Background Early diagnosis of erosive lesions in rheumatoid arthritis (RA) remains today an important task, especially in the absence of specific laboratory markers. Promising research aimed at studying the informative instrumental diagnostic methods (ultrasound, Rg, MRI) to identify the characteristics of erosive joint damage in patients with RA [1].

Objectives To study diagnostic possibilities of instrumental methods to identify the species of erosive joint damage in patients with RA.

Methods We examined 104 patients with RA. Among patients of the 1st group were women 81 (77.9%), men - 23 (22,1%), average age was 38±12.1 years. Diagnosis of rheumatoid arthritis was exhibited with the EULAR diagnostic criteria [2] and the ACR [3]. All patients were Rg-graphy, ultrasound and MRI of the hands. Statistical processing of the information package.

Results Erosive lesion of joints at RA is presented by the proliferation-caused erosion (erosion of the pannus) in combination with the development of the focal pannus with vascularization and inflammatory-destructive erosion (true erosion inflammation) outside the pannus (image 1). In the study the true erosion of inflammation of the articular surface of the bone ultrasound method identified at 87.9% of the joints in RA, significantly higher (p<0,0001) than in 34% of the joints in Rg-study; erosion pannus identified in 99.2% of the joints in patients with RA by means of ultrasonography, was significantly higher (p<0,0001) than 24.3% of the joints in the Rg-study. So erosion from the focal invasive growth of pannus, associated erosion, erosion, acute and chronic inflammation of the articular surface of the bone in patients with RA by ultrasonography were visualized significantly more often (p<0,0001) than in Rg, which allowed to define only the fact of presence of erosive lesions of the joints, but not allowed to determine the erosive lesions. The sensitivity of ultrasound accounted for 97.9% (95% CI: 97,7–98,1%); specificity - of 95.7% (95% CI: of 95.5–95.9 per cent). And in Rtg-graphy sensitivity accounted for 55.3% (95% CI: 54,8–55,8%); the specificity - of 87.7% (95% CI: 87,4–88%).

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Conclusions When comparing the results of a comprehensive study of joints in patients with RA despite the fact that Rg and MRI allow us to visualize and measure bone structure and pathology, ultrasound is only allowed to identify two types of erosive lesions of the joints: the true erosion inflammation and erosion of the pannus.

References

1. Sirotka V. Cliniko-tool differential diagnostics erosive lesions of joints at patients with rhematoid and reactive arthritis. V. Sirotka, A. Litvyakov. Vedecky Prumysl Evropskeno Kontinentu-2013: Materialy IX Mezinarodni Vedecko-Prakticka Conference, Praha, 27 Listopadu - 05 Prosincu 2013 rocu. Praha Publishing House “Education and Science”. Praha, 2013. pp. 23–24.

2. 2010 Rheumatoid Arthritis Classification Criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative/D. Aletaha et al. Ann. Rheum. Dis. 2010(69)1580–1588.

3. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis/F.C. Arnrett et al. Arthritis Rheum. 1988(31):315–324.

References

Acknowledgements Gratitude my supervisor professor, PhD. Litvyakov A., for the help in conducting studies head of the Department of ultrasonic diagnosis PhD. Shilenok V. and my family (Sirotka and Seviaryn) for their support and understanding.

Disclosure of Interest None declared