rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2013-1497rsp-1313Research ArticleСтатьиArticlesЗначение артросонографии для диагностики поражения плюснефаланговых суставов у пациентов с ревматоидным артритомSignificance of arthrosonography in the diagnosis of metatarsophalangeal joint injury in patients with rheumatoid arthritisОсипянцР. А.OsipyantsRita Aleksandrovnapchelka_maya.07@mail.ruКаратеевДмитрий ЕвгеньевичKarateevD E-ПанасюкЕ. Ю.PanasyukE Yu-ЛукинаГ. В.LukinaG V-СмирновА. В.SmirnovA V-ГлуховаС. И.GlukhovaS I-АлександроваЕлена НиколаевнаAleksandrovaE N-ВолковА. В.VolkovA V-201315062013513№3 (2013)255260Copyright © Осипянц Р.А., Каратеев Д.Е., Панасюк Е.Ю., Лукина Г.В., Смирнов А.В., Глухова С.И., Александрова Е.Н., Волков А.В., 20132013Осипянц Р.А., Каратеев Д.Е., Панасюк Е.Ю., Лукина Г.В., Смирнов А.В., Глухова С.И., Александрова Е.Н., Волков А.В.Osipyants R.A., Karateev D.E., Panasyuk E.Y., Lukina G.V., Smirnov A.V., Glukhova S.I., Aleksandrova E.N., Volkov A.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/1313

Цель — оценить вклад артросонографии в диагностику поражения плюснефаланговых суставов (ПлФС) и выявить предикторы функциональных нарушений у пациентов с ревматоидным артритом (РА). Материал и методы. В исследование были включены 50 больных с диагнозом РА, соответствующим критериям Американской коллегии ревматологов 1987 г. В зависимости от давности заболевания пациенты были разделены на две группы: 1-я — ранний РА (РРА) с продолжительностью болезни до 2 лет (n=9); 2-я — РА с длительностью свыше 2 лет (ДтРА; n=41). Всем больным проводили клиническую оценку суставов, лабораторное и инструментальное обследование, включая рентгенографию и ультразвуковое исследование (УЗИ) суставов. Результаты. Воспалительный процесс в суставах стоп достоверно чаще определяется по данным сонографии, чем клинически (p<0,0001). Частота выявления эрозий по результатам УЗИ была достоверно выше таковой при рентгенологической оценке, особенно при РРА (p=0,01). Сравнительный анализ пациентов с низкими и высокими значениями индекса HAQ показал зависимость функционального статуса от возраста больных, выраженности боли и наличия воспалительного процесса в V ПлФС по данным УЗИ. Ассоциаций с длительностью болезни, традиционными показателями клинико-лабораторной активности РА и эрозивными изменениями в стопах отмечено не было. Заключение. УЗИ суставов в повседневной клинической практике позволяет объективно оценить патологические изменения стоп и вероятность потери трудоспособности при РА.

Objective: to estimate the contribution of arthrosonography to the diagnosis of metatarsophalangeal joint (MTPJ) injury and to reveal predictors for functional impairments in patients with rheumatoid arthritis (RA). Subjects and methods. The investigation enrolled 50 patients with the RA diagnosis meeting to the American College of Rheumatology 1987 criteria. According to disease duration, the patients were divided into two groups: 1) 9 patients with an early RA history of less than 2 years (ERA); 2) 41 patients with a RA history of over 2 years (LRA). All the patients underwent clinical joint evaluation, laboratory and instrumental examination, including joint X-ray and ultrasonography (USG). Results. An inflammatory process in the foot joints is significantly more frequently detected on ultrasound than clinically (p < 0.0001). The detection rate of erosions, as evidenced by USG, was significantly higher than that by X-ray, in ERA in particular (p = 0.01). Comparison analysis of patients with low and high HAQ scores showed the relationship between functional status, age, pain degree, and inflammatory process in the fifth MTPJ, as shown by USG. There were no associations with disease duration, traditional clinical and laboratory parameters of RA activity, and erosive changes in the feet. Conclusion. Joint USG in daily clinical practice makes it possible to objectively evaluate pathological changes in the feet and the probability of work disability due to RA.

