Author + information
- Xiujuan Hou,
- Junfu Ma,
- Wei Zheng and
- Yuelan Zhu
To explore the objective diagnostic evidences for traditional Chinese medical (TCM) syndrome types of rheumatoid arthritis (RA), by analyzing of relationship between musculoskeletal ultrasound (MSUS) changes and related clinical indices.
Clinical data and serum of 45 (129 joints and the wrist count as a small joint) inpatients and outpatients with the dampness-heat impeding syndrome or the cold-dampness impeding syndrome of RA were collected. MSUS was applied to detect the thickness of synovial hyperplasia, joint effusion thickness, blood flow signal classification, tendinitis/tenosynovitis and bone erosion, which changed in the small joints of the hands (wrist, metacarpophalangeal joints and proximal interphalangeal joints) of RA patients. Laboratory indices including erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-cyclic citrullinated (anti-CCP) antibody, rheumatoid factor (RF), D-dimer, immunoglobulin (IgG, IgM, IgA) and blood routines (white blood cell, red blood cell, hemoglobin and platelet) were tested by conventional methods, the disease activity scores 28 (DAS28) and syndromes quantitative scores of TCM were calculated.
The doppler blood flow signal classification has a significant difference between RA two syndrome types in TCM (P < 0.05), while the thickness of synovial hyperplasia, joint effusion, bone erosion and the incidence rate of synovial hyperplasia, joint effusion, tendonitis/tenosynovitis, bone erosion are not statistically significant between them (P > 0.05). Draw the ROC curve of doppler blood flow signal classification when define the dampness-heat impeding syndrome as a positive event, and the AUC is 0.594. The positive rate of RF and anti-CCP antibody between the two syndromes are not statistically significant (P > 0.05). There is a certain correlation between duration of disease and the thickness of bone erosion (P < 0.05,r=0.344). There is a certain correlation between platelets and the thickness of synovial hyperplasia and joint effusion (P < 0.05,r=0.465). There is a certain correlation between CRP and the thickness of synovial hyperplasia and the thickness of synovial hyperplasia, joint effusion, bone erosion (P < 0.05), and the correlation coefficient are 0.481, 0.455 respectively. There is a certain correlation between immunoglobulin M and the thickness of synovial hyperplasia and joint effusion (P < 0.05,r=0.573).
There are some different performance of the doppler blood flow signal classification in both of the two types syndrome of RA. Combined the joints changes observed with MSUS and clinical laboratory indices will provide objective diagnostic evidences between dampness-heat impeding and cold-dampness impeding pattern of RA.