Sirotka V., Litvyakov A.

Vitebsk state medical University, Vitebsk

CRITERIA FOR DIAGNOSIS OF RHEUMATOID ARTHRITIS ULTRASOUND METHOD

Introduction. Differential diagnosis of rheumatoid arthritis today is challenging in cases of atypical clinical picture arthritis [1]. Often the use of standard x-ray is not informative for the first two years of the disease [2]. After the first 3 months from the onset of the disease, in acute development of RA 26% of patients, the formation of erosive lesions of joints and more than 70% - after 1 year (Klareskog L., 2009). Эрозивное affection of joints is detected by a standard Rg-graphy only after 2 years from the onset of the disease and only in 36% of cases, while the degree of articular destruction progresses over time and is associated with a decreased function of joints. Assignment delay adequate basic therapy increases the level of disability in these patients.

The purpose of the work. Development of criteria for the diagnosis of rheumatoid arthritis using ultrasonic technique for the study of joints.

Materials and methods. We surveyed 113 patients with RA, 30 people without articular pathology - the control group (KG).

In the group of patients with RA - 88 people were women (79,7%), 35 persons (20.3%) men; the median age of which amounted to 40.3 years (33-46), while the median duration of RA - 4 years (1,75-10).

Diagnosis of RA was determined in accordance with the modified criteria ACR 1987. The activity of the inflammatory process of the I degree was 31 (27,5%) patients, II - 59 (52,2%), III - 23 (20,3%).

The control group were the patients with a history of clinically at the time of inspection was symptomatic disease of the joints. Among them 15 men (50%) and 15 women (50%). The median age in KG amounted to 38.5 years (33-48).

All patients were dynamic study II, V metacarpophalangeal and wrist joints expert class ultrasonic apparatus «Voluson 730 GE-Expert» with the use of the sensor at 12 MHz.

Results and discussion. In patients from the control group with an ultrasound of the joints we visualized the articular surfaces of bones in the form of hyperechoic structures with clear equal contour, homogeneous echogenicity structure; synovial membrane not visualized or she had homogeneous echogenicity structure and a thickness of not more than 2.9 mm; tendon was defined as hyperechoic structures strand, not thicker than 1.5 mm.

In patients with RA identified the following ultrasound signs of lesions of the joints: patchy pannus (96,6%) - a site pathologically changed synovial membrane thickness exceeding 3 mm with invasive growth and the presence of pathological vascularization (indirect signs neoangiogenesis) brought to light when using Doppler over the erosion of pannus; thinning synovia outside erosion (99%); erosion pannus (99%); combined erosion (96%); erosion of inflammation: acute (45.6%) and chronic (89%); moderate sinovit (89,4%); swelling of the periarticular soft-tissue (88,4%); tenosynovitis (67,6%); periarticular effusion (66,9%), positive sore sample 6% of cases under ultrasound control.

Conclusions. In the course of research, we have defined the indications for ultrasound examination of joints in rheumatology. These include:

• arthralgia;

• increase in volume of joint swelling, hyperthermia, hyperemia periarticular soft tissues;

• subjective complaints and objectively determined by the restriction of movements in the joints;

• morning stiffness of the joints;

• screening study of people from risk groups (inflammatory diseases of joints relatives);

• not confirmed артритогенная infection;

• differential diagnosis of arthritis in complex clinical cases;

• medical examination in dynamics to assess the progression of arthritis;

• evaluation of effectiveness of basic therapy.

Taking into account the obtained results, we have developed ultrasonic diagnostic criteria RA.

Diagnostic criteria for rheumatoid arthritis:

1. Pannus with pathological vascularization;

2. Thinning synovia outside pannus;

3. Erosion of articular surface of the bone (erosion pannus, combined erosion inflammation);

4. Moderate synovitis;

5. Tenosynovitis;

6. Periarticular edema/effusion;

7. Negative sore test» under ultrasound control.

LITERATURE:

1. Hakkinen, A. A randomized two-year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity and bone mineral densiny in early rheumatoid arthritis / A. Hakkinen // Ibid. – 2001. – Vol. 44. – P. 515-521.

2. Raftery, G. Comparison of musculoskeletal ultrasound practices of a rheumatologist and a radiologist / G. Raftery, G. Hide, D. Kane // Rheumatology. – 2007. – Vol. 232, № 46 (3). – Р. 519-522.