Rheumatoid arthritis: a primary care approach

PURPOSE: To provide primary care providers with guidelines on the evaluation, diagnosis and management of patients with rheumatoid arthritis (RA). DATA SOURCES: Research-based articles in the medical literature, review articles, and clinical practice is a chronic inflammatory disease that affects mainly synovial joints. Diagnosis is based primarily on clinical examination. Clinical criteria developed by the American Rheumatism Association can help the primary care provider recognize this potentially devastating disease and facilitate early referral to a rheumatologist for treatment. IMPLICATIONS FOR PRACTICE: Patients with RA should be treated early and aggressively. Laboratory tests are not essential to confirm the diagnosis of RA. The clinical usefulness of the rheumatoid factor could be increased by restricting the test to patients who have a high probability of RA based on clinical symptoms.     

类风湿性关节炎磁共振成像诊断国内外研究的对比分析

背景:类风湿性关节炎的诊断主要依赖于临床表现、实验室检查和影像学检查,磁共振成像技术由于具有良好的组织分辨率,在类风湿性关节炎的早期诊断上敏感性较高。目的:对类风湿性关节炎磁共振成像诊断研究的国内外文献资料进行对比分析,了解这一领域的研究趋势。方法:以电子检索方式对CNKI数据库和SCI数据库2002-01/2011-12收录有关类风湿性关节炎磁共振成像诊断研究的文献进行分析,中文检索词为"类风湿性关节炎;影像;磁共振成像",英文检索词为"MRI;rheumatoid arthritis;RA",运用数据库的分析功能和Excel软件图表的功能分析数据特征。结果与结论:CNKI数据库共收录文献60篇,SCI数据库收录文献数量明显高于CNKI数据库为300篇,两个数据库文献数量均呈现总体上升趋势。CNKI数据库发表类风湿性关节炎磁共振成像诊断研究文献量较多的期刊为《磁共振成像》、《中国医学影像技术》和《中国医学计算机成像杂志》,SCI数据库发表文献最多的期刊为Annals of the Rheumatic Diseases《风湿性疾病年报》,且影响因子最高为8.727。CNKI数据库收录文献最多的机构是北京大学人民医院为5篇,SCI数据库中利兹大学文献数量最多为37篇,其次为奥克兰大学和哥本哈根大学医院。从文献的下载频次来看,Arthritis and Rheumatism《关节炎和风湿病》杂志的被引排名较靠前,为类风湿性关节炎磁共振成像诊断研究的经典期刊。从文献的国家分布来分析,英格兰和美国在SCI数据库中发表文献数量最多,中国在SCI数据库发表文献数量较少。     

早期类风湿性关节炎手腕部的MRI影像观察

目的评估MRI对手腕部早期类风湿性关节炎的诊断价值.方法对30例临床诊断为早期类风湿性关节炎的患者进行手腕部X线平片和MRI检查,比较2种技术对病变的显示能力.结果 X线平片显示所有患者均未见骨侵蚀, 17例可见关节肿胀,28例可见骨质疏松,10例关节间隙轻度狭窄.MRI显示20例关节面骨侵蚀,所有30例均可见关节滑膜增厚、关节积液以及关节周围炎性渗出,23例可见血管翳形成,7例合并关节周围肌腱韧带损伤.平片和MRI对病变关节数目的检出率分别为20%及81%.结论 MRI是诊断早期类风湿性关节炎的较好方法.     

类风湿腕关节的X 线与磁共振影像对比研究

目的 探讨类风湿性腕关节的Ｘ线与磁共振成像的诊断价值。方法 分析８例类风温性关节炎患者和１例正常人的腕关节Ｘ线片和ＭＲＩ,ＳＥ序列Ｔ１ＷＩ和Ｔ２ＷＩ及Ｇｄ－ＤＴＰＡ进行对比研究。结果 Ｘ线平片示８例患者均有腕关节软组织肿胀,６例骨质稀疏,骨囊状破坏,并节间隙窄,２例无异常改变;ＭＲＩ示８例均可见不同程度范围的血管翳,滑膜炎及韧带,肌腱损伤,而骨皮质破坏无法观察。结论 ＭＲＩ在提供病变炎怀过程,如滑膜炎,关节积液,肌腱滑膜炎等的变化优于Ｘ线片;对早期和活动期关节敏感性高,是很用的诊断方法。     

