类风湿关节炎的超声影像表现

类风湿关节炎（rheumatoid arthritis,RA）是一种以骨关节非化脓性滑膜炎为特征的自身免疫系统疾病,早期常见小关节尤其是掌指关节近端指间关节对称性、持续性肿胀和压痛,伴有进行性关节结构破坏性炎症。对RA患者进行早期诊断和治疗可明显延缓患者的病情发展,减少关节损伤,部分患者可望治愈,否则可有较高的致残率。本文对20例RA患者的手足小关节进行超声检查,观察分析病变关节的声像图特征,以期为临床诊断和治疗提供依据。     

超声在类风湿关节炎的应用及进展

类风湿关节炎(RA)是一种以滑膜关节进展性损害为主要特征的慢性炎症性病变。肌骨超声(MSUS)在类风湿关节炎的诊断和监测治疗等方面起着越来越重要的作用,它能在关节炎症的早期阶段就发现滑膜炎,软骨的破坏和骨质侵蚀等。而能量多普勒超声(CDE)正逐渐成为评估RA活动性和进展性的一个有效的方法。超声新技术如:超声造影(CEUS)、三维超声(3DUS)、三维能量多普勒超声(3D-PDUS)等方法为RA的早期诊断、治疗监测及预后评估提供了更为敏感和准确的途径。本文将就MSUS在RA的应用及一些研究进展做一综述。     

类风湿关节炎的诊断与治疗进展

类风湿关节炎(rheumatoid anhritis，RA)是一种慢性、炎性、系统性的自身免疫性疾病。临床特征性的表现为外周关节持续性和进行性的滑膜炎，继而引起软骨破坏和骨侵蚀，造成关节畸形和强直。RA病程多种多样，可表现为良性自限性到进行性破坏性的临床类型。研究表明，遗传因素造成了RA的易感性，感染因子可能触发疾病，多种复杂的因子参与了RA关节内与全身的免疫紊乱过程。     

类风湿性关节炎实验室及影像学早期诊断

类风湿性关节炎（Rheumatoid Arthritis，RA）是一种以慢性破坏性关节滑膜炎为主要特征的系统性自身免疫疾病．常白手足小关节开始，后侵犯大关节，晚期造成关节畸形，致残率较高，严重影响生活质量。研究表明，关节滑膜的破坏在RA发病的3个月内就可以出现．一旦出现骨质破坏及关节畸型就难以逆转。因此，早期诊断并争取在3个月内开始治疗至关重要。     

DCE-MRI定量与半定量分析在类风湿关节炎活动度评估中的应用研究进展

类风湿关节炎（RA）是以多发性和对称性增生性滑膜炎为主要表现的慢性全身性自身免疫性疾病,由于炎症反复加重、缓解,引起关节软骨和关节囊的破坏,最终导致关节强直畸形。早期诊断治疗是改善预后的关键。现就DCE-MRI原理及其在RA活动度评价中的应用情况进行综述。     

抗环瓜氨酸肽抗体和类风湿因子联合检测在类风湿性关节炎诊断中的应用

类风湿性关节炎（rheumatoid arthritis,RA）是一种常见的慢性自身免疫性疾病,其特征为对称性的大小关节滑膜的炎症。起初症状包括指关节肿胀疼痛,并且在关节部位有晨僵。滑膜炎持久反复发作,导致关节内软骨和骨质破坏,关节功能障碍,终致残废。长期以来,RA诊断主要依靠临床症状,实验室类风湿因子（rheumatoid factor,RF）检测和X线改变,缺乏特异性,符合诊断标准的患者常常已经出现骨关节破坏,丧失最好的治疗时机。因此,要提高RA的早期诊     

类风湿性关节炎病人中手骨间肌腱腱鞘炎的发病率

正摘要目的本研究的目的是确定类风湿性关节炎(RA)人群中手骨间肌腱腱鞘炎的发病率,并联合评估与掌指(MCP)关节滑膜炎、屈肌腱腱鞘炎和尺侧偏斜的相关性。材料与方法44例RA病人及20例正常对照组接受了手的MRI扫描。冠状面3D T1VIBE序列增强前后进行对比和重建。出现有骨间肌腱腱鞘炎伴随MCP关节滑膜炎、屈肌肌腱     