артросонография стопревматоидный артритсиновитнарушения функционального статусаfoot arthrosonographyrheumatoid arthritissynovitisfunctional impairmentsReferences<div><p>Trieb K. Management of the foot in rheumatoid arthritis. Bone Joint Surg 2005;87-B:1171—7.</p><p>Michelson J., Easley M., Wigley F.M., Hellmann D. Foot and ankle problems in rheumatoid arthritis. Foot Ankle Int 1994;15:608-13.</p><p>Kuper H.H., van Leeuwen M.A., van Riel P.L. et al. Radiographic damage in large joints in early rheumatoid arthritis: relationship with radiographic damage in hands and feet, disease activity, and physical disability. Br J Rheumatol 1997;36:855-60.</p><p>Rojas-Villarraga A., Bayaona J., Zuluaga N. et al. The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis. BMC Musculoskelet Disoder 2009;10:67.</p><p>Abdo R.V., Iorio L.J. Rheumatoid arthritis of the foot and ankle. J Am Acad Orthop Surg 1994;12:326-32.</p><p>Landewe R., van der Heijde D., van der Linden S. et al. Twenty-eight-joint counts invalidate the DAS28 remission definition owing to the lower extremity joints: a comparison with the original DAS remission. Ann Rheum Dis 2006;65:637-41.</p><p>Klinkhoff A.V., Bellamy N., Bombardier C. et al. An experiment in reducing interobserver variability of the examination for joint tenderness. J Rheumatol 1988;15:492-4.</p><p>Backhaus M., Kamradt T., Sandrock D. et al. Arthritis of the finger joints. A comprehensive Approach Comparing Conventional Radiography, Scintigraphy, Ultrasound, and Contrast-Enhanced Magnetic Resonance Imaging. Arthr Rheum 1999;42:1232-45.</p><p>Prevoo M.L.L., van Hoff M.A., Kuper H.H. et al. Modified disease activity scores that include twenty-eight-joints counts. Arthr Rheum 1995;38:44-52.</p><p>Wakefield R., Balint P., Szkudlarek M. et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005;32:2485-7.</p><p>Hammer H., Haavardsholm E., Boyesen P. et al. Bone erosions at the distal ulna detected by ultrasonography are associated with structural damage assessed by conventional radiography and MRI: a study of patients with recent onset rheumatoid arthritis. Rheumatology 2009;48:1530-2.</p><p>Van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol 2000;27:261-3.</p><p>Funck-Brentano T., Etchepare F., Joulin S. et al. Benefits of ultrasonography in the management of early arthritis: a cross-sectional study of baseline data from the ESPOIR cohort. J Rheumatol 2009;48:1515-9.</p><p>Wakefield R., Green M., Marzo-Ortega H. et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 2004;63:382-5.</p><p>Filer A., de Pablo P., Allen G. et al. Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis. Ann Rheum Dis 2011;70:5007.</p><p>Dougados M., Devauchelle-Pensec V., Ferlet J. et al. The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound. Ann Rheum Dis 2012; doi:10.1136/annrheumdis-2012-201469.</p><p>Magnani M., Salizzoni E., Mule R. et al. Ultrasonography detection of early bone erosions in the metacarpophalangeal joints of patients with rheumatoid arthritis. Clin Exp Rheumatol 2004;22:743-8.</p><p>Lopez-Ben R., Bernreuter W., Moreland L., Alarcon G. Ultrasound detection of bone erosions in rheumatoid arthritis: A comparison to routine radiographs of the hands and feet. Skeletal Radiol 2004;33:80-4.</p><p>Ohrndorf S., Naumann L., Dietz E. et al. Evaluation of the 7-Joint Ultrasound Score (US7) by One Year Follow-up Data with Regard to Disease Duration. Arthr Rheum 2009;60(Suppl 10):1467.</p><p>McNally E. Ultrasound of the small joints of the hand and feet: current status. Skeletal Radiol 2008;37:99-113.</p><p>Grassi W., Filippucci E., Farina A. et al. Ultrasonography in the evaluation of bone erosions. Ann Rheum Dis 2001;60:98-103.</p><p>Riente L., Delle Sedie A., Scire C. et al. Utrasound imaging for the rheumatologist. XXXI. Sonographic assessment of the foot in patients with rheumatoid arthritis. Clin Exp Rheumatol 2011;29:1-5.