近年來，民眾對於類風溼性關節炎的認知，經由媒體衛教及網路資訊傳