類風溼性關節炎病人於棘上肌肌腱撕裂的超音波形態

Ultrasonographic pattern of supraspinatus tendon tear in patients with rheumatoid arthritis

Objective: To identify supraspinatus tendon tear and its pattern in rheumatoid arthritis (RA), and toinvestigate the effects of supraspinatus tendon tear on shoulder symptomatology.Methods: We enrolled adult RA patients at an outpatient department during a one-year period from 1Jan 2015 to 31 Dec 2015. Each patient received physical examination and standard ultrasound (US)assessment of bilateral shoulders. Supraspinatus tendon tear and its pattern were analyzed. Serology,inflammatory markers and simplified disease activity index (SDAI) were assessed.Results: Sixty-seven RA patients (total 134 shoulders) were enrolled. Intratendinous hypoechoic area andmicrocalcification identified by US were the most common abnormalities of rotator cuff. The prevalenceof supraspinatus tendon tear was 12.7%. Among these tears, superficial tear and deep tear predominated.There were no significant differences in shoulder symptomatology, serology, inflammatory markers andSDAI between patients with and without supraspinatus tendon tear. However, the age of RA patientswith supraspinatus tendon tear was statistically significant older in comparison to the group withoutsupraspinatus tendon tear. Glenohumeral synovitis was relatively rare.Conclusion: Supraspinatus tendon tear is relatively common in RA. We recommend US assessment forRA patients with symptomatic shoulder, especially in the elderly. 目的：鑑別類風溼性關節炎病人的棘上肌肌腱撕裂及其形態，並研究棘上肌肌腱撕裂於肩部症狀學上之影響。方法：本研究於民國104年1月1日至民國104年12月31日間收集門診之成人類風濕性關節炎病人，每位病人均接受雙肩之理學檢查暨超音波標準檢查流程。針對棘上肌肌腱撕裂及其形態進行分析，並收集且評估其血清學表現、發炎指標、和簡化版之疾病活動度指數。結果：共67位類風溼性關節炎病人，134個肩部被納入此研究。於超音波中最常見的旋轉肌異常發現為肌腱內低迴音區域與微鈣化點。棘上肌肌腱撕裂之盛行率為12.7%，其中表層肌腱股撕裂和深層肌腱股撕裂占多數。無論有無棘上肌肌腱撕裂，兩者於肩部症狀、血清學表現、發炎指標、和簡化版之疾病活動指數皆無顯著差異。唯棘上肌肌腱撕裂之病人族群，其年齡較長有統計上的顯著意義。肩關節滑囊炎相對罕見。結論：於類風濕性關節炎病人中，棘上肌肌腱撕裂相對常見。本研究建議於有肩部症狀的類風濕性關節炎病人行超音波評估，特別是老年族群。