</p><p>Hameed B., Pilcher J., Heron C. et al. The relation between composite ultrasound measures and the DAS 28 score, its components and acute phase markers in adult RA. Rheumatology 2008;47:476-80.</p><p>Naredo E., Bonilla G., Gamero F. et al. Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 2005;64:375-81.</p><p>Назаренко Г.И., Героева И.Б., Хитрова А.Н. и др. Возможности ультразвукового исследования в оценке активности воспалительного процесса и эффективности лечения пациентов с ревматоидным артритом. Ультразвук и функц диагн 2007;5:83-91.</p><p>Scheel A., Hermann K.-G., Kahler E. et al. A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis. Arthr Rheum 2005;52:733-43.</p><p>Treslev L., Torp-Pedersen S., Savnik A. et al. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis. Arthr Rheum 2003;48:2434-41.</p><p>Александрова Е.Н., Насонов Е.Л. Инновационные технологии в лабораторной диагностике ревматических заболеваний. Науч-практич ревматол 2010;2:13-20.</p><p>Van der Leeden M., Steultjens M., Dekker J. et al. The relationship of diseases duration to foot function, pain and disability in rheumatoid arthritis patients with foot complaints. Clin Exp Rheumatol 2007;25:275-80.</p><p>Puolakka K., Kautiainen H., Pekurinen M. et al. Monetary value of lost productivity over a five year follow up in early rheumatoid arthritis estimated on the basis of official register data on patients' sickness absence and gross income: experience from the FIN-RACo trial. Ann Rheum Dis 2006;65:899-904.</p><p>Вакуленко О.Ю., Кричевская О.А., Горячев Д.В. и др. Взаимосвязь клинических характеристик ревматоидного артрита с трудоспособностью и производительностью труда. Науч-практич ревматол 2012;52(3):60—67.</p><p>Rojas-Villarraga A., Bayona J., Zuluaga N. et al. The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis. BMC Musculoskeletal Disorders 2009;10:67.</p><p>Hooper L., Bowen C., Gates L. et al. Prognostic indicators of foot-related disability in patients with rheumatoid arthritis: results of a prospective three-year study. Arthr Care Res 2012;64:1116-24.</p></div><br /><div><p>Trieb K. Management of the foot in rheumatoid arthritis. Bone Joint Surg 2005;87-B:1171—7.</p><p>Michelson J., Easley M., Wigley F.M., Hellmann D. Foot and ankle problems in rheumatoid arthritis. Foot Ankle Int 1994;15:608-13.</p><p>Kuper H.H., van Leeuwen M.A., van Riel P.L. et al. Radiographic damage in large joints in early rheumatoid arthritis: relationship with radiographic damage in hands and feet, disease activity, and physical disability. Br J Rheumatol 1997;36:855-60.</p><p>Rojas-Villarraga A., Bayaona J., Zuluaga N. et al. The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis. BMC Musculoskelet Disoder 2009;10:67.</p><p>Abdo R.V., Iorio L.J. Rheumatoid arthritis of the foot and ankle. J Am Acad Orthop Surg 1994;12:326-32.</p><p>Landewe R., van der Heijde D., van der Linden S. et al. Twenty-eight-joint counts invalidate the DAS28 remission definition owing to the lower extremity joints: a comparison with the original DAS remission. Ann Rheum Dis 2006;65:637-41.</p><p>Klinkhoff A.V., Bellamy N., Bombardier C. et al. An experiment in reducing interobserver variability of the examination for joint tenderness. J Rheumatol 1988;15:492-4.</p><p>Backhaus M., Kamradt T., Sandrock D. et al. Arthritis of the finger joints. A comprehensive Approach Comparing Conventional Radiography, Scintigraphy, Ultrasound, and Contrast-Enhanced Magnetic Resonance Imaging. Arthr Rheum 1999;42:1232-45.</p><p>Prevoo M.L.L., van Hoff M.A., Kuper H.H. et al. Modified disease activity scores that include twenty-eight-joints counts. Arthr Rheum 1995;38:44-52.</p><p>Wakefield R., Balint P., Szkudlarek M. et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005;32:2485-7.</p><p>Hammer H., Haavardsholm E., Boyesen P. et al. Bone erosions at the distal ulna detected by ultrasonography are associated with structural damage assessed by conventional radiography and MRI: a study of patients with recent onset rheumatoid arthritis. Rheumatology 2009;48:1530-2.