Abstract：【Objective】To investigate the value of ultrasonography in the early diagnosis of RA in 2010 ACR/EULAR classification criteria.【Methods】Fifty-four cases of early patients with suspected RA were strictly selected, and all patients were tested by ultrasound of 38 jionts [GSUS≥1 and PDUS(+)]and clinical physical examination; the number and location of affected joints were counted, and the results of the three methods were applied to the 2010 ACR/EULAR classification standard score, and the score results were statistically evaluated;At the same time, the patients were scored by ACR 1987 classification criteria.The sensitivity, specificity and the different classification criteria were calculated according to the use of DMARDs and(or) the RA judged rheumatoid specialist as a "gold standard" for the diagnosis of RA on the base of "2010 ACR/EULAR Classification Standard Joint Initiative". The difference between different classification criteria (Methods) was compared.【Results】Of the 54 cases, 37 were diagnosed as RA with the above criteria, 39 patients met 2010 ACR/EULAR GSUS(+)standard, 21 cases met the standard of 2010 ACR/EULAR PDUS (+), 27 cases met the 2010 ACR/EULAR clinical physical examination standard, and18 cases met the ACR 1987 standard.Of the different ultrasonic evaluation standard GSUS ≥1, the comparison of PDUS (+) and clinical physical examination on the detection rate of affected joints, the detection rate of GSUS ≥1 of all joints, the detection rate of PDUS (+) metatarsophalangeal jointthe and the GSUS≥1 total detection rate were all higher than those of the clinical examination, the difference was statistically significant (P<0.05).The standard sensitivity of 2010 ACR/EULAR ultrasound was higher than 2010 ACR/EULAR clinical physical examination standard and ACR 1987 standard:the sensitivity of 2010 GSUS≥1 was the highest, and ACR 1987 was the lowest; the specificity of PDUS (+) was the highest, and the lowest was 2010 GSUS≥1; the diagnostic coincidence rate was 2010 GSUS≥1, and ACR 1987 was the lowest;the highest Youden's index was PDUS (+), the highest Kappa value was 2010 GSUS≥1; 2010 PDUS (+) was the highest in the diagnostic reliability (AUC).【Conclusion】Different ultrasonic evaluation criteria can detect subclinical synovitis in multiple joints where as that the usual clinical examination is unable to find out, among which the GSUS≥1 and PDUS (+) metatarsophalangeal joint hold the higher detection rate. Evidence of affected joint involvement provided by the different ultrasound evaluation standards is applied to the 2010 ACR/EULAR classification standard, whose efficiency is higher than that of ACR 1987 standard and ACR/EULAR 2010clinical examination standard.The affected joint evidence provided by 2010 PDUS (+) has higher diagnostic efficacy.
王群,陈红天,袁柳,夏晓辉,刘亮. 滑膜炎超声影像在评估早期类风湿性关节炎中的诊断价值[J]. 医学临床研究, 2017, 34(10): 1911-1915.
WANG Qun, CHEN Hong-tian, YUAN Liu, et al. Evaluation of Synovial Evidence in the Diagnosis of Early Rheumatoid Arthritis by Ultrasound. JOURNAL OF CLINICAL RESEARCH, 2017, 34(10): 1911-1915.
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2017, Vol. 34 