磁共振成像技术在腕关节类风湿关节炎诊断中的应用研究

目的 探讨MRI不同序列成像在腕关节类风湿关节炎诊断中的应用价值.方法 采用不同序列对45例类风湿性关节炎行腕关节MRI检查,观察滑膜增厚、软组织肿胀、关节积液、骨髓水肿、骨质破坏、肌腱炎和腱鞘炎显示情况.结果 T1fl3D water和T2me-3D序列显示异常征象阳性率最高,PDWI脂肪抑制、T2WI脂肪抑制序列、...     

核磁共振与关节镜对类风湿关节炎患者膝关节病变诊断的比较

目的 探讨核磁共振成像（MRI）在膝关节类风湿关节炎中的诊断价值.方法 随机选取我院2008年10月至2012年10月临床及MRI检查均高度疑为类风湿关节炎的患者106例,进一步行关节镜检查确诊,分析MRI诊断类风湿关节炎的敏感性、特异性、阳性预测值、阴性预测值、一致率和Kappa值.结果 与关节镜金标准结果对比,MRI对诊断类风湿关节炎的病变种类包括关节积液、滑膜增厚/血管翳形成、软骨和骨侵蚀、周围软组织病变等的敏感度、特异性、阳性预测值、阴性预测值、一致率和Kappa值分别为90.91％、88.10％、66.67％、97.37％、91.51％和0.712,MRI诊断类风湿关节炎的敏感度、特异性、阳性预测值、阴性预测值、一致率和Kappa值分别为94.74％、83.91％、56.25％、98.48％、85.85％和0.687,膝关节软骨退行性变损害的MRI分级与关节镜分级的符合率为99.06％,Kappa值为0.654,两者具有高度一致性（P＜0.05）.结论 MRI诊断类风湿关节炎有较好的一致性,并可准确判断病变种类和软骨损伤的程度,对类风湿关节炎的早期诊断和指导临床治疗都有重要意义.     

先天性主动脉缩窄的影像学表现

目的 提高对先天性主动脉缩穿表现,特别是ＭＲＩ表现的认识。方法 回顾分析２例主动脉缩窄的Ｘ线平片,主动脉造影和ＭＲＩ所见,并作文献复习,结果 Ｘ线平片和主动脉造影有特征性改变,但ＭＲＩ即能显示主动脉缩窄的部位、范围、程度及并发症,又能反应压力差的功能学变化。结论 ＭＲＩ是诊断先天性主动脉缩穿无创性最佳手段。     

MRI对早期类风湿性关节炎手、腕部关节的诊断价值

目的 研究早期类风湿性关节炎（RA）手、腕部关节的MRI对早期RA的诊断及临床价值。方法 对40例早期RA患者行双手掌指关节及腕关节X线平片检查和MR扫描。对X线和MRI发现的骨侵蚀病灶分别进行计数，并对滑膜炎进行分级评分。同时搜集患者的临床资料包括症状、体征、实验室化验指标。统计并分析X线和MRI征象与临床检查之间的关系。结果 MRI见26例49只腕关节有184处明确的骨侵蚀改变，X线平片仅发现11例14只腕关节21处有骨侵蚀征象。21例患者掌指关节有32处MRI骨侵蚀改变，X线仅发现6处骨侵蚀征象。X线和MRI对早期RA患者的骨侵蚀病灶的检出上的差异有统计学意义。MRI所见40例RA患者均出现滑膜炎性改变，其中31例见明显强化，9例未见明显强化。对明显强化的滑膜炎进行分级评分，腕关节得分为2.5，掌指关节为2.8。腕关节滑膜强化组、无强化组与患者的临床检查的差异性有统计学意义，同时腕关节滑膜炎分级与骨侵蚀征象有较高相关性（r=0.91，P〈0.01）。另外，MRI还可显示早期RA的骨髓水肿、关节积液、肌腱炎等征象。结论 MRI能显示早期RA手腕部关节的病理改变，对骨侵蚀的检出明显优于传统X线检查。MRI可以对早期RA的滑膜炎进行半定量化分级评分，为早期RA滑膜炎的深入研究提供新的平台。早期滑膜炎、骨侵蚀病变对评价RA的活动性及预测疾病进程、预后方面有重要价值。     

