Zusammenfassung
Hintergrund
Die rheumatoide Arthritis (RA) kann zu destruierenden Arthritiden an den Gelenken insbesondere der Hände führen. Nur wenn die Krankheit frühzeitig, auch mit Hilfe bildgebender Methoden, diagnostiziert wird, lassen sich durch rasche und kontinuierliche sog. zielgerichtete Behandlungsansätze strukturelle Gelenkschäden mit den daraus folgenden Behinderungen sowie systemische Manifestationen, wie z. B. kardiovaskuläre Schäden, vermeiden.
Ziel der Arbeit
Systematische Beschreibung und Befundung der bildgebenden Verfahren bei der RA als der häufigsten autoimmunologischen rheumatologischen Erkrankung mit ihren typischen synovitischen manuellen Arthritismustern.
Material und Methoden
Narratives Review auf dem Boden der aktuellen Literatur zum Thema aus radiologischer und rheumatologischer Sicht.
Ergebnisse
Entzündliche Manifestationen an den Händen stellen bei der RA die häufigsten betroffenen Regionen am Körper dar. Hinsichtlich der Topik der bevorzugt befallenen anatomischen Strukturen an den Händen und der typischen synovitischen Arthritismuster zeigen sich Variabilitäten zwischen Früh- und Spätstadien. Kenntnisse der bildmorphologischen Veränderungen dieser komplexen Erkrankung insbesondere an den Händen werden vermittelt, um dadurch eine größere Sicherheit in deren Diagnostik und in der Erkennung von Frühstadien zu erlangen.
Diskussion
Zur bildgebenden Diagnostik der RA an den Händen sind Basiskenntnisse essenziell, um die notwendige Sicherheit in der systematischen diagnostischen Evaluation der typischen manuellen Arthritismuster sowohl bei der Erstdiagnose als auch im Erkrankungsverlauf sowie in der Einordnung von Früh- und Spätstadien zu erlangen, welche dem Rheumatologen als Weichenstellungen für Therapieentscheidungen dienen.
Abstract
Background
Rheumatoid arthritis can cause joint destruction, especially joints of the hands. Diagnosed at an early stage, which often includes imaging methods, can minimize structural joint damage and resulting disabilities as well as avoid systemic manifestations such as cardiovascular damage through rapid and continuous so-called targeted treatment approaches.
Objective
The aim of this work is the systematic description and report of imaging findings in rheumatoid arthritis as the most common autoimmunologic rheumatologic disease, which is characterized by a typical pattern of synovitis of the hands.
Materials and methods
Narrative review based on the current literature on the subject from the radiological and rheumatological point of view.
Results
Inflammation of the hands represents the most frequently affected area of the body in rheumatoid arthritis. Taking into consideration the topology and typical synovitis patterns of the hands, differences between early and late stages are described. Knowledge regarding image-based morphological changes associated with this complex disease, especially in the hands, is important in the differential diagnosis, especially in early stages of the disease.
Conclusions
For the diagnosis of rheumatoid arthritis of the hands, the radiologist must be familiar with basic knowledge of arthritis in the hands to confidently analyze the typical patterns present in the diagnostic imaging at initial diagnosis and during the course of the disease, which serve as a guide for therapy decisions.
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Für diesen Beitrag wurden von dem Autor keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.
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Bollow, M. Rheumatoide Arthritis der Hand. Radiologe 61, 362–374 (2021). https://doi.org/10.1007/s00117-021-00833-3
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DOI: https://doi.org/10.1007/s00117-021-00833-3
Schlüsselwörter
- Autoimmunologische rheumatologische Erkrankungen
- Bildgebung der Hände
- Synovitische Arthritismuster
- Frühstadium
- Spätstadium