engleski

Color duplex Doppler ultrasound in rheumatoid arthritis

Rheumatoid arthritis is systemic inflammatory disease that has dominant manifestations on joints synovia, as persistent synovitis. Hand joints are affected in almost all patients. Over the last years ultrasound has become important imaging modality for diagnosis and follow-up of patients suffering from rheumatic diseases. Ultrasound enables demonstration of pannus, inflammatory changes of synovia, joint effusions, paraarticular changes and tendons. Doppler enables demonstration of vascularization of pathologically altered joint. Evaluation of the degree of inflammatory changes and their follow-up during the treatment is of the particular interest. Aim of the study are to determine Doppler changes (degree of vascularization, the value of peak systolic velocity-PSV, enddiastolic velocity- EDV) and resistance index-RI) of ulnocarpal (UC) and metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis (RA) before and after therapy and to compare morphologic and Doppler findings with the clinical disease activity score (DAS 28), Health assessment questionnaire (HAQ), and values of serum inflammatory parameters (RF, ESR, CRP). Color Doppler (CDI) features were analyzed of 360 UC and MCP joints in 30 patients with RA (21 women, 9 men) before and after six- months therapy. Rheumatoid factor (RF), serum erythrocyte ratio (ESR) and C-reactive protein (CRP) values were determined. Disease activity score (DAS 28) was determined and Health assessment questionnaire (HAQ) filled. On CDI degree of joint vascularization was evaluated, and resistance index (RI), PSVs and EDVs were measured. Values of DAS-28 and ESR decreased after therapy (p<0.001, p=0.01), as well as RF (p=0.015), and HAQ (P=0.03). Significant correlation was determined between HAQ/DAS and RI before and after therapy in MCP-I and MCP-II joints (p=0.004- p=0.03), and in RI and EDV in both UC joints (p<0.001-<0.05). Analysis of cut-off values of RI in the group before therapy has shown that cut-off RI < 0.40 has sensitivity and specificity of 100%. In the group after therapy for the cut-off value of RI ≥ 0.55 the sensitivity of 100%, specificity of 87%, PPV of 94%, and NPV of 100% was observed ; in the time of initial diagnosis RI < 0.40 indicates the disease, while after therapy RI ≥ 0.55 indicates good therapeutic response. Doppler parameters indicate the efficacy of therapy of RA. CDI of UC and MCP joints should be routinely used in diagnosis and evaluation of therapeutic response of patients with RA.

Musculoskeletal joint; Ultrasound-Colour Doppler; Diagnostic procedure; Arthritides

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