活血祛风通络中药对类风湿性关节炎患者指端微循环血流的影响

类风湿关节炎（rheumatoidarthritis,RA）是一种以关节滑膜炎症为特征的全身性自身免疫性疾病,病程冗长可达数十年,其间症状反复发作,30％患者日趋加重,晚期出现关节畸形,功能活动障碍,甚者致残。本病的不同阶段均出现不同程度的血管损害、血管内膜改变、血管炎症与微循环障碍。     

类风湿性关节炎的光动力学疗法

类风湿性关节炎(rheumatoid arthritis,RA)是一种以关节滑膜炎症为主要病理变化的自身免疫性疾病,如不及时治疗病变会继续加重甚至致残.光动力学疗法(photodynamic therapy,PDT)是近几年兴起的治疗RA的新颖疗法,作为一种选择性杀伤病变组织而不伤及正常组织、创伤小的新型疗法,有着广泛的发展前景.笔者简述PDT的原理,着重综述PDT治疗RA可用的光敏剂和PDT治疗条件的优化.     

高频超声在早期类风湿关节炎诊断中的应用

类风湿关节炎(Rheumatoid Arthritis,RA)是一种常见的以关节组织慢性炎症为主要表现的全身性疾病,临床表现为受累关节疼痛、肿胀、畸形、功能下降。病变呈持续、反复发作过程。病理特点为关节滑膜炎,血管翳形成,当累及软骨及骨质时出现骨质侵蚀破坏,关节间隙改变,邻近骨质疏松,关节畸形。既往对RA的影像学诊断主要依赖X线平片的检查,许多研究表明,RA患者在症状出现6~12月后95%出现X线改变[1]。但X线片对关节滑膜及周围软组织病变不敏感,不能显示RA的早期改变。MRI对软组织病变敏感性高,目前常用于评估大关节病变(如膝关节),可以较清…     

The clinical role of nuclear medicine in rheumatoid arthritis patients. A comparison with other diagnostic imaging modalities.

In patients with rheumatoid arthritis (RA) synovitis activity is the dominant clinical variable that determines the therapeutic approach. At present, the amount of painful and swollen joints assessed by physical examination, is generally used to measure the degree of synovitis activity. A gold standard for the assessment of synovitis activity is not available. The availability of an objective and reproducible method to evaluate synovitis activity in RA would be of great value in patient management and in examination of therapeutic effects. An advantage of the use of radiopharmaceuticals in detection of arthritis activity, compared with other imaging techniques, is the possibility to depict all joints in a single image. Furthermore the technique may image joints which are difficult to assess clinically or radiographically and may also detect joint inflammation in an early phase. In this overview different scintigraphic techniques are compared with each other and with other diagnostic imaging modalities.     

18F-FDG PET imaging of rheumatoid knee synovitis correlates with dynamic magnetic resonance and sonographic assessments as well as with the serum level of metalloproteinase-3

Purpose The aim of this study was to assess rheumatoid arthritis (RA) synovitis with positron emission tomography (PET) and ¹⁸F-fluorodeoxyglucose (¹⁸F-FDG) in comparison with dynamic magnetic resonance imaging (MRI) and ultrasonography (US).Methods Sixteen knees in 16 patients with active RA were assessed with PET, MRI and US at baseline and 4 weeks after initiation of anti-TNF- treatment. All studies were performed within 4 days. Visual and semi-quantitative (standardised uptake value, SUV) analyses of the synovial uptake of FDG were performed. The dynamic enhancement rate and the static enhancement were measured after i.v. gadolinium injection and the synovial thickness was measured in the medial, lateral patellar and suprapatellar recesses by US. Serum levels of C-reactive protein (CRP) and metalloproteinase-3 (MMP-3) were also measured.Results PET was positive in 69% of knees while MRI and US were positive in 69% and 75%. Positivity on one imaging technique was strongly associated with positivity on the other two. PET-positive knees exhibited significantly higher SUVs, higher MRI parameters and greater synovial thickness compared with PET-negative knees, whereas serum CRP and MMP-3 levels were not significantly different. SUVs were significantly correlated with all MRI parameters, with synovial thickness and with serum CRP and MMP-3 levels at baseline. Changes in SUVs after 4 weeks were also correlated with changes in MRI parameters and in serum CRP and MMP-3 levels, but not with changes in synovial thickness.Conclusion ¹⁸F-FDG PET is a unique imaging technique for assessing the metabolic activity of synovitis. The PET findings are correlated with MRI and US assessments of the pannus in RA, as well as with the classical serum parameter of inflammation, CRP, and the synovium-derived parameter, serum MMP-3. Further studies are warranted to establish the place of metabolic imaging of synovitis in RA.     

