OBJECTIVETo observe the differential effect of joint ultrasound on the syndrome differentiation of rheumatoid arthritis (RA) by observing the high frequency ultrasound performances among inactive stage and different syndromes in active stage.

METHODSTotally 83 RA patients in the active stage were assigned to the dampness heat syndrome group (DHS, 59 cases)and the cold dampness syndrome group (CDS, 24 cases) according to Chinese medicine (CM) syndrome typing. Besides, 20 RA patients in the remission stage were recruited as the control group (abbreviated as the remission group). By using high frequency ultrasound and power Doppler ultrasound technology, a comparative observation of synovitis, tenosynovitis, synovial blood flow, and bone erosion in the 2nd-5th metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints, wrist joints, knee joints, the second and the fifth metatarsophalangeal (MTP) joints (a total of 24 joints) was performed in all patients. Correlation analyses were performed between the ultrasound performance, laboratory indices, and the disease activity. Ultrasound data of each RA patient were analyzed by their total scores. Χ2 test was used for enumeration data. The measurement data was expressed as x ± s. One-way ANOVA was used for data of normal distribution, while non- parametric test was used for data of non-normal distribution. Correlation analysis of two variables was performed for clinical indicators and ultrasound indicators. Its significance was detected using Pearson correlation.

RESULTSCompared with the remission group, the severity degree of synovitis, tenosynovitis, synovial blood flow, and bone erosion significantly increased in the DHS group (P < 0.01). There was statistical difference in ESR, CRP, anti-CCP, DAS28 score, and the positive rate of RF (P < 0.05, P < 0.01). There was statistical difference in the severity degree of synovitis and synovial blood flow, and DAS28 score in the CDS group (P < 0.05). Compared with the CDS group, there was statistical difference in the four ultrasound indices (P < 0.05, P < 0.01), ESR, CRP, anti-CCP, DAS28 score, and the positive rate of RF in the DHS group (P < 0.05, P < 0.01). There was no statistical difference in G, IgG, IgA, or IgM among the three groups (P > 0.05). There existed positive correlation between ESR and the synovitis degree, synovial blood flow, and bone erosion in the DHS group (r = 0.444, 0.397, 0.486, P < 0.05).There existed positive correlation between ESR and the synovitis degree, bone erosion, and synovial blood flow in the DHS group (r = 0.378, 0.270, P < 0.05). There existed positive correlation between the DAS28 score and the synovitis degree and synovial blood flow in the DHS group (r = 0.304, 0.351, P < 0.05).

CONCLUSIONSThe inflammation degree was the most severe in RA patients of DHS. High frequency ultrasound could provide better evidence for Chinese medical syndrome differentiation of RA patients.

Arthritis, Rheumatoid ; diagnostic imaging ; Humans ; Medicine, Chinese Traditional ; Metacarpophalangeal Joint ; ultrastructure ; Syndrome ; Synovitis ; diagnostic imaging ; Ultrasonography

