RESUMEN
We used Doppler sonography to evaluate the therapeutic effects of infliximab on the knee and metacarpophalangeal (MCP) joints of 10 patients with rheumatoid arthritis (RA), based on the color flow signals (CFS) and resistance index (RI) of synovial vascularity. After three injections of infliximab, we observed significant improvement in numbers of tender joints (P < 0.01), values of C-reactive protein (CRP) (P < 0.01), erythrocyte sedimentation rate (ESR) (P < 0.001), disease activity scores including tender joints, swollen joints, and ESR (DAS28-E3) (P < 0.0001), and CFS of knee (P < 0.001) and MCP (P < 0.05) joints. There was no significant improvement in RI values of knee or MCP joints after the therapy. We observed significant correlation between CFS of knee joints (knee-CFS) and values of CRP (P < 0.01), ESR (P < 0.01), and DAS28-E3 (P < 0.05), but not between CFS of MCP joints (MCP-CFS) and values of CRP, ESR, and DAS28-E3. However, no significant correlation was observed between 10 difference values (before values-after values) of CFS grades of knee or MCP joints and 10 difference values each of CRP, ESR, or DAS28-E3. The knee joints are more suitable than MCP joints for obtaining CFS in Doppler sonography, and are more useful than MCP joints for evaluation.
Asunto(s)
Anticuerpos Monoclonales/administración & dosificación , Antirreumáticos/administración & dosificación , Artritis Reumatoide/diagnóstico por imagen , Artritis Reumatoide/tratamiento farmacológico , Articulación de la Rodilla/diagnóstico por imagen , Articulación Metacarpofalángica/diagnóstico por imagen , Ultrasonografía Doppler/métodos , Adulto , Anciano , Artritis Reumatoide/fisiopatología , Sedimentación Sanguínea , Proteína C-Reactiva/metabolismo , Femenino , Humanos , Infliximab , Articulación de la Rodilla/irrigación sanguínea , Masculino , Articulación Metacarpofalángica/irrigación sanguínea , Persona de Mediana Edad , Membrana Sinovial/irrigación sanguínea , Membrana Sinovial/diagnóstico por imagenRESUMEN
BACKGROUND: C reactive protein (CRP) and serum amyloid A (SAA) are similarly sensitive indicators of inflammation, but discrepancies are recognized in several disease conditions. SAA levels are generally higher and vary more among individuals. The significance of the SAA/CRP ratio was evaluated in the estimation of SAA. METHODS: Sera of out-patients with rheumatoid arthritis (RA) and healthy subjects were measured for CRP and SAA cross-sectionally and longitudinally by a highly sensitive latex agglutination turbidimetric immunoassay. The results were classified into four groups according to the CRP concentration, and the SAA/CRP ratios were calculated and evaluated. RESULTS: In the cross-sectional study, CRP and SAA were shown to correlate significantly in sera of patients with RA, but not in healthy subjects. The SAA/CRP ratios were wide RA patients and tended to decrease in the range and mean values were observed depending on the concentration of CRP. In the longitudinal study, variations of the ratio among individuals were wide, but smaller and similar within individuals. The difference in magnitude of the ratios is due to the difference in SAA concentration. CONCLUSION: Variations of SAA/CRP ratios were affected by SAA concentrations. The ratio should be checked in the evaluation of SAA.
Asunto(s)
Artritis Reumatoide/sangre , Artritis Reumatoide/patología , Proteína Amiloide A Sérica/análisis , Índice de Severidad de la Enfermedad , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Estudios de Casos y Controles , Estudios Transversales , Humanos , Inflamación/diagnóstico , Estudios LongitudinalesRESUMEN
Synovial vascularization was analyzed by power Doppler and spectral Doppler sonography in 42 knee joints of 28 patients with rheumatoid arthritis. The synovial vessels with greater intensity of color flow signals demonstrated significantly lower indicators of vascular resistance - resistive index (P < 0.01) and pulsatility index (P < 0.01) - than those with lesser intensity. Consequently, an inverse correlation was observed between intensity of color flow signals and both resistive index (P < 0.01) and pulsatility index (P < 0.01).
RESUMEN
Synovial vascularization in the knee joints of six patients with rheumatoid arthritis who were treated with infliximab was evaluated by Doppler sonography. Power Doppler sonography demonstrated a significant reduction of color flow signals (P < 0.05), and spectral Doppler sonography demonstrated a significant increase in vascular resistance (P < 0.05) at week 6 (after three injections) evaluation of the therapy. A significant decrease in the number of tender joints (P < 0.05) and C-reactive protein value (P < 0.05) was also observed in these patients.