超声在鉴别类风湿性和痛风性跖趾关节炎骨质侵蚀中的应用

Ultrasound diagnosis of metatarsophalangeal joint erosions in rheumatoid arthritis and gouty arthritis

目的探讨超声在类风湿性关节炎与痛风性关节炎骨质侵蚀的诊断与鉴别诊断价值。方法回顾性分析本院43例类风湿性关节炎患者和52例痛风性关节炎患者的足部跖趾关节骨质侵蚀声像图特征,观察骨质侵蚀发生的部位、形态、边界、内部血流分布等直接征象及滑膜或关节腔积液内点状高回声、痛风石、双轨征等特异性间接征象。结果骨侵蚀在类风湿性关节炎中第五跖趾关节均受累(n=43例,100%),边界模糊(n=40例,93.0%),外形以圆形为主(n=39例,90.7%),滑膜增生(n=38例,88.4%);而在痛风性关节炎中第一跖趾关节均受累(n=52例,100%),边界清晰(n=39例,75%),外形呈椭圆形或圆形(61.5%vs 38.5%),滑膜增生(n=10例,19.2%),两组之间差异均有统计学意义(P<0.001);且在痛风组中出现了特异性间接征象(P<0.001),滑膜或关节腔积液内点状高回声(n=23例,44.2%),痛风石(n=33例,63.5%),双轨征(n=21例,40.4%),而在类风湿性关节炎中均无上述间接征象出现。结论超声可以依据骨侵蚀的特征鉴别类风湿性与痛风性跖趾关节炎。

Objective The aim of this study was to assess the value of joint erosions on ultrasound （US） for diagnosing rheumatoid arthritis （RA） and gouty arthritis （GA）. Methods US of bilateral metatarsophalangeal （MTP） joints in RA （ti=43） and GA （n=52） was retrospectively analyzed. The direct signs included location, morphology, border, and Doppler color flow of the ero-sions. Indirect signs including echogenic foci in the synovium or joint effusion, tophus, and double contour sign were also recorded. Results The joint erosions of RA were round （39/42, 90.7%） with poorly-defined borders （40/42, 93.0%） and synovial prolifera-tion （38/42, 88.4%） involving most commonly the fifth MTP joint （43/43, 100%）. In GA, the joint erosions were round （61.5%） or oval （38.5%） with well-defined border （39/52, 75.0%） and synovial proliferation （10/52, 19.2%） involving most frequently the first MTP joint （43/52,82.7%）. The difference between RA and GA was statistically significant （P〈0.001）. Indirect signs of tophus （33/ 52, 63.5%）, double contour sign （21/52, 40.4%）, and echogenic foci in the synovium or effusion （23/52, 44.2%）were found only in GA （P〈0.001）. Conclusion US characteristics of joint erosions in RA and GA are useful for differential diagnosis.