</p><p>Van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol 2000;27:261-3.</p><p>Funck-Brentano T., Etchepare F., Joulin S. et al. Benefits of ultrasonography in the management of early arthritis: a cross-sectional study of baseline data from the ESPOIR cohort. J Rheumatol 2009;48:1515-9.</p><p>Wakefield R., Green M., Marzo-Ortega H. et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 2004;63:382-5.</p><p>Filer A., de Pablo P., Allen G. et al. Utility of ultrasound joint counts in the prediction of rheumatoid arthritis in patients with very early synovitis. Ann Rheum Dis 2011;70:5007.</p><p>Dougados M., Devauchelle-Pensec V., Ferlet J. et al. The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound. Ann Rheum Dis 2012; doi:10.1136/annrheumdis-2012-201469.</p><p>Magnani M., Salizzoni E., Mule R. et al. Ultrasonography detection of early bone erosions in the metacarpophalangeal joints of patients with rheumatoid arthritis. Clin Exp Rheumatol 2004;22:743-8.</p><p>Lopez-Ben R., Bernreuter W., Moreland L., Alarcon G. Ultrasound detection of bone erosions in rheumatoid arthritis: A comparison to routine radiographs of the hands and feet. Skeletal Radiol 2004;33:80-4.</p><p>Ohrndorf S., Naumann L., Dietz E. et al. Evaluation of the 7-Joint Ultrasound Score (US7) by One Year Follow-up Data with Regard to Disease Duration. Arthr Rheum 2009;60(Suppl 10):1467.</p><p>McNally E. Ultrasound of the small joints of the hand and feet: current status. Skeletal Radiol 2008;37:99-113.</p><p>Grassi W., Filippucci E., Farina A. et al. Ultrasonography in the evaluation of bone erosions. Ann Rheum Dis 2001;60:98-103.</p><p>Riente L., Delle Sedie A., Scire C. et al. Utrasound imaging for the rheumatologist. XXXI. Sonographic assessment of the foot in patients with rheumatoid arthritis. Clin Exp Rheumatol 2011;29:1-5.</p><p>Hameed B., Pilcher J., Heron C. et al. The relation between composite ultrasound measures and the DAS 28 score, its components and acute phase markers in adult RA. Rheumatology 2008;47:476-80.</p><p>Naredo E., Bonilla G., Gamero F. et al. Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 2005;64:375-81.</p><p>Назаренко Г.И., Героева И.Б., Хитрова А.Н. и др. Возможности ультразвукового исследования в оценке активности воспалительного процесса и эффективности лечения пациентов с ревматоидным артритом. Ультразвук и функц диагн 2007;5:83-91.</p><p>Scheel A., Hermann K.-G., Kahler E. et al. A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis. Arthr Rheum 2005;52:733-43.</p><p>Treslev L., Torp-Pedersen S., Savnik A. et al. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arthritis. Arthr Rheum 2003;48:2434-41.</p><p>Александрова Е.Н., Насонов Е.Л. Инновационные технологии в лабораторной диагностике ревматических заболеваний. Науч-практич ревматол 2010;2:13-20.</p><p>Van der Leeden M., Steultjens M., Dekker J. et al. The relationship of diseases duration to foot function, pain and disability in rheumatoid arthritis patients with foot complaints. Clin Exp Rheumatol 2007;25:275-80.</p><p>Puolakka K., Kautiainen H., Pekurinen M. et al. Monetary value of lost productivity over a five year follow up in early rheumatoid arthritis estimated on the basis of official register data on patients' sickness absence and gross income: experience from the FIN-RACo trial. Ann Rheum Dis 2006;65:899-904.</p><p>Вакуленко О.Ю., Кричевская О.А., Горячев Д.В. и др. Взаимосвязь клинических характеристик ревматоидного артрита с трудоспособностью и производительностью труда. Науч-практич ревматол 2012;52(3):60—67.</p><p>Rojas-Villarraga A., Bayona J., Zuluaga N. et al. The impact of rheumatoid foot on disability in Colombian patients with rheumatoid arthritis. BMC Musculoskeletal Disorders 2009;10:67.</p><p>Hooper L., Bowen C., Gates L. et al. Prognostic indicators of foot-related disability in patients with rheumatoid arthritis: results of a prospective three-year study. Arthr Care Res 2012;64:1116-24.</p></div><br />

The authors declare that there are no conflicts of interest present.