关键词: 关节炎, 类风湿；滑膜炎；超声检查；抗环瓜氨酸肽抗体

Abstract: Background　Subclinical synovitis refers to synovitis found under ultrasound or nuclear magnetic resonance，and no signs of joint swelling are found in clinical physical examination. Studies have shown that subclinical synovitis joints in patients with rheumatoid arthritis （RA） still have radiological progression of bone erosion，suggesting that subclinical synovitis joints are still in disease activity.Objective　To investigate the clinical features of subclinical synovitis measured with ultrasound in RA.Methods　In this clinical trial，a total of 132 outpatients and inpatients with RA receiving treatment from Department of TCM Rheumatology，China-Japan Friendship Hospital from April 2017 to May 2018 were enrolled.We used clinical physical examination and ultrasound to evaluate 28 joints including the metacarpophalangeal joints，proximal interphalangeal joints，wrist joints，elbow joints，shoulder joints and knee joints.The joints that showed no swelling in physical examination，but were detected with subclinical synovitis by ultrasound （i.e. subclinical synovitis joints） were recorded.The number of joints affected with subclinical synovitis in RA patients were analyzed by gender，age，erythrocyte sedimentation rate （ESR），C-reactive protein （CRP），rheumatoid factor （RF），and anti-cyclic citrullinated peptide （CCP） antibody.Results　Among the 132 cases，14 were male and 118 were female；37 were 18-44 years old，53 were 45-59 years old，42 were 60-75 years old；ESR：43 normal cases，89 abnormal cases；CRP：45 normal cases，87 abnormal cases；RF：34 negative cases，56 cases of low titer，42 cases of high titer；anti-CCP antibody：33 negative cases，17 cases of low titer，82 cases of high titer.Number of joints with subclinical synovitis：106 patients were found with subclinical synovitis and other 26 without.Gender，age，levels of ESR，CRP and RF were not associated with the number of joints with subclinical synovitis in RA patients（P>0.05）．High titer of anti-CCP antibody was associated with more joints affected with subclinical synovitis while negative and low titer of anti-CCP antibodies were not（P<0.05）．Conclusion　High titer of anti-CCP antibody is associated with subclinical synovitis in RA to various degrees，suggesting that in addition to clinical physical examination，ultrasound examination is needed for RA patients with high titer of anti-CCP antibody in order to assess the disease activity of RA intensively.

Key words: Arthritis, rheumatoid；Synovitis；Ultrasonography；Anti-cyclic citrullinated peptide antibody