超声在近端指间关节周围胶原沉积症与类风湿关节炎鉴别诊断中的应用价值

Application value of ultrasound in the differential diagnosis of pachydermodactyly and rheumatoid arthritis in the proximal interphalangeal joint

目的探讨超声在近端指间关节周围胶原沉积症(PDD)与类风湿关节炎(RA)鉴别诊断中的应用价值。方法选取2020年9月至2023年3月就诊于河南科技大学第一附属医院的21例PDD患者(PDD组)和21例RA患者(RA组)作为研究对象。分别对受累近端指间关节(PIP)进行超声检查,比较两组患者PIP肿胀关节好发部位、受累PIP真皮层的厚度、滑膜炎及骨侵蚀的受累关节数、指屈肌腱腱鞘炎及指伸肌腱附着端炎的肌腱数。结果两组患者肿胀关节均好发于PIP2及PIP3,差异无统计学意义(P>0.05);PDD组患者受累PIP真皮层厚度为(2.02±0.67)mm,明显厚于RA组的(1.07±0.27)mm,差异有统计学意义(P<0.05);PDD组患者的滑膜炎、骨侵蚀、指伸肌腱附着端炎和指屈肌腱腱鞘炎的发生率分别为2.8%、2.4%、2.4%、2.4%,明显低于RA组的68.1%、24.8%、36.7%和39.0%,差异均有统计学意义(P<0.05)。结论超声可以清晰显示并准确测量PIP真皮层厚度,可以检查出PIP是否存在滑膜炎、骨侵蚀、指伸肌腱附着端炎及指屈肌腱腱鞘炎,能够为PDD与RA的鉴别诊断提供可靠的影像学依据。

Objective To explore the application value of ultrasound in the differential diagnosis of pachydermodactyly(PDD)and rheumatoid arthritis(RA)in the proximal interphalangeal joint.Methods Twenty-one PDD patients(PDD group)and 21 RA patients(RA group)who visited the First Affiliated Hospital of Henan University of Science and Technology from September 2020 to March 2023 were selected as the study subjects.Ultrasound examination was performed on the affected proximal interphalangeal joint(PIP)to compare the incidence of PIP swelling,thickness of the affected PIP dermis,number of affected joints with synovitis and bone erosion,and number of tendons with extensor tendon enthesitis and flexor tendon tenosynovitis in two groups of patients.Results Swelling of the joints was more common in PIP2 and PIP3 in both groups of patients,and the difference was not statistically significant(P>0.05).The thickness of the affected PIP dermis in the PDD group was(2.02±0.67)mm,significantly thicker than(1.07±0.27)mm in the RA group(P<0.05).The incidences of synovitis,bone erosion,extensor tendon enthesitis,and flexor tendon tenosynovitis in the PDD group were 2.8%,2.4%,2.4%,2.4%,significantly lower than 68.1%,24.8%,36.7%,39.0%in the RA group(P<0.05).Conclusion Ultrasound can clearly display and accurately measure the thickness of the dermis layer of PIP,and can detect the presence of synovitis,bone erosion,extensor tendon enthesitis,and flexor tendon tenosynovitis in PIP.It can provide reliable imaging evidence for the differential diagnosis of PDD and RA.