Power Doppler sonography, a non-invasive method of assessment of the synovial inflammation in patients with early rheumatoid arthritis.

Vreju F, Ciurea M, Roşu A, Muşetescu A, Grecu D, Ciurea P.

Source

Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Romania. florin_vreju@yahoo.com

Abstract

OBJECTIVE:

To detect synovitis is important in both the diagnosis and outcome assessment of early rheumatoid arthritis. This study was meant to assess the validity and reproducibility of ultrasonography (US) as a mean of detection for the knee synovitis, by comparing US findings with clinical examination and histopathological findings in synovial membrane.

METHODS:

The study group included 65 patients with early rheumatoid arthritis - below 12 months from the debut, naive for DMARDs, in whom demographic data - gender, age, disease duration, the number of tender and swollen joints, HAQ score (Health Assessment Questionnaire) and serum samples for CRP, RF, anti-CCP2 antibodies (ELISA, QUANTA LiteTM, CCP IgG, INOVA Diagnostics Inc, USA), VEGF (ELISA, VEGF2, DRG International, IRC, USA) determination were recorded. Disease Activity Score for 28 joints (DAS28) was calculated. PDS signal was scored from 0 to 3 according to the overall expression of PDS findings at the knees. A sample of synovial tissue was obtained in 35 patients during the arthroscopy, and the vascularisation of the synovial tissue was evaluated by immunohistochemistry and was analyzed qualitatively by a pathologist who was unaware of the PDS findings. Written, informed consent was obtained from each patient before entering the study. They all had active synovitis of the knee, ultrasonographically confirmed, with the identification of the target biopsy sites. The study was approved by the Ethics Committee of the University of Medicine and Pharmacy of Craiova.

RESULTS:

Angiogenesis was evaluated and quantified by immunohistochemical evaluation of synovial VEGF, one of the most specific endothelial growing factors, that proved to correlate significantly with the serum levels of VEGF, DAS28 as well as with the power Doppler sonography (PDS) score.

CONCLUSIONS:

The statistical analysis of the data showed that PDS could be used as non-invasive marker with predictive value regarding synovial inflammation and disease progression in early forms of the disease as well as a useful method in the assessment of the therapeutic response.

PMID: 21655655

多普勒超声评估早期RA滑膜炎症与滑膜VEGF表达有相关性

Hammer HB, et al. Ann Rheum Dis. 2011 Jul 22. 提前在线发表.

目的: 对于早期类风湿关节炎的诊断和预后评估而言，滑膜炎检测是重要的。

本研究拟通过比较超声检查和组织病理学检查来评估超声超声检测膝滑膜炎的有效性与可重复性。

方法: 研究对象包括65例初诊早期类风湿关节炎患者，病程小于12个月,未用过DMARDs。采集人口学数据(性别、年龄)、病程、压痛和肿胀关节计数、HAQ，并测定血清CRP、抗CCP2抗体(ELISA法)以及VEGF(ELISA法)。采用DAS28评估疾病活动度。多普勒超声(PD)检查膝关节的总体评估为0 - 3分。利用关节镜对35例患者采集滑膜样品。用免疫组化技术分析滑膜组织的血管生发，并由一位对超声检查不知情的病理学医生对组化检查进行定量评估。

每位患者入组前均前述纸质知情同意书。

他们的活动性膝关节滑膜炎均得到超声和关节镜活检证实。这项研究得到罗马尼亚Craiova医学与制药大学伦理委员会的批准。

结果: VEGF是重要的特异性血管内皮生长因子之一。本研究利用免疫组化定量评估滑膜VEGF的表达以反映滑膜血管增生。结果显示滑膜VEGF的表达水平与血清VEGF水平、DAS28以及多普勒超声评分相关。

结论: 本研究的分析结果显示多普勒超声可作为一种无创伤性标记物，用于预测早期病程的滑膜炎症和疾病进展，也可用于评估治疗反应。