medicina57巻12号

2020年11月発行

特集 膠原病・自己免疫疾患を「見える化」する 臨床から見える化する 【関節リウマチ】

関節炎局所を見える化する—関節エコーとMRI

著者： 池田啓¹

所属機関： ¹千葉大学大学院医学研究院アレルギー臨床免疫学

ページ範囲：P.2059 - P.2063

Point
◎関節炎の症状や所見は多様であり，問診および触診のみでの評価は難しい場合がある．
◎関節エコーおよびMRIでは，滑膜炎，関節包炎，腱鞘滑膜炎，滑液包炎，付着部炎，骨炎，結晶沈着などを見える化することができる．
◎関節炎の見える化により，疾患の診断と除外，モニタリングの精度が向上しうる．
◎関節炎の見える化により，疾患概念が変化することがありうる．

参考文献

1）Kobayashi Y, et al：Severity and diurnal improvement of morning stiffness independently associate with tenosynovitis in patients with rheumatoid arthritis. PLoS One 11：e0166616, 2016

2）Wouters F, et al：Difficulties making a fist in clinically suspect arthralgia；An easy applicable phenomenon predictive for RA that is related to flexor tenosynovitis. Ann Rheum Dis 78：1438-1439, 2019

3）Nakagomi D, et al：Ultrasound can improve the accuracy of the 2010 American College of Rheumatology/European League against rheumatism classification criteria for rheumatoid arthritis to predict the requirement for methotrexate treatment. Arthritis Rheum 65：890-898, 2013

4）Tamai M, et al：A prediction rule for disease outcome in patients with undifferentiated arthritis using magnetic resonance imaging of the wrists and finger joints and serologic autoantibodies. Arthritis Rheum 61：772-778, 2009

5）Ikeda K, et al：Correlation of radiographic progression with the cumulative activity of synovitis estimated by power Doppler ultrasound in rheumatoid arthritis；Difference between patients treated with methotrexate and those treated with biological agents. J Rheumatol 40：1967-1976, 2013

6）Østergaard M, et al：New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier. Arthritis Rheum 48：2128-2131, 2003

7）Lillegraven S, et al：Tenosynovitis of the extensor carpi ulnaris tendon predicts erosive progression in early rheumatoid arthritis. Ann Rheum Dis 70：2049-2050, 2011

8）Matthijssen XME, et al：A search to the target tissue in which RA-specific inflammation starts；A detailed MRI study to improve identification of RA-specific features in the phase of clinically suspect arthralgia. Arthritis Res Ther 21：249, 2019

9）van Steenbergen HW, et al：Characterising arthralgia in the preclinical phase of rheumatoid arthritis using MRI. Ann Rheum Dis 74：1225-1232, 2015