早期类风湿关节炎腕关节MRI与临床对照研究

目的探讨腕关节早期类风湿关节炎（RA）的各种主要MRI表现及临床症状、实验室检查等指标对于早期类风湿关节炎的诊断价值。方法经随访临床确诊早期RA病人78例，对确诊前研究对象的平片及MRI表现及临床症状、实验室检查指标进行分析。临床方面指标包括有晨僵、对称性关节肿胀、关节肿胀个数、血沉（ESR），类风湿因子（RF），C反应蛋白（CRP）。MRI对腕骨间关节的滑膜，骨骼，软骨，肌腱等进行观察。对照分析早期RA各种主要MRI征象及临床症状、实验室检查的准确性、特异性及敏感性。结果敏感性最高的MRI指标血管翳强化与晨僵或RF阳性同时存在时，特异性及准确性均较高。结论MRI血管翳强化与晨僵或类风湿因子阳性同时存在时，对于诊断早期类风湿关节炎具有较大的价值。     

The role of magnetic resonance imaging in the early diagnosis of rheumatoid arthritis

Rheumatoid arthritis (RA) is a common disease that affects 1% of the population. With the advent of disease-modifying therapies, it became particularly important to detect RA as early as possible. In this article, we discuss the role of magnetic resonance imaging (MRI) in the imaging of early RA. Imaging of soft tissues manifestations, which precede the development of osseous erosions, is discussed. We also review the role of MRI in establishing correct diagnosis in cases of arthritis, which do not demonstrate classical clinical presentation. The role of MRI in the follow-up of RA is addressed.     

股骨头缺血坏死的影像学分析

目的:分析股骨头缺血坏死的平片、CT及MRI表现,并对其应用价值作一初步探讨。材料和方法:对32例股骨头缺血坏死的X线平片、CT及MRI摄片进行双盲分期和Kappa-致性检验及对照分析。结果:X线平片诊断主要依据股骨头塌陷、囊变、碎裂、硬化及股骨头变扁和股骨颈缩短。CT则以星芒缺失征、斑片状骨硬化、新月征、囊变及碎裂为特点。MRI则主要依据股骨头内出现斑片状或不规则形T_1低信号T_2高信号、双线征、新月征、囊变及股骨头塌陷。结论:MRI是诊断股骨头缺血坏死最敏感有效的方法,其次为CT。对于早期病变的发现需依靠MRI或CT检查。X线平片虽对早期诊断缺乏一定的优势,但依然是本病诊断和分期的常规手段。     

磁共振显微线圈在早期类风湿性关节炎诊断中的价值

目的 探讨磁共振（Magnetic Resonance Imaging,MRI）显微线圈在早期类风湿性关节炎（Rheumatoid Ar-thritis,RA）诊断中的价值.方法 对早期RA患者48例使用显微线圈Micro-23行近端指间关节MRI检查,观察早期RA近端指间关节的软骨损伤在MRI上的表现,对比X线检查及MRI检查对早期RA的诊断价值,并分析抗环瓜氨酸肽（CCP）抗体及类风湿因子（RF）与MRI提示的关节软骨损伤程度的相关性.结果 本组48例患者中,X线平片阳性8例,阳性率为16.7％,而MRI均有不同程度阳性表现,其阳性率为100％.在所有病例近端指间关节的软骨损伤程度MRI分级中,不同MRI软骨损伤分级,血清抗CCP抗体水平、RF水平均有显著差异,且差异有统计学意义（P＜0.001）;损伤程度越高,抗CCP抗体水平和RF水平值越大.结论 MRI显微线圈较常规X线对早期RA诊断率高,可以观察类风湿关节炎患者软骨损伤程度,更好地反映疾病的进展及预后,抗CCP抗体和RF均与MRI提示的关节软骨损伤程度具有相关性,提示抗CCP抗体及RF可以用来评价疾病活动度和预测软骨侵蚀程度.     

