VRIJEDNOST DIJAGNOSTIČKOG ULTRAZVUKA I POWER DOPPLERA U DETEKCIJI RANOG ARTRITISA

Porin Perić, Nadica Laktašić-Žerjavić

Magnetic resonance imaging (MRI) of small joints of the hands and feet is still “the gold standard“ in detecting early inflammatory changes in the patients with rheumatoid arthritis (RA). Radiographic assessment has only limited value in early diagnostic of RA. The limited accessibility of MRI makes both ultrasound (US) and Power Doppler (PD) of small joints of hands and feet equally useful tools as they give the same results as MRI in evaluating some of the pathologies such as: bone erosions, intraarticular effusions and changes of tendons. Power Doppler can detect subclinically synovitis of the small joints in the early phase of RA. Nowdays, in the fi eld of rheumatology we talk about US and PD as “a rheumatologist’s prolonged finger“ or as “ a rheumatological stetoscope“, exactly because of their accessibility and possibility of getting quick and useful information about the patient himself. Since US and PD are inexpensive and non-invasive procedures, they can greatly improve diagnostics in RA and especially the assessment of the early phase of the inflammatory diseases, which can serve as a reliable indicator of the overal progression of the disease. Some new data show possibility of monitoring patients with RA and their response on disease modifying antirheumatic drugs (DMARDs) or biologicals by US and PD.

U detekciji ranih upalnih promjena u bolesnika s RA magnetska rezonancija (MR) još uvijek predstavlja “zlatni standard”. Radiološka pretraga općenito ima samo ograničenu vrijednost u ranoj dijagnostici RA. Zbog teže i ograničene dostupnosti MR aparata, primjena dijagnostičkoga ultrazvuka (UZV) i Power Doplera (PD) malih zglobova šaka i stopala vrlo je korisna i u nekim dijelovima podudarna s nalazima rezultata MR, posebice u otkrivanju koštanih erozija, tendinitisa i intraartikularnog izljeva. Power Doppler može otkriti subklinički sinovitis malih zglobova šaka u ranoj fazi RA. Danas se u reumatologiji o UZV i PD govori kao “produženom prstu reumatologa” ili “reumatološkom stetoskopu”, upravo zbog njihove dostupnosti i mogućnosti brzoga dobivanja kvalitetnih informacija o bolesniku. Budući se radi o izrazito neinvazivnim i jeftinim pretragama, primjenom UZV i PD osobito u ranim fazama bolesti, znatno se može unaprijediti dijagnostika u RA i procijeniti stupanj upalnih promjena u upalnim reumatskim bolestima, što može biti pokazatelj i ukupne progresije bolesti. Noviji radovi ukazuju i na mogućnost praćenja odgovora na temeljnu i biološku terapiju primjenom UZV i PD.