ACR：骨骼肌肉超声可对风湿病门诊诊断进行补充和修正

  来自罗马尼亚克卢日 - 纳波卡康复临床医院的MIHAELA C. MICU等人进行了一项研究，该研究的目的是评价骨骼肌肉超声（MSUS）作为一种临床快速诊断和治疗决策拟定的补充方法，对繁忙的风湿病门诊所起的作用。研究结果在线发布在2013年4月的《关节炎护理及研究》（Arthritis Care & Research）杂志上。作者发现，MSUS评价能获得的更多的信息，对临床检查后的初始诊断和治疗策略的修正具有重要意义。
  该研究共纳入60位具有不同骨骼肌肉症状的患者。三位风湿病专家对其进行临床检查并完成一份标准的临床报告表，该报告表包括如下参数：一般和/或本地诊断，规范的系统和/或局部治疗方案及治疗决定（包括是否考虑使用MSUS作为临床检查的补充）。另一位风湿病专家，在对临床数据不知情的情况下，对临床医生选择的解剖区域进行MSUS检查。依据初步临床诊断和治疗策略的改变程度，来评价MSUS获得新信息的对初步诊断和治疗策略的作用。
  研究结果如下，在60位患者（67个解剖部位）中，39位（65%）患者、总共43个解剖区域（64.17%）经临床检验之后，MSUS被认为是必须的。60%解剖区域的初步临床诊断的出现改变。在所有解剖区域中（100%），新诊断更加的客观和详细。25%解剖区域的初始系统治疗出现改变，36%的解剖区域的初始局部治疗出现改变。MSUS对15%解剖区域中的诊断具有指导意义，对22%解剖区域中的局部灌注治疗具有指导意义。
  研究发现，MSUS评价能获得的更多的信息，导致临床检查后的初始诊断和治疗策略的修正，具有重要的应用价值。

Impact of musculoskeletal ultrasound in an outpatient rheumatology clinic.
OBJECTIVE
To evaluate the impact of musculoskeletal ultrasound (MSUS) as a complementary method to clinical assessment on rapid diagnosis and therapeutic decisions in a busy outpatient rheumatology clinic.
METHODS
Sixty patients with different musculoskeletal symptoms were included in the study. Three expert rheumatologists performed the clinical examination and filled out a standardized clinical report sheet with the following parameters: general and/or local diagnoses, planned systemic and/or local treatment, and their decision concerning the use of MSUS evaluation complementary to clinical examination. Another rheumatologist, blinded to clinical data, performed the MSUS assessment of the anatomic areas selected by the clinicians. The impact of the new information obtained by MSUS on the initial diagnosis and therapeutic strategy was estimated by the degree of change in the initial clinical diagnosis and therapy decisions.
RESULTS
Of 60 patients (67 anatomic areas), MSUS was considered as necessary after clinical examination in 39 patients (65%), totaling 43 anatomic areas (64.17%). An overall change of the initial clinical diagnosis was present in 60% of the anatomic areas (P = 0.0175). In all of the anatomic areas (100%), the new diagnosis was more objective and detailed. An overall change of the initial systemic therapy was present in 25% of anatomic areas (P = 0.0014) and in 36% of anatomic areas (P = 0.095) for local therapy. A guided diagnostic aspiration was decided to be performed in 15% of anatomic areas and a guided therapeutic injection in 22% of anatomic areas.
CONCLUSION
Enhanced information obtained by MSUS evaluation leads to changes, with a significant impact on the initial diagnosis and treatment strategy designed after clinical examination.