Imaging techniques in neuro-oncology

OBJECTIVES: To review neuroimaging techniques used in the diagnosis and follow-up of patients with brain tumors as well as promising new technology. DATA SOURCES: Published articles and reference books. CONCLUSION: The primary method used in the initial diagnosis, monitoring of response, and determination of progression in neuro-oncology is neuroimaging techniques such as magnetic resonance imaging. New techniques, such as spectroscopy and diffusion-weighted imaging allow the clinician to look at the metabolic make-up of the tumor in addition to the size and amount of enhancement. These techniques will allow for better understanding of the occurrence of changes in the tumor with therapy and hold the promise of earlier diagnosis of progression and response. IMPLICATIONS FOR NURSING PRACTICE: Understanding the application of current neuroimaging techniques is essential for the oncology nurse caring for brain tumor patients to provide education and assist with interpretation of results.     

早期类风湿性关节炎腕关节病变超声与MRI对比研究

目的 探讨超声与MRI在诊断早期类风湿性关节炎腕关节病变中的作用和价值.方法 对31例临床诊断为类风湿性关节炎的患者进行腕关节超声和MRI检查,比较2种影像学方法对病变的检出能力.结果 31例RA患者62个腕关节中超声显示滑膜炎62个,关节积液42个,肌腱腱鞘炎38个,骨侵蚀24个;MRI显示滑膜炎62个,关节积液43个,肌腱腱鞘炎41个,骨侵蚀35个,同时还显示骨髓水肿16个.对早期RA腕关节滑膜炎、关节积液、肌腱腱鞘炎的检出,2种检查方法之间差异无统计学意义(P>0.05);对骨侵蚀的检出,2种检查方法之间差异有统计学意义(P<0.05).结论 对临床疑诊的类风湿性关节炎患者首选超声检查,若超声表现不典型者再行MRI检查.     

Ovarian cancer

OBJECTIVES: To review the progress in the management of ovarian cancer in the last decade and future directions. DATA SOURCES: Research studies, review articles, and abstracts. CONCLUSIONS: There is an increased understanding of ovarian cancer biology, the genetic basis for hereditary ovarian cancer, staging and the role of cytoreductive surgery, and more effective chemotherapy, resulting in an increase in the percentage of patients who will live 5 years from the time of diagnosis. IMPLICATIONS FOR NURSING PRACTICE: The nurse can play an invaluable role as the options of treatment are considered and weighed against quality-of-life considerations.     

软组织血管瘤的影像学诊断

目的:探讨各种影像学检查方法(X线平片,血管造影,CT和MRI)在诊断软组织血管瘤的作用。材料和方法:回顾性分析38例血管瘤患者的影像资料,全部患者进行了X线、CT检查,25例做了血管造影检查,35例做了MRA检查。结果:除组织深部的血管瘤均表现软组织肿胀,密度不均。X线平片出现静脉石,对软组织血管瘤的诊断具有重要意义,但在本组病例中静脉石的出现率只占40%;血管造影可显示供养血管的来源及血管团,并与动-静脉畸形鉴别;且能明确病变的大小和范围。CT和MRI对肿瘤的性质帮助很大,并能精确地确定病变的部位、大小及邻近组织的关系,为手术提供依据。但是,CT由于是轴位扫描,所以肿瘤范围难以确定。结论:CT和MRI对本病的诊断明显优于普通X线平片。CT扫描肿瘤边界难以确定,增强扫描有风险。MRI检查具有安全、无创的优点,故本病应首选X线相辅助的检查方法,MRI检查必不可少,准备手术的患者可选择血管造影。     