Advanced imaging in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disorder primarily affecting the synovium. We now recognise that conventional radiographic images show changes of rhuematoid arthritis late after irreversible joint damage has occured. With the advent of powerful disease-modifying drugs there is a need for early demonstration of rheumatoid arthritis and to monitor progress of the disease and response to therapy. Advanced imaging techniques such as ultrasound and MRI have focussed on the demonstration and quanitification of synovitis and erosions and allow early diagnosis of RA. The technology to quantify synovitis and erosions is developing rapidly and now allows change in disease activity to be assessed. However, problems undoubtedly exist in quantification techniques and this review serves to highlight them. Much of the literature on advanced imaging in RA appears in rheumatological journals and may not be familiar to radiologists. This review article aims to increase the awareness of radiologists to this field and to encourage them to participate and contribute to the ongoing development of these modalities. Without this collaboration it is unlikely that these modalities will reach their full potential in the field of rheumatological imaging. This review is in two parts. This first part addresses synovitis imaging. The second part will look at advanced imaging of erosions in RA. Part 1 of this article (Synovitis) can be found at: . In our previous article we described issues surrounding the advanced imaging of synovitis. This article addresses erosions in a similar manner.     

Advanced imaging in rheumatoid arthritis

Rheumatoid arthritis (RA) is a chronic and progressive inflammatory disorder primarily affecting the synovium. We now recognise that conventional radiographic images show changes of rheumatoid arthritis long after irreversible joint damage has occured. With the advent of powerful disease-modifying drugs, there is a need for early demonstration of rheumatoid arthritis and a need to monitor progress of the disease and response to therapy. Advanced imaging techniques such as ultrasound and MRI have focussed on the demonstration and quantification of synovitis and erosions and allow early diagnosis of RA. The technology to quantify synovitis and erosions is developing rapidly and now allows change in disease activity to be assessed. However, problems undoubtedly exist in quantification techniques, and this review serves to highlight them. Much of the literature on advanced imaging in RA appears in rheumatological journals and may not be familiar to radiologists. This review article aims to increase the awareness of radiologists about this field and to encourage them to participate and contribute to the ongoing development of these modalities. Without this collaboration, it is unlikely that these modalities will reach their full potential in the field of rheumatological imaging. This review is in two parts. The first part addresses synovitis imaging. The second part will look at advanced imaging of erosions in RA. Part 2 of this article (Erosions) can be found at .     

Assessment of disease activity in rheumatoid arthritis with (18)F-FDG PET.

The aim of this study was to assess synovitis by (18)F-FDG PET in an individual joint analysis and in a global analysis of rheumatoid arthritis (RA) disease activity and to compare (18)F-FDG PET parameters with clinical, biologic, and sonographic (US) rheumatoid parameters. METHODS: Three hundred fifty-six joints were assessed in 21 patients with active RA: the knees in all subjects and either wrists as well as metacarpophalangeal and proximal interphalangeal joints in 13 patients, or ankles and the first metatarsophalangeal joints in the remaining 8 patients. PET analysis consisted of a visual identification of (18)F-FDG uptake in the synovium and measurements of standardized uptake values (SUVs). Independent assessors performed the clinical and US examinations. RESULTS: PET positivity was found in 63% of joints, whereas 75%, 79%, and 56% were positive for swelling, tenderness, and US analysis, respectively. Both the rate of PET-positive joints and the SUV increased with the number of positive parameters present (swelling, tenderness, US positivity) and with the synovial thickness. The mean SUV was significantly higher in joints where a power Doppler signal was found. In a global PET analysis, the number of PET-positive joints and the cumulative SUV were significantly correlated with the swollen and tender joint counts, the patient and physician global assessments, the erythrocyte sedimentation rate and C-reactive protein serum levels, the disease activity score and the simplified disease activity index, the number of US-positive joints, and the cumulative synovial thickness. CONCLUSION: (18)F-FDG PET is a unique imaging technique that can assess the metabolic activity of synovitis and measure the disease activity in RA.     