OBJECTIVE: To investigate the agreement between clinical signs (tenderness and/or swelling) in ankles and feet joints and ultrasound findings in patients with rheumatoid arthritis (RA). METHODS: RA patients with at least 1 tender and/or swollen joint in bilateral ankles and metatarsophalangeal (MTP) joints detected by physical examination were enrolled and underwent ultrasound examination by greyscale (GS) and power Doppler (PD) mode. The agreement between clinical signs and ultrasound-detected inflammation (joint effusion, synovitis, or tenosynovitis) was analyzed. RESULTS: In the study, 113 consecutive RA patients were included, with mean age of (52.5±12.6) years, median duration of 60 (13, 129) months, mean disease activity score in 28 joints based on erythrocyte sedimentation rate [DAS28 (ESR)] of 5.1±1.7, mean disease activity score in 28 joints based on C reactive protein[DAS28 (CRP)]of 4.6±1.5. The tenderness and swelling was most commonly detected in ankles (52.7% and 31.9%, respectively), while GS (+) synovitis was most frequently detectable in MTP2 (34.1%), followed by ankles (32.7%) and MTP1 (27.9%), and PD (+) synovitis was most frequently detectable in MTP1 (14.2%), followed by ankles (12.4%) and MTP2 (10.6%). The prevalence of tenosynovitis was 41.1%, which mostly located in tibialis posterior tendon (22.1% of GS positive and 17.6% of PD positive). The highest prevalence of joint effusion was detected in ankles (9.7%), while that of bone erosion in MTP5 (19%). The overall concordance rate between positive clinical signs and ultrasound-determined joint inflammation was poor in the above joints (κ < 0.2, P < 0.05), in which swelling had the highest κ coefficient with ultrasound-determined joint inflammation in ankles (κ=0.225, P < 0.05). Moreover, swelling had the highest κ coefficient with synovitis in ankles (κ=0.231, P < 0.05).The concordance between tenosynovitis and signs in ankles was also poor (κ < 0.20, P < 0.05). There was no significant agreement between joint effusion and clinical signs (P > 0.05). CONCLUSION The overall concordance between clinical signs and inflammation on ultrasound was poor in ankles and feet joints. Tenderness and swelling was more common in ankles, while more lesions were detected by ultrasound at MTP joints. Ultrasound is useful in assessing the lesions besides physical examination in patients with RA.
Adult ; Aged ; Ankle ; Arthritis, Rheumatoid/diagnostic imaging* ; Humans ; Inflammation/diagnostic imaging* ; Middle Aged

Objective To evaluate the value of high-frequency ultrasound (HFUS) in diagnosing peripheral nerve compression in patients with rheumatoid arthritis (RA). Methods The upper limb nerves were evaluated by HFUS in 80 RA patients (RA group) and 60 non-RA patients (control group),then the incidence of peripheral nerve compression was recorded respectively. RA patients with/without neurological symptoms were compared in terms of age,disease course,Health Assessment Questionnaire Disability Index (HAQ-DI) score,and clinical disease activity index (CDAI). Results The incidence of upper limb nerve compression in RA group was significantly higher than that in control group(15.0% vs. 3.3%,P=0.046).The patients with nerve compression was older [(60.2±11.4)y vs.(49.2±7.9)y;t=2.343,P=0.039] and had longer disease course [(9.50±5.99) y vs. (5.88±3.87)y;t=2.639,P=0.023] and higher HAQ-DI score (1.58±0.75 vs.0.85±0.67;t=2.490,P=0.030). These two groups had no statistical differences in CDAI (14.50±11.68 vs.16.62±9.24;t=1.141,P=0.278).Conclusions Peripheral neuropathies are common extra-articular manifestations in RA patients. HFUS can be valuable in patients suspected of RA.
Adult ; Arthritis, Rheumatoid ; diagnostic imaging ; Disease Progression ; Humans ; Middle Aged ; Nerve Compression Syndromes ; diagnostic imaging ; Ultrasonography

OBJECTIVETo assess the performance of high-frequency ultrasound in evaluating articular lesions in a rat of model collagen-induced arthritis model (CIA).

METHODSSixty Wistar rats randomized into CIA group (n=50) and the control group (n=10), and in the former group, CIA was induced by immunization with collagen type II. On day 45, the ankle joint was assessed based on the arthritic index (AI) and examined with high-frequency ultrasound in all the rats. Histological evaluations of the joint were performed and the results were compared with ultrasound findings.

RESULTSIn CIA group, 62 ankles were confirmed pathologically to have synovitis with typical inflammatory cell infiltration and pannus formation. AI score-based diagnosis was confirmed in 42 ankles with a detection rate of 68% (42/62), significantly lower than the rate of 87% (54/62) with high-frequency ultrasound (P<0.05).

CONCLUSIONHigh-frequency ultrasound is an ideal method for observing CIA in rats in vivo. High-frequency ultrasound can show blood flow in rheumatoid arthritis and is useful in studies of RA synovial angiogenesis.