Imaging for spine tumors and new applications

OBJECTIVES: Discuss intramedullary, intradural/extramedullary, and extradural spinal tumors including imaging characteristics with emphasis on MR and advances in treatment. METHODS: Literature and institutional review. RESULTS: Spinal tumors: intramedullary, intradural/extramedullary, and extradural, comprise a wide range of histological tumors with an even wider range of clinical symptoms and prognostic features. They are relatively rare and if left untreated, can cause serious neurological deficits and disability. An accurate diagnosis is therefore crucial in determining prognosis and directing therapy. Magnetic resonance imaging (MRI) has revolutionized the diagnosis of intraspinal tumors, allowing for early detection and improved anatomical localization. Magnetic resonance has also become an integral part in staging of both primary and metastatic neoplasms of the spine for guiding therapy and is an excellent modality for follow-up. Advances in MRI (perfusion and molecular imaging) may help refine and describe these neoplasms for accurate treatment and prognosis in the future. Surveillance protocols and role of magnetic resonance are not well established. CONCLUSIONS: Magnetic resonance plays an integral role in evaluation of spinal tumors with increasing role in staging and treatment.     

Anakinra treatment of patients with rheumatoid arthritis

OBJECTIVE: To summarize the safety data arising from clinical trials of anakinra, a human recombinant form of interleukin-1 receptor antagonist (IL-1Ra) developed for the treatment of rheumatoid arthritis (RA). DATA SOURCES: Primary articles and abstracts identified through the National Library of Medicine's PubMed database (1982-2001) and secondary sources. STUDY SELECTION AND DATA EXTRACTION: All the articles and abstracts identified from the data sources were evaluated and all information deemed relevant was included in this review. DATA SYNTHESIS: Overall, anakinra was shown in 4 trials to be efficacious as monotherapy or combination therapy, compared with placebo, for the treatment of active RA. The magnitude of clinical improvement tended to increase with increasing doses of anakinra. In monotherapy trials, the primary adverse event was injection-site reactions, which usually were mild and transient. In com bination therapy (anakinra plus methotrexate), the frequency and severity of adverse events were similar to those seen in the monotherapy trials. CONCLUSIONS: The use of anakinra in patients with RA inhibits disease activity with a favorable tolerability profile.     

Flow cytometry: basic concepts and clinical applications in immunodiagnostics.

OBJECTIVE: To review current and possible future clinical applications of flow cytometry in immunodiagnostic procedures. DATA SOURCES: Recent research and review articles and textbooks on laboratory diagnosis and flow cytometry. STUDY SELECTION: Not applicable. DATA EXTRACTION: Performed by the author. DATA SYNTHESIS: Flow cytometry is the measurement of cellular and fluorescent properties of stained cells in a fluid stream as they move past a set of fixed detectors. The instruments are capable of measuring these properties on thousands of cells in but a few seconds. Many specimen types can be analyzed on the flow cytometer. CONCLUSION: Flow cytometry is especially useful in monitoring immunodeficiencies, leukemias, and other malignancies, but it has other uses, as well. Improvements in instruments, reagents, and methods will cause an increase in the number of applications for flow cytometry. More laboratories will be able to purchase the equipment as it becomes less expensive. Flow cytometry provides the clinician valuable information in the diagnosis and treatment of disease.     

腕关节功能体位摄影技术与应用价值

目的：研究腕关节功能体位摄影技术，探讨对腕关节不稳定的诊断价值。材料与方法：收集整理同时摄影腕关节正侧位片和功能体位片者70例，由5名放射诊断医师分析腕关节不稳定在两种摄影片中的X线表现。结果：腕关节常规片发现异常26例，功能体位片发现异常40例，其中舟月骨分离17例，月骨脱位20例，头月骨刷围脱位3例。结论：腕关节常规摄影是腕部损伤主要检查方法，根据需要增加腕关节功能摄影片，腕关节功能体位摄影片既能发现静力性不稳定，又可发现动力性不稳定，从而避免腕关节不稳定症的漏检。