生长抑素关节腔内注射治疗类风湿性关节炎

目的 :探讨关节腔内注射生长抑素对类风湿性关节炎的疗效。方法 :在应用氨甲喋呤 (MTX)、青霉胺 (D PEN)、柳氮磺胺吡啶 (SSZ)等药物的基础上 ,对 30例类风湿性关节炎的患者 ,在膝关节腔内注射生长抑素 75 0 μg ,每周 1次连续 6次。结果 :炎症缓解率 5 7%。结论 :关节腔内注射生长抑素对类风湿性关节炎有较好的疗效 ,远期疗效尚需进一步研究     

超声引导下膝关节骨性关节炎注射治疗

目的:观察对比超声引导下膝关节骨性关节炎注射治疗与传统盲法注射治疗的临床疗效.方法:选取2018年12月—2019年12月我院注射治疗的膝关节骨性关节炎患者50例,按照随机数字表法分为两组,每组各25例.A组患者行超声引导下膝关节腔注射治疗,B组患者采用解剖定位盲法进行膝关节腔注射治疗.记录所有患者治疗前、治疗后1个月...     

超声对类风湿性肩关节炎的早期诊断价值

目的探讨超声在类风湿性关节炎(RA)肩关节病变中的早期诊断价值。方法应用高频超声(HFUS)对40例RA患者(RA组)的60侧病变肩关节进行扫查,观察肩关节腔腋囊侧及后隐窝侧、肩峰下滑囊、肱二头肌长头肌腱鞘4个区域内滑膜厚度、积液深度;观察肱骨头(大结节、前内侧及后外侧)骨表面侵蚀及肩袖损伤;利用能量多普勒超声(PDUS)观察病变区域滑膜血流情况,并与20名健康志愿者(对照组)40侧肩关节扫查结果进行对比。结果超声检出RA组5种病变类型:关节积液、滑膜增生、血管过度形成、肩袖撕裂以及骨质侵蚀,检出率分别为42.50%(102/240)、39.58%(95/240)、20.83%(50/240)、31.67%(19/60)和36.11%(65/180);对照组肩关节腔内未见积液,滑膜未见增生,未见血流信号。与对照组比较,RA组滑膜明显增厚(P<0.01)。结论 HFUS和PDUS可检出类风湿性肩关节炎引起的多种病变,有助于早期诊断。     

超声技术诊断类风湿性关节炎缓解期的应用进展

类风湿关节炎（RA）是一种以滑膜炎症为主的慢性无菌性炎症,表现为关节肿胀、关节压痛和关节破坏。经过治疗,部分RA患者达到临床缓解期标准,但此时关节仍可有持续性滑膜炎并造成关节持续破坏。肌肉骨骼超声（MSUS）具有非侵入性、易于接受、性价比高、短期内可重复检查、能多角度全方面检查ROI的优点,其在RA的诊断、监测治疗和评估预后等方面具有重要的作用。本文就超声技术（如灰阶超声、能量多普勒超声、CEUS等）在RA临床缓解期的应用及其在治疗效果及预后评估等方面的应用做一综述。     

超声引导下关节腔药物注射治疗类风湿性关节炎疗效观察

选取2015年9月~2016年8月在我院接受治疗的56例类风湿性关节炎患者进行回顾分析。依据随机数字表法以及所采取治疗手段的不同将所有患者均分至采取常规药物联合超短波进行治疗的对照组与行超声引导下关节腔药物治疗的观察组,对比不同治疗方案下对类风湿性关节炎患者临床疗效的差异。无论是治疗后类风湿性关节炎患者临床总有效率方面,还是患者治疗后膝关节评分方面,观察组均显著优于常规治疗的对照组,二者差异显著(P0.05)。对于类风湿性关节炎患者采取超声引导下关节腔内药物注射治疗方案不仅临床效果显著,而且患者治疗后膝关节功能恢复效果佳,值得推广应用。     

类风湿性关节炎误诊为桡骨茎突狭窄性腱鞘炎1例分析

对类风湿性关节炎误诊为桡骨茎突狭窄性腱鞘炎1例分析如下。1病历摘要男,60岁。该患于2008—07—14因右手腕及拇指疼痛,肿胀活动受限,随到某县级医院骨科门诊就诊,查体右侧桡骨茎突肿胀有～2cm结节有明显压痛,右拇指掌指关节肿胀,有压痛,屈伸受限。实验室检查：抗0正常,类风湿因子阴性,未拍手关节X线片。接诊医生诊断为桡骨茎突狭窄性腱鞘炎。     

