类风湿关节炎及风湿性多肌痛患者肩关节病变的超声表现

Discrepancies of ultrasound findings of shoulders in patients with rheumatoid arthritis and polymyalgia rheumatica

目的探讨并比较RA和风湿性多肌痛（PMR）患者肩关节病变的超声表现。方法入选有肩关节疼痛、肿胀或活动受限的RA和PMR患者，进行双侧肩关节的超声检查并进行对比。评估的内容包括炎性病变如肱二头肌长头腱（LHB）腱鞘炎、肩峰下-三角肌下（SASD）滑囊炎、冈上肌腱（SS）腱炎、盂肱关节（GH）和肩锁（AC）关节积液或滑膜炎，以及结构性病变包括SS撕裂、肱骨头和肩锁关节的骨侵蚀和骨赘。2组间率的比较采用χ^2检验。结果共入选192例RA和37例PMR患者，超声共检查458个肩关节。RA患者中最常见的炎性病变为LHB腱鞘炎（31.3%），其次为SASD滑囊炎（25%）、SS腱炎（11.5%）、肩锁和盂肱关节关节积液/滑膜炎（分别为10.4%和5.7%）。LHB腱鞘炎（37.8%）是PMR患者中最常见的炎性表现，其次为冈上肌腱腱炎（27%）、SASD滑囊炎（24.3%）、肩锁/盂肱关节关节积液/滑膜炎（2.7%），未发现盂肱关节关节积液/滑膜炎。19例（9.9%）RA和3例（8.1%）PMR患者存在SS肌腱部分或完全撕裂。骨侵蚀和骨赘在2组患者中都很常见。PMR患者SS腱炎比RA患者更常见（χ^2=6.255，P〈0.05），而盂肱关节关节积液/滑膜炎在RA患者中更常见（χ^2=3.983，P〈0.05）。RA患者中的单侧SASD滑囊炎和SS腱炎更普遍（分别为77.1%和77.3%），而盂肱关节积液/滑膜炎更多为双侧病变（63.6%）。结论超声发现，RA和PMR患者中最常见的炎性病变均为LHB腱鞘炎。RA患者更多见关节内的炎性病变（盂肱关节关节积液/滑膜炎），而PMR患者更常见关节旁的炎性病变（冈上肌腱腱炎）。RA患者中的SASD滑囊炎和冈上肌腱腱炎更常为单侧，而盂肱关节关节积液/滑膜炎更多为双侧病变。

ObjectiveTo investigate the features and discrepancies of the ultrasound findings of shoulders in patients with rheumatoid arthritis （RA） and polymyalgia rheumatica （PMR）.MethodsPatients with RA and PMR who complained of pain, swelling or limited mobility of shoulder were enrolled for bilateral ultrasound assessment. Inflammatory lesions including long head biceps （LHB） tenosynovitis, subacromial-subdeltoid （SASD） bursitis, tendinosis of supraspinatus （SS） tendon effusion/synovitis in glenohumeral （GH） and acromioclavicular （AC） joints, as well as structural damages including SS tear, bone erosions and osteophytes on humeral head and AC joints were evaluated. Comparison of frequency of ultrasound features between the two groups was analyzed by χ^2 test.ResultsA total of 458 shoulders from 192 RA and 37 PMR patients were assessed by ultrasound. In RA patients, the most prevalent inflammatory findings were LHB tenosynovitis （31.3%）, followed by SASD bursitis （25%）, SS tendinosis （11.5%）, AC and GH effusion/synovitis （10.4% and 5.7%, respectively）. LHB tenosynovitis was the most frequent finding in PMR patients （37.8%）, followed by SS tendinosis （27%）, SASD bursitis （24.3%）, AC and GH effusion/synovitis （2.7% and 0, respectively）. Partial or complete tear of SS tendon was found in 9.9% RA and 8.1% PMR patients, respectively. SS tendinosis was more frequently presented in PMR than RA patients （χ^2=6.255, P〈0.05）, while GH effusion/synovitis was more common in RA group （χ^2=3.983, P〈0.05）. Bone erosions and osteophytes were common in both groups. SASD bursitis and SS tendinosis appeared to be more unilateral （77.1% and 77.3%, respectively）, while GH effusion/synovitis tended to be bilateral （63.6%） in RA patients.ConclusionIntra-articular inflammatory involvement （GH effusion/synovitis） is more frequent in RA, while peri-articular inflammatory involvement （SS tendinosis） is more frequent in patients with PMR. SASD bursitis and SS tendinosis appears to be unilateral, while GH effusion/synovitis tends to be bilateral in RA patients.