Animals ; Arthritis, Experimental ; diagnostic imaging ; Arthritis, Rheumatoid ; Collagen Type II ; Joints ; diagnostic imaging ; Neovascularization, Pathologic ; Rats ; Rats, Wistar ; Ultrasonography

OBJECTIVETo measure the synovial thickness in the bilateral wrist joints, metacarpophalangeal (MCP) joints and proximal interphalangeal (PIP) joints using high-resolution intraoperative ultrasound probe in healthy young and middle-aged volunteers to determine the normal reference ranges of synovial thickness in the joints.

METHODSThis study was conducted in 100 healthy young and middle-aged volunteers, including 50 male (mean age 36.2∓5.0 years; range 18-54 years) and 50 female (mean age 38.8∓5.5 years; range 20-56 years) individuals. The synovial thickness in the bilateral wrist joints, MCP joints and PIP joints was measured using the GE Logiq S8 18 MHz polo stick-like linear probe array.

RESULTSs No statistical significance was found in the synovial thickness of the wrist joints, MCP joints and PIP joints between the left and right hands, between young (<40 years) and middle-aged (≥40 years) subjects, or between the flexor surface and the extensor surface. In the male subjects, however, the synovial thickness in the wrist joints, MCP joints and PIP joints was significantly greater than that in female subjects. A significant difference was noted in the synovial thickness between the wrist joints, MCP joints and PIP joints.

CONCLUSIONMeasurement of the synovial thickness of the wrist joints, MCP joints and PIP joints using high-resolution intraoperative ultrasound probe is beneficial for early diagnosis and therapy of rheumatoid arthritis.

Adolescent ; Adult ; Arthritis, Rheumatoid ; diagnostic imaging ; Female ; Hand ; diagnostic imaging ; Humans ; Male ; Metacarpophalangeal Joint ; diagnostic imaging ; Middle Aged ; Synovial Membrane ; diagnostic imaging ; pathology ; Ultrasonography ; Wrist ; diagnostic imaging ; Wrist Joint ; diagnostic imaging ; Young Adult

OBJECTIVETo compare MR imaging with radiographs in detection of the erosions of the wrists in patients with rheumatoid arthritis (RA).

METHODSIn 50 wrists of 25 patients with RA, radiographs of AP projection and MR imaging examination were performed within 1 week. The MRI sequences were SE T1-weighted image, FSE T2-weighted image, and GE T2* weighted image in coronal plane. Gd-DTPA enhanced SE T1-weighted image with same parameters of pre-contrast administration SE T1WI was performed in 25 wrists, which showed prominent lesions in each 25 patients.

RESULTSIn 50 wrists of 25 patients with RA, bone erosions were found by MR images compared to radiographs in 46 versus 14 wrists, respectively. There were 170 sites of carpal erosions found by MR images, while radiographs found only 23 sites of carpal erosions. Among them triquetrum and lunate were the most frequently involved sites. Significant difference (P < 0.001) was statistically found between conventional radiography and MR imaging in detection of erosions of the wrists of RA. MR imaging also permitted demonstrating synovitis and joint effusion in the wrists. Gd-DTPA-enhanced images allowed distinguishing pannus changes from joint effusion.

CONCLUSIONMRI is superior to conventional radiography with respect to detection of bone erosion in wrists. For those whose conventional radiographs show suspected RA, MRI examination should be advised for the early diagnosis.

Adult ; Aged ; Arthritis, Rheumatoid ; diagnosis ; diagnostic imaging ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Radiography ; Wrist Joint ; pathology

OBJECTIVETo investigate the effect of Qingre Huoxue decoction, (QRHX) on radiographic progression in patients with rheumatoid arthritis (RA) with X-ray imaging.

METHODSFrom July 2007 to March 2009, 86 patients with active RA who were diagnosed as damp-heat and blood stasis syndrome were randomly divided into QRHX group and QRHX plus methotrexate (MTX) group, 43 cases in each group. Patients in the QRHX group were treated with QRHX decoction [composed of Huangbai, Chishao, Bixie, Danshen, Ezhu, Qingfengteng, raw Huangqi, Jinyinhua, Tufuling, Wugong, Fengfang, raw Yiyiren, which was cooked with water as 400 ml liquid); while patients in the other group were treated with QRHX decoction plus MTX. After one-year observation, 21 patients in each group (42 in total) were evaluated,with 19 females in QRHX group, average age of (43.0 +/- 11.3) years, and the course of the disease was 2 (1,3) years; and 18 females in QRHX+MTX group, average age of (44.5 +/- 14.0) years, and the course of the disease was 3 (1.7, 5) years. Radiographs of hands were obtained at baseline and 12 months after treatment. Images were evaluated by investigators blinded to chronology and clinical data, and assessed according to Sharp/van der Heijde methods.

