临床缓解期患者和20例健康志愿者的双侧腕关节、掌指关节及近端指指关节进行超声检查,记录PDUS及SMI对增厚滑膜内血流分级结果,观察两种血流模式对滑膜血流的显示率和滑膜血流分级的差异。 结果:在40例RA临床缓解期患者中,PDUS和SMI显示的缓解率分别为60%和27.5%,两者的差异有统计学意义（P<0.05）;在20例健康志愿者中SMI和PDUS对滑膜血流的显示率为0,但在40例RA临床缓解期患者中,PDUS及SMI对滑膜血流的显示率分别为8.64%、12.8%,两种血流模式的血流信号显示率差异具有统计学意义（P<0.05）;PDUS与SMI对滑膜血流分级结果一致性较好（kappa=0.741）; SMI阳性患者继续强化治疗后,滑膜血流显示率明显下降。结论：在类风湿关节炎临床缓解期,SMI和PDUS都有一定的临床应用价值。但SMI比PDUS能够更敏感的发现手腕关节滑膜中的血流信号。