DIAGNOSIS OF RHEUMATOID ARTHRITIS: A COMPARISON OF RADIOLOGICAL DIAGNOSTIC METHODS

Reumatoidni artritis je kronična multisustavna autoimuna bolest čije su primarno sijelo sinovijalni, i to mali zglobovi šaka i stopala. Dovodi do oštećenja zglobnih tijela te posljedičnih deformiteta koji u konačnici uvelike degradiraju kvalitetu života oboljelih pacijenata. Koštane erozije su ireverzibilne i uobičajeno se smatraju znakom uznapredovale bolesti. Supresija simptoma, remisija bolesti ali i sprječavanje nastanka erozija moguća je primjenom nove vrste farmakološke terapije- bioloških agenata. Iskorištavanje svih prednosti koje donosi nova terapija moguće je uz pravodobnu dijagnozu. Radiologija dobiva novi zadatak- detektirati upalni proces koji predstavlja početnu fazu bolesti i prethodi nastanku koštanih erozija. Primjena bioloških agenata neminovno rezultira dobrom prognozom za pacijente s RA. Konvencionalna radiologija, iako pouzdana, ne nudi mogućnost konkretnog prikaza ranih simptoma RA. Ultrazvučna dijagnostika i magnetna rezonancija pružaju dijagnostičke informacije koje konvencionalna radiologija ne može dati. Sinovitis i tenosinovitis kao indikatore upalnog stanja možemo prikazati ultrazvučnom dijagnostikom i magnetnom rezonancom. Potonja se izdvaja u prikazu edema kosti, koji nije moguć niti jednim drugim opisanim modalitetom. Ultrazvuk se u našem pregledu znanstvenih radova pokazao učinkovitijim u prikazu ranih koštanih erozija i sinovitisa nego li magnetna rezonancija. Iako je edem kosti najpouzdaniji prediktor ove bolesti, držimo da je ultrazvučna dijagnostika ipak metoda izbora za ranu dijagnozu reumatoidnog artritisa, prvenstveno radi široke dostupnosti i ekonomskih razloga, ali i kvalitetnog prikaza sinovitisa.Rheumatoid arthritis (RA) is a chronic, multisystemic autoimune disease that onsets primarily in the small joints of hands and feet. It causes structural damage in the joints and leads to deformities that can greatly degrade the quality of patients' lives. Bone erosions caused by this disease are irreversible and tend to be considered as an indicator of a progressed disease. New drug treatment - biological agents can significantly effect the course of the disease and even cause remission. The only way to yield these benefits is by detecting the disease early on. Therefore, radiology gets assigned with a new task - to detect early signs of inflammation; it being the first stage of the disease. New drug treatment - biological agents offer undeniable benefits in patients with early RA. Although reliable, conventional radiography gives poor information in the early diagnosis. Both ultrasound and magnetic resonance offer valuable depictions in the early diagnosis, ones where conventional radiography is not sufficient. Synovitis and tenosynovitis are considered to be early signs of inflammation, both detectable by magnetic resonance and ultrasound. Bone marrow edema, on the other hand, is detectable only by magnetic resonance. Although bone marrow edema is considered to be the strongest predictor of RA, conclusion made in this work suggests that ultrasound is the best method in this area. Foremly for its wide availability and economic reasons, but also for its good depiction of synovitis