Sonografie in der Früherkennung und Bewertung von Arthritiden

Zusammenfassung

Bei Verdacht auf eine neu aufgetretene Arthritis ist frühzeitig eine eindeutige Diagnose und Prognoseeinschätzung wichtig. Die Sonografie zeigt, ob Beschwerden durch entzündliche Veränderungen erklärt werden können. Dabei kann sie zwischen Synovitis, Erguss, Tenosynovitis, Bursitis oder anderen Raumforderungen unterscheiden. Durch die Sonografie können Schmerzsyndrome, Arthrosen, Psoriasis-Arthritis, Gicht, Pseudo-gicht, eitrige Arthritiden oder eine Polymyalgia rheumatica von der rheumatoiden Arthritis abgegrenzt werden. Im Praxisalltag wird die Sonografie für den Verlauf bei fraglichem klinischem Befund eingesetzt, um Therapieentscheidungen zu treffen. Ob eine routine-mäßige Suche nach subklinischen Entzündungen im Verlauf eine Prognoseverbesse-rung bewirkt, ist noch nicht erwiesen. Scores eignen sich insbesondere für die Verlaufs -beurteilung in Studien. Der sonografische Nachweis einer synovialen Hyperperfusion, von Erosionen trotz radiografisch normalen Befunden sowie einer Tenosynovitis der Extensor-carpi-ulnaris-Sehne erhöhen die Wahrscheinlichkeit einer radiografisch erosiv verlaufenden rheumatoiden Arthritis.

Summary

In suspected early arthritis definite diagnosis and evaluation of prognosis are crucial. Ultrasound allows determining if symptoms can be explained by inflammation. It helps to differentiate synovitis from effusion, bursitis and soft tissue masses. Ultrasound allows distinguishing rheumatoid arthritis from pain syndromes, osteoarthritis, psoriatic arthritis, gout, pseudogout, septic arthritis or polymyalgia rheumatica. For follow-up, ultrasound aids in clinical practice to reach therapeutic decisions in clinically ambivalent situations. It is not yet clear if routine ultrasound exams for detecting subclinical inflammation would improve the prognosis of rheumatoid arthritis. However, ultrasound has become an outcome parameter in clinical trials using evaluated scores. Prognostic ultrasound parameters for developing radiographically erosive rheumatoid arthritis are synovial hyperperfusion, detection of erosions despite normal X-rays, and extensor carpi ulnaris tenosynovitis.

Schlüsselwörter

Ultraschall - Arthritis - rheumatoide Arthritis - Früharthritis

Keywords

Ultrasound - arthritis - rheumatoid arthritis - early arthritis

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