RESULTSHigh intrareader agreements were reached (mean intraobserver intraclass coefficients: 0.95). No significant change in any imaging parameters of joint destruction was observed at 12 months after treatment in both groups; and there were no statistical differences between the two groups (P > 0.05). The severity of progress in two groups was also similar (P = 0.46), 7 patients without radiographic progress in QRHX group and 8 patients in QRHX+MTX group,3 patients with obvious radiographic progress in QRHX group and 1 patient in QRHX+MTX group.

CONCLUSIONRadiographic progress of RA patients in two groups is similar, indicating QRHX decoction has a potential role in preventing bone destruction.

Adult ; Arthritis, Rheumatoid ; diagnostic imaging ; drug therapy ; Female ; Humans ; Male ; Medicine, Chinese Traditional ; Methotrexate ; therapeutic use ; Middle Aged ; Radiography

OBJECTIVE: To evaluate the classification criteria of early rheumatoid arthritis (ERA) and compare the sensitivity and specificity with the criteria of 1987 American College of Rheumatology (ACR) criteria and 2010 ACR/European League Against Rheumatism (EULAR). METHODS: Patients from 4 hospitals, aged more than 16 years, with arthritis, whose disease duration was ≤1 year, and with ≥1 joint pain and swelling were enrolled in the study. The indicators including clinical manifestations, laboratory tests and imaging examinations were observed. The ERA patients were dignosed by two experienced rheumatologists based on the clinical features, drug therapy information and radiography features. RESULTS: (1) A total of 325 patients with arthritis were enrolled, including 98 males (30.15%) and 227 females (69.85%), The average age was (47.53±14.44) years, and the median disease duration was 5 (2, 8) months. Finally, 236 patients were dignosed with ERA, and 89 patients were dignosed with other diseases (Non-ERA, including osteoarthritis, reactive arthritis, undifferentiated arthritis, spondyloarthritis, etc). (2) The sensitivity of ERA criteria was 87.29%, and the specificity was 84.37%. The sensitivity was higher than that of 1987 ACR criteria (χ²=43.641, P < 0.001), and had no significant difference compared with 2010 ACR/EULAR criteria (χ²=0.446, P=0.593). But the specificity of ERA criteria was lower than that of 1987 ACR criteria (χ²=4.891, P=0.027), which was not statistically significant compared with 2010 ACR/EULAR criteria (χ²=0.044, P=1.000). (3) In the patients with arthritis whose disease duration was ≤3 months and ≤6 months, the sensitivity of ERA criteria was 81.71% and 86.79%, respectively, both were higher than the 1987 ACR criteria (χ²=7.131, P=0.008; χ²=22.015, P < 0.001) and had no statistically difference compared with the 2010 ACR/EULAR criteria (χ²=0.220, P=0.755; χ²=0.473, P=0.491). The differences of the three criteria in specificity were not statistically significant. (4) The three different classification criteria were consistent with the clinical diagnosis, among which the ERA criteria and 2010 ACR/EULAR criteria were slightly higher (Kappa>0.6). The results of the consistency comparison between the three criteria showed that the ERA criteria and 2010 ACR/EULAR criteria had a better consistency (Kappa=0.836). CONCLUSION The sensitivity of ERA classification criteria in the diagnosis of ERA was higher than that of 1987 ACR criteria, and was equivalent to that of 2010 ACR/EULAR criteria. There is no significant difference in specificity between these three criteria. The ERA criteria can also identify patients with RA at a very early stage in arthritis with disease duration ≤3 months.
Adolescent ; Adult ; Arthritis, Rheumatoid/diagnostic imaging* ; Female ; Humans ; Male ; Middle Aged ; Osteoarthritis ; Radiography ; Rheumatology ; Sensitivity and Specificity ; United States

