肌肉骨骼超声在类风湿关节炎目标治疗中的应用价值

The role of musculoskeletal ultrasound in the treat-to-target in rheumatoid arthritis

以临床缓解和低疾病活动度为目标的治疗策略极大地改善了类风湿关节炎患者的预后，然而肌肉骨骼超声的引入给RA目标治疗带来了新的挑战和机遇。研究发现达到临床缓解的RA患者中亚临床滑膜炎普遍存在，这种亚临床滑膜炎给RA患者带来了潜在危害，包括骨侵蚀进展以及缓解后的疾病复发，因此临床缓解很可能是RA患者并不充分的治疗目标。在临床评价基础上联合超声评价指导治疗可以更好地帮助控制RA患者的疾病活动度，临床缓解联合超声缓解的目标治疗可能给RA患者更好的长期预后带来希望。

The treat-to-target （T2T） strategies has greatly improved the prognosis of rheumatoid ar- thritis （RA）. However, the emergence of musculoskeletal ultrasound has further brought new challenges and opportunities for RA T2T treatment. It has been revealed the subclinical synovitis generally presented in RA patients who achieved clinical remission. The subclinical synovitis has been confirmed to be associated with subsequent progression of bone erosion and flare. Therefore, clinical remission or low disease activity may he inappropriate or insufficient target. The ultrasound evaluation in addition to clinical assessment can help to control the disease activity better, which may eventually improve the long-term outcomes of RA patients.