Izvorni znanstveni članak
https://doi.org/10.3325/cmj.2015.56.280
Gray-scale and color duplex Doppler ultrasound of hand joints in the evaluation of disease activity and treatment in rheumatoid arthritis
Gordana Ivanac
; Department of Diagnostic and Interventional Radiology, Ultrasound Unit, University Hospital “Dubrava,” University of Zagreb School of Medicine, Zagreb, Croatia
Jadranka Morović-Vergles
; Department of Internal Medicine, Division of Clinical Immunology and Rheumatology, University Hospital “Dubrava,” University of Zagreb School of Medicine, Zagreb, Croatia
Boris Brkljačić
; Department of Diagnostic and Interventional Radiology, Ultrasound Unit, University Hospital “Dubrava,” University of Zagreb School of Medicine, Zagreb, Croatia
Sažetak
Aim To evaluate the role of gray-scale and color duplex-
Doppler ultrasound (CDUS) in diagnosis of changes of
hand joints and assessment of treatment efficacy in patients
with rheumatoid arthritis (RA) by comparing qualitative
and quantitative US parameters with clinical and laboratory
indicators of disease activity.
Methods Ulnocarpal (UC), metacarpophalangeal (MCP),
and proximal interphalangeal (PIP) joints in 30 patients
with RA were examined by gray-scale and CDUS before and
after six months of treatment. Morphologic and quantitative
Doppler findings (synovial thickness, effusion quantity,
vascularization degree, resistance index, velocities) were
compared with clinical indicators of disease progression:
disease activity score (DAS 28), Health Assessment Questionnaire
(HAQ), rheumatoid factor (RF), erythrocyte sedimentation
rate (ESR), and C reactive protein (CRP).
Results Clinical indicators changed significantly after
treatment: ESR from 38.1 ± 22.4 mm/h to 27.8 ± 20.9 mm/h
(P = 0.013), DAS 28 from 5.47 ± 1.56 to 3.87 ± 1.65 (P < 0.001),
and HAQ from 1.26 ± 0.66 to 0.92 ± 0.74 (P = 0.030), indicating
therapeutic effectiveness. In all MCP and UC joints we
observed a significant change in at least one US parameter,
in 6 out of 12 joints we observed a significant change in
≥2 parameters, and in 2 UC joints we observed significant
changes in ≥3 parameters. The new finding was that the
cut-off values of resistance index of 0.40 at baseline and of
0.55 after the treatment indicated the presence of active
disease and the efficacy of treatment, respectively; also it
was noticed that PIP joints can be omitted from examination
protocol.
Conclusion Gray scale and CDUS are useful in diagnosis of
changes in UC and MCP joints of patients with RA and in
monitoring the treatment efficacy.
Ključne riječi
Hrčak ID:
151331
URI
Datum izdavanja:
15.6.2015.
Posjeta: 977 *