类风湿性膝关节炎核素放射性滑膜切除术后的高频超声影像改变

目的:研究类风湿性膝关节炎放射性滑膜切除治疗后的高频超声影像变化,为疗效的判定提供客观的影像学指标。方法:用高频超声观察49例患者治疗前及治疗后不同阶段膝关节滑膜积液、滑膜形态及厚度,并进行比较分析。结果:治疗后1~2周,19例(38.78%)滑膜囊积液增加,2例(4.08%)积液减少,31例(63.27%)积液中显示细点状回声,18例(36.73%)显示粗大光点及细带状回声,16例(32.65%)滑膜厚度较治疗前增加,9例(18.37%)滑膜厚度减少。治疗后6~12月,41例(83.67%)滑膜囊积液明显减少至(2.7±0.9)mm,36例(73.47%)滑膜明显变薄,厚度降至(2.1±0.7)mm,绒毛退化或消失,显示为较光滑的线状增强回声。结论:高频超声可敏感而准确地显示类风湿性膝关节炎放射性滑膜切除术后的病理形态学变化,可作为其疗效判定的客观指标。     

超声引导下药物注射封闭治疗腱鞘炎的临床探讨

目的：探讨超声引导下腱鞘内醋酸曲安奈德注射治疗急慢性腱鞘炎的临床应用和效果。方法：将12例（18根肌腱腱鞘）不同部位的腱鞘炎分为急性（7例）和慢性（5例）、单发（9例）和多发（3例）。均采用醋酸曲安奈德注射液,配合2%利多卡因在超声实时引导下,行鞘管内注射。结果：平均随访1个月,1次治愈率95%,有效率100%,无效率0%。2次治愈率100%。结论：超声引导下腱鞘内注射药物准确率和有效率远远高于传统封闭治疗,疗效肯定,作用持久,是一种安全有效的方法。     

超声诊断类风湿性肩关节炎肩袖损伤：与关节镜手术对照

目的 探讨超声检查对类风湿性肩关节炎肩袖损伤的诊断价值。方法 应用超声对47例临床拟诊肩袖损伤的类风湿性肩关节炎患者的47侧肩袖进行扫查,依次观察肩胛下肌腱、冈上肌腱、冈下肌腱、小圆肌腱在静止状态和运动状态下有无损伤及撕裂。 在超声检查1周内对所有患者行肩关节镜手术治疗,将超声结果与手术结果进行对照。结果 超声可清晰显示类风湿性肩关节炎肩袖病变的形态学特征,包括有无撕裂和厚度改变;共检出31侧肩袖损伤,其中不完全撕裂18侧,完全撕裂7侧,肩袖肌腱厚度变薄6侧。与关节镜手术结果比较,超声诊断肩袖损伤的总体敏感度为90.62%(29/32),特异度为86.67%(13/15),准确率为89.36%(42/47)。超声对肩袖完全撕裂的诊断准确率为100%(7/7)。结论 超声对检出和判断类风湿性肩关节炎肩袖损伤程度有较高价值,尤其对显示完全撕裂和肩袖肌腱厚度变薄意义更显著。     

56例类风湿关节炎患者手部影像学资料分析

目的：探讨类风湿关节炎患者（RA）手部X线的表现与临床病程的关系。方法：对56例临床资料完整的RA病例行双手的CR后前位X线检查,并按病程分为2组（A组为为符合类风湿关节炎X线I期表现的30例，B组为符合类风湿关节炎X线II期以上表现的病人26例），分别统计类风湿关节炎患者的活动性指标RF、ESR、CRP及免疫球蛋白的水平并进行两组比较。结果：两组RA患者的急性炎性反应指标ESR、CRP的数值两组比较，差异无显著性（P>0.05）。而类风湿因子及免疫球蛋白的水平，对照组明显高于研究组，两组差异具有显著性（P<0.05）。结论：类风湿关节炎的骨关节的损害的程度与RF和免疫球蛋白的水平有关，而手部X线的影像学检查在RA的早期诊断及判断预后方面具有重要的作用。     

类风湿性关节炎患者自身抗体的检测及应用

目的探讨抗核抗体（ANA）检测在类风湿性关节炎（RA）诊断中的意义。方法随机选取该院2010～2013年收治的RA患者67例,以间接免疫荧光法及免疫印迹发检测ANA,以速率散射免疫比浊法检测类风湿因子（RF）,并分析ANA和RF在诊断RA中的相关性。结果检测ANA有利于RA的诊断。67例标本中抗-nRNP／Sm、抗-SS-A、抗一组蛋白阳性率最高,分别为21％、18％、18％。RA组ANA核型主要为均质型,其次为颗粒型,也有部分为阴性。结论临床上治疗RA患者时,应注意监测是否同时患有多重自身免疫性疾病。     