OBJECTIVE: To investigate the population distribution of cervical spine instability in rheumatoid arthritis (RA) patients, and to analyze the clinical characteristics in RA patients with cervical spine instability. METHODS: A total of 439 RA patients who had completed cervical spine X-ray examination from Department of Rheumatology and Immunology of Peking University Shenzhen Hospital and Peking University Third Hospital from August 2015 to March 2019 were enrolled. The clinical data, laboratory data and cervical radiographic data were collected and analyzed by t-test, rank sum test and Chi-square test to clarify the clinical characteristics in the RA patients with cervical spine instability. RESULTS: Of the 439 RA patients, 80.9% (355/439) were female, with an average age of (52.9±13.9) years, a median duration of the disease was 60 months, the shortest history was 2 weeks, and the longest history was up to 46 years. 29.6% (130/439) of the RA patients showed cervical spine instability. Among them, 20 RA patients were complicated with two different types of cervical instability, the atlantoaxial subluxation (AAS) accounted for 24.6% (108/439), the vertical subluxation (VS) accounted for 7.3% (32/439) and the subluxial subluxations (SAS) accounted for 2.3% (10/439). The patients with cervical spine instability had a longer duration of disease [120 (36, 240) months vs. 48 (12, 120) months], a higher proportion of peripheral joint deformity (56.9% vs. 29.9%), and a higher visual analog scale (VAS) measuring general health score (4.89±2.49 vs. 3.93±2.38), a lower hemoglobin [(111.31±19.44) g/L vs. (115.56±16.60) g/L] and a higher positive rate of anti-cyclic citrullina-ted peptide (CCP) antibody (90.8% vs. 76.6%). There were no significant differences in gender, age, number of swollen joints, number of tenderness joints, erythrocyte sedimentation rate, rheumatoid factor level, 28-joint disease activity score, positive rate of anti keratin antibody, duration of glucocorticoid use and duration of disease modifying anti-rheumatic drugs use between the two groups. CONCLUSION In the study, 29.6% of the RA patients showed cervical spine instability. RA patients with cervical spine instability had a long-term disease, a higher proportion of peripheral joint deformity, a higher VAS measuring general health score, a lower hemoglobin and a higher positive rate of anti-CCP antibody.
Adult ; Aged ; Arthritis, Rheumatoid/epidemiology* ; Autoantibodies ; Cervical Vertebrae/diagnostic imaging* ; Demography ; Female ; Humans ; Joint Instability/epidemiology* ; Middle Aged

OBJECTIVETo continuously observe the long-term effects of synovectomy for improving joint damage and quality-of-life in patients with the rheumatoid knee.

METHODSTwenty-one consecutive patients with rheumatoid arthritis (RA) involving 24 knees underwent open synovectomy from November 1988 to January 1997 between November 1988 and January 1997. The changes in radiographic damage were assessed with Larsen score on plain films before and 6 months after surgery with subsequent annual assessment for 8 years, and the functional recovery of the patients was also evaluated with Health Assessment Questionnaire (HAQ) at the same time.

RESULTSThe radiographic joint damage and juxta-articular osteoporosis or bone erosion was ameliorated after surgery in all the patients. Larsen score began to decrease 6 months after the operation, and the best effects were achieved at one year and maintained for at least 5 years after the operation, but then followed by recurrence of joint lesions. HAQ scores were improved after the surgery with the best effects observed 6 months after the operation lasting for over 2 years. HAQ score gradually decreased 4 years after the operation till reaching the preoperative scores.

CONCLUSIONSynovectomy in the patients with rheumatoid knee not only reverses progressive joint damage, but also improves juxta-articular bone erosions and the patients' quality of life. However, radiographic joint damage and functional deterioration may recur due to hyperplasia of the inflammatory synovium in the long term after operation, suggesting that the inflammatory synovium participates in local joint damage with bone erosions and systemic pathologic process of RA.

Adult ; Arthritis, Rheumatoid ; diagnostic imaging ; surgery ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Radiography ; Synovectomy ; Time Factors