MR imaging for evaluation of early rheumatoid arthritis

In rheumatoid arthritis (RA), due to its superior contrast resolution and tomographic nature, magnetic resonance (MR) imaging can depict soft tissue and joint involvement better than plain radiography. Active synovitis and pannus are shown by a wide variety of contrast on T1- and T2-weighted images. They are markedly enhanced by intravenous gadolinium-chelate injection. Fat-suppressed T1-weighted imaging with gadolinium enhancement is the most sensitive technique to demonstrate these tissues. Compared with plain radiography, MR imaging is more sensitive and equally specific in the diagnosis of early RA compared with plain radiography. MR imaging is useful in the diagnosis and treatment of patients who are suspected of having early RA.     

Contrast-enhanced dynamic magnetic resonance imaging of finger joints in osteoarthritis and rheumatoid arthritis: an analysis based on pharmacokinetic modeling

PURPOSE: To investigate a two-compartment kinetic model applied to the dynamic time course of contrast enhancement as a method to differentiate between finger-joint synovitis in established osteoarthritis (OA) and rheumatoid arthritis (RA). MATERIAL AND METHODS: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) of one hand in 19 patients and six healthy volunteers was undertaken. Eight patients had OA of the hand and eleven patients had RA. From the signal intensity curves, the three parameters Kps (endothelial transfer constant), Kep (elimination rate constant from extracellular space back to plasma) and Kel (elimination rate constant from plasma by renal excretion) were calculated. RESULTS: The rate constant Kps showed the best separation between the groups with significantly higher values in the RA group compared to the OA group (P<0.005) and in the OA group compared to the control group (P<0.005). Significantly higher values of Kep were also found in the RA group compared with the OA group (P<0.005). CONCLUSION: DCE-MRI may provide useful information that can help differentiate synovitis in OA from synovitis in RA.     

Imaging of bone erosion in rheumatoid arthritis

Rheumatoid arthritis (RA) is the most common type of inflammatory arthritis, with a prevalence of 1% in the United States. Recently introduced disease-modifying antirheumatic drugs have been extremely successful in preventing irreversible joint damage, particularly if initiated early. Accordingly, accurate and early diagnosis of RA has become imperative. This shift places increased demands on imaging to identify even the slightest traces of erosive joint damage and predict future structural and functional deterioration. Unfortunately, conventional radiography has been shown to be insensitive for bone erosions, particularly in early stages of the disease. Computed tomography (CT) is rarely used, but its tomographic perspective offers advantages over projectional radiography. Ultrasound (US) detects more erosions than radiography does and also can evaluate synovitis. Scintigraphy also can detect inflammation and bone turnover at sites of active erosion. It lacks spatial resolution but offers greater anatomical coverage, making whole-body assessments possible. Of all imaging modalities, however, magnetic resonance imaging (MRI) shows the greatest sensitivity for detecting and monitoring bone erosions and also can detect and follow pre-erosive features of RA, such as synovitis, bone marrow edema or osteitis, and tendinous and ligamentous abnormalities. In this article, we review the appearance of bone erosions on conventional radiography and alternative imaging modalities including MRI, CT, US, and scintigraphy. We also review alternative acquisition techniques for MRI in RA and discuss the utility of fat suppression and contrast enhancement.     

MR imaging appearance of rheumatoid arthritis in the foot

Although conventional radiographs remain the initial mainstay for imaging of the foot in patients with rheumatoid arthritis (RA), magnetic resonance (MR) imaging has afforded the ability to detect early signs of the disease (i.e., synovitis, tenosynovitis, bone lesions, and bursitis), especially at the forefoot. In addition, the relatively symmetric distribution of the imaging abnormalities depicted in the metatarsophalangeal joints and the frequent involvement of the retro-calcaneal bursitis are almost specific for RA. In more advanced stages of the disease, MR imaging is well suited to evaluation of the hindfoot joints and tendons as well as the musculoskeletal complications of RA (e.g., tendon disruption, rheumatoid nodules, sinus tarsi syndrome).