高频能量多普勒超声在类风湿性关节炎治疗监测中的应用

目的：探讨利用高频能量多普勒超声测定滑膜厚度、滑膜血流评估类风湿性关节炎(RA)疗效的价值。方法临床明确诊断的 RA 患者36例,给予甲氨蝶呤片或重组人Ⅱ型肿瘤坏死因子α受体抗体融合蛋白治疗24周。治疗前后对双手第2掌指关节(MCP2)、双腕关节进行滑膜厚度、滑膜血流积分检查,同时进行血沉、C 反应蛋白(CRP)及 DAS28检查,以超声指标与 DAS28、血沉、CRP 进行相关性分析。结果无论治疗前后,MCP2滑膜厚度、腕关节滑膜厚度、MCP2滑膜血流积分与 DAS28的相关性最强(P <0.05),MCP2滑膜血流积分与 CRP 也具有良好的相关性。结论利用高频超声检测 MCP2以及腕关节的滑膜厚度和滑膜积分,均能有效评估 RA 患者的病情活动程度,并作为疗效评价的一种手段,具有一定的价值。     

Orbital blood flow velocities in patients with rheumatoid arthritis

PURPOSE: To assess orbital blood flow changes in patients with rheumatoid arthritis using Doppler sonography. PATIENTS AND METHODS: The study comprised 35 patients who were diagnosed with RA and were treated at the Department of Physical Therapy and Rehabilitation at Duzce Medical School. A control group consisted of 35 healthy volunteers. Color Doppler imaging was used to measure peak systolic velocity (PSV) and end diastolic velocity (EDV), from which the resistance index (RI) was calculated in the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary arteries (PCAs). RESULTS: In the OA, PSV, EDV, and RI were, respectively, 36.7 +/- 0.6 cm/sec, 9.7 +/- 0.2 cm/sec, and 0.73 in the control group versus 34.7 +/- 3.0 cm/sec, 9.1 +/- 1.1 cm/sec, and 0.74 in the patient group. In the CRA, they were, respectively, 11.8 +/- 1.7 cm/sec, 3.6 +/- 0.7 cm/sec, and 0.66 in the control group versus 11.1 +/- 1.7 cm/sec, 3.4 +/- 0.7 cm/sec, and 0.68 in the patient group. In the PCAs, they were, respectively, 13.2 +/- 1.2 cm/sec, 4.7 +/- 0.6 cm/sec, and 0.65 in the control group versus 12.4 +/- 1.2 cm/sec, 4.2 +/- 0.6 cm/sec, and 0.66 in the PCAs. PSV, EDV, and RI of the PCAs and OA and RI of the CRA were significantly different between patients and controls, whereas there was no difference in the serum levels of glucose, triglyceride, low-density lipoprotein cholesterol, and total cholesterol. In the patient group, there was a significant correlation between orbital blood flow and duration of disease. CONCLUSION: Ocular blood flow appears to be slightly lower in RA patients than in healthy controls, suggesting that RA is a systemic inflammatory disease that may also involve ocular vessels.     

B-flow及超声造影在类风湿关节炎手腕小关节滑膜血流显像中的应用

目的探讨彩色多普勒、B-flow及超声造影在类风湿性关节炎手腕小关节滑膜血流显像的价值。方法采用GE Logiq S8 18 M马球棍形线阵探头检查240例类风湿性关节炎患者腕关节、掌指关节及近端指间关节,应用彩色多普勒检查滑膜血流信号并按Szkudlarek半定量法分为0~3级。对250个滑膜血流信号1级及以上的关节,应用频谱多普勒测量滑膜血管翳阻力指数（RI）并与半定量法作相关性分析。应用B-flow检查滑膜血流信号并与彩色多普勒比较两种技术对滑膜血流显示率的差异。对90个彩色多普勒显示滑膜无血流的类风湿性关节炎关节行超声造影,并与B-flow比较两种技术对滑膜血流检出率的差异。结果240例类风湿性关节炎滑膜均为不均匀低回声。其中200例类风湿性关节炎关节滑膜可探及血流信号（1级82例、2级72例、3级46例）。随着血流分级的增加,RI逐渐减低,血流分级与RI呈负相关。彩色多普勒与B-flow对类风湿性关节炎关节滑膜血流信号的显示率分别为154/250及206/250,差异有统计学意义（P<0.05）。90个彩色多普勒显示滑膜无血流的类风湿性关节炎关节,B-flow与超声造影的血流显示率为56/90与74/90,差异有统计学意义（P<0.05）。结论B-flow与超声造影较彩色多普勒对类风湿性关节炎关节滑膜血流显示率高,尤以超声造影明显,滑膜血管翳RI可有效评估类风湿性关节炎活动性,对类风湿性关节炎早期诊断及治疗用药,甚至治疗终点的决定有重要指导意义。     

彩色多普勒超声诊断类风湿性关节炎手腕关节病变

目的 探讨类风湿性关节炎(RA)手腕关节病变的超声影像学特点及其诊断价值.方法 RA患者47例和健康志愿者30例,超声测量双侧腕关节、掌指关节滑膜的厚度、滑膜动脉阻力指数,观察有无关节积液、肌腱炎及骨侵蚀.结果 47例RA患者中超声发现滑膜增厚47例,与健康志愿组差异有统计学意义.探测到血流信号41例,且血流分级与RI呈负相关.超声发现关节积液32例,肌腱周围炎性渗出25例,骨侵蚀19例.结论 彩色多普勒超声检查有助于RA患者手腕关节病变的诊断.     

Predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis

Ursum J, Horsten NC, Hoeksma AF, Dijkmans BA, Knol DL, van Schaardenburg D, Dekker J, Roorda LD. Predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis.

Objectives

To identify early predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis (RA).

Design

A longitudinal study of an inception cohort.

Setting

A large outpatient clinic.

Participants

Consecutive patients who attended the Early Arthritis Clinic for at least 2 years and fulfilled the American College of Rheumatology criteria for RA at baseline and/or at the 1-year follow-up were invited to participate until 200 patients were included.

Interventions

Not applicable.

Main Outcome Measures

Stenosing tenosynovitis, assessed by means of a standardized physical examination. Hand-related activity limitations, assessed with the Disabilities of Arm, Shoulder and Hand questionnaire (DASH). A DASH score above the upper limit of the 95% range of the normative score was defined as abnormal. Prognostic factors: demographic and disease activity–related variables, radiographic damage, the Health Assessment Questionnaire (HAQ) total score and category scores at the 2-year follow-up.

Results

The mean age ± SD of the patients was 59.7±10.7 years (75% female). The mean time ± SD between the 2-year follow-up and the assessment of the dependent variables was 3.9±2.7 years. Stenosing tenosynovitis was present in 33%. The median (interquartile range) DASH score was 26.7 (10.8–42.5); 30% were abnormal. Stenosing tenosynovitis was predicted by the HAQ subscale regarding the use of hands (HAQ-hand) at the 2-year follow-up (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.2–4.2). Hand-related activity limitations were predicted by the Disease Activity Score in 28 joints (OR, 1.8; 95% CI, 1.3–2.4) and HAQ-hand (OR, 2.4; 95% CI, 1.3–5.8) at the 2-year follow-up.

Conclusions

Stenosing tenosynovitis in patients with RA was predicted by HAQ-hand at the 2-year follow-up, and hand-related activity limitations were predicted by disease activity and HAQ-hand at the 2-year follow-up.     

Evaluation of finger joint synovial vascularity in patients with rheumatoid arthritis using contrast-enhanced ultrasound with water immersion and a stabilized probe

PURPOSE.: To assess synovial microvascularity in finger joints with rheumatoid arthritis (RA) by contrast-enhanced ultrasound (CEUS), distinguishing between cases of active disease and those in remission; to standardize the technique for software analysis. METHODS.: Fifty-two finger joints of RA patients (26 with active disease and 26 in remission) were immersed in water and examined by CEUS using a fixed probe. Signal intensity curves were calculated with the software. RESULTS.: Contrast enhancement was detectable in all 26 patients with active RA (100%), but not in 25 of 26 patients in remission (96%); one of the latter patients (4%) showed minimal enhancement. The method's sensitivity and specificity in distinguishing active disease from remission were 100% and 96%. The grades of synovial enhancement correlated with clinical disease activity and software flow parameters. The peak contrast levels correlated with clinical activity, a peak of 9% representing the cutoff between remission and active disease. CONCLUSIONS.: CEUS with a fixed probe on finger joints immersed in water detected synovial vascularization in RA, producing results suitable for standardized software analysis and avoiding artifacts.     

腕部MRI体积定量分析评价类风湿关节炎疗效

目的探讨腕部MRI体积定量分析对于评价类风湿关节炎(RA)疗效的价值。方法收集30例活动期RA并接受规律治疗1年患者,应用MRI体积定量分析软件测量治疗前后同一腕关节滑膜炎、骨髓水肿体积,并获取同期患者红细胞沉降率(ESR)和C反应蛋白(CRP),计算28关节疾病活动度(DAS28)。分析治疗前后滑膜炎、骨髓水肿、CRP、ESR、DAS28变化,并将滑膜炎、骨髓水肿变化量与CRP、ESR、DAS28变化量进行相关性分析。结果治疗后滑膜炎体积、骨髓水肿范围、CRP、ESR、DAS28均显著降低(P均<0.05)。滑膜炎与骨髓水肿变化量呈正相关(r=0.61,P<0.01)。滑膜炎、骨髓水肿变化量与ESR、CRP变化量均无明显相关(P均>0.05),滑膜炎、骨髓水肿变化量均与DAS28变化量呈正相关(r=0.50、0.56,P=0.01、<0.01)。结论 MRI定量分析可作为量化指标,准确客观监测RA病情和评价疗效。