老年和青年类风湿关节炎患者超声影像对比研究

Comparative study on ultrasonic images of elderly-onset versus young-onset rheumatoid arthritis

目的比较老年类风湿关节炎(EORA)与青年类风湿关节炎(YORA)临床及超声特征。方法104例类风湿关节炎患者以发病年龄≥60岁分为EORA组(70例)和YORA组(34例),比较两组间患者临床表现、实验室检查及超声影像特点。结果EORA组男性比例明显高于YORA组(24.3%vs.8.8%,P=0.048),EORA组与YORA组间的病程、基于28关节疾病活动度评分、红细胞沉降率、C反应蛋白、类风湿因子、抗环瓜氨酸肽抗体阳性率均无统计学差异(P>0.05),EORA组合并骨关节炎和骨质疏松的发生率明显高于YORA组(P=0.018,P=0.011)。超声结果显示:EORA组指关节骨侵蚀的发生率明显高于YORA组(14.9%vs.4.3%,P<0.001),而EORA和YORA两组的指关节、腕关节、膝关节、跖趾关节、踝关节、肘关节的滑膜增生及肌腱/腱鞘炎受累的发生率无明显统计学差异(P>0.05)。二元Logistic回归显示,不同年龄组、病程、骨关节炎、骨质疏松对RA患者超声显示的滑膜增生、肌腱/腱鞘炎、骨侵蚀改变均无影响。结论EORA与YORA之间临床疾病活动度及病程无统计学差异,两组间关节炎症受累模式相似。EORA与YORA相比,EORA患者指关节的骨侵蚀发生率更高。

Objective To compare the clinical and ultrasonic features of elderly-onset rheumatoid arthritis(EORA)and young-onset rheumatoid arthritis(YORA).Methods A total of 104 patients diagnosed with rheumatoid arthritis were categorized into two groups based on their age of onset:the EORA group,consisting of 70 patients,and the YORA group,consisting of 34 patients.A comparative analysis was conducted on the clinical manifestations,laboratory findings,and ultrasonic images of patients in these two groups.Results The male ratio in the EORA group was significantly higher than that in the YORA group(24.3%vs.8.8%,P=0.048).There were no statistical differences in the course of disease,DAS28,ESR,CRP,RF,and anti-CCP antibody positive rates between the two groups(P>0.05)when compared with the YORA group.The incidence of osteoarthritis and osteoporosis in the EORA group was significantly higher than that in the YORA group(P=0.018,P=0.011).Ultrasonic results revealed a significantly higher incidence of phalangeal bone erosion in the EORA group compared to the YORA group(14.9%vs.4.3%,P<0.01).Binary logistic regression analysis indicated that different age groups,disease duration,osteoarthritis,and osteoporosis did not have an effect on the ultrasonic changes of synovial hyperplasia,tendonitis,tenosynovitis,and bone erosion in RA patients.Conclusions There is no significant difference in the clinical disease activity and disease progression between EORA group and YORA group.Additionally,the pattern of joint inflammation involvement is similar in both groups.Ultrasound examinations revealed a higher incidence of bone erosion in finger joints of EORA patients compared to YORA patients.