关键词: 关节炎, 类风湿；证候；超声检查；肌肉骨骼系统

Abstract: Background　Previous studies have shown that laboratory，imaging and clinical parameters differ significantly in rheumatoid arthritis（RA）patients by traditional Chinese medicine（TCM）syndrome，and studying these parameters can provide evidence for TCM syndrome differentiation.TCM syndrome-based analysis of musculoskeletal ultrasound findings of 28 joints in RA patients provide evidence for the treatment of this disease according to syndrome differentiation.Objective　To perform a TCM syndrome-based analysis of musculoskeletal ultrasound findings of 28 joints in RA patients，so as to provide a basis for incorporating musculoskeletal ultrasonography into TCM syndrome differentiation system of RA.Methods　From April 2017 to April 2018，120 inpatients and outpatients were selected from Department of TCM Rheumatology，China-Japan Friendship Hospital，and were divided into 4 commonly seen syndromes defined in Guidelines for Clinical Research of New TCM Drugs.Clinical and laboratory data were collected，including age，sex，course of RA，C-reactive protein（CRP），erythrocyte sedimentation rate（ESR），anti-cyclic citrullinated peptide（ACPA），rheumatoid factor（RF）（since anti-ACPA and RF were exponentially increased，it is convenient to process data using ln（ACPA+1）and ln（RF+1）for data statistics），28-tender joint count（TJC28），28-swollen joint count（SJC28），self-rated general health（GH）score，and Disease Activity Score 28（DAS28）．Findings of musculoskeletal ultrasound of 28 joints were also obtained，including synovitis joint count，synovitis score，Power Doppler（PD）joint count，PD score，and bone erosion count.Results　For the TCM syndromes of 120 patients，there were 42 cases of dampness-heat obstruction syndrome，32 cases of deficiency of liver and kidney syndrome，25 cases of cold-dampness obstruction syndrome，and 21 cases of phlegm-stasis obstruction syndrome.The average RA course of patients with deficiency of liver and kidney syndrome was longer than that of those with dampness-heat obstruction syndrome or phlegm-stasis obstruction syndrome（P<0.05）．The average levels of CRP，ESR，ln（RF+1），SJC28，self-rated GH score，DAS28 of patients with dampness-heat obstruction were higher than those of other three groups（P<0.05）．The average TJC28 of patients with dampness-heat obstruction was more than that of those with cold-dampness obstruction or phlegm-stasis obstruction（P<0.05）．Both average synovitis joint count and synovitis score of patients with dampness-heat obstruction and those with deficiency of liver and kidney were larger than those of patients with cold-dampness obstruction and those with phlegm-stasis obstruction（P<0.05）．Patients with dampness-heat obstruction showed greater average PD joint count and PD score compared with other three groups（P<0.05）．The average bone erosion count of patients with dampness-heat obstruction was less than that of those with deficiency of liver and kidney，but greater than that of those with cold-dampness obstruction（P<0.05）．The average bone erosion count of patients with deficiency of liver and kidney was greater than that of those with cold-dampness obstruction or phlegm-stasis obstruction（P<0.05）．Conclusion　Laboratory and clinical parameters are closely related to the TCM syndrome in RA patients.In particular，dampness-heat obstruction syndrome is associated with high RA disease activity.Moreover，TCM syndrome has a certain correlation with the musculoskeletal ultrasound findings of 28 joints in RA patients.The dampness-heat obstruction syndrome is closely related to synovitis and PD，while the deficiency of liver and kidney syndrome is accompanied by more bone erosion joints.

Key words: Arthritis, rheumatoid；Symptom complex；Ultrasonography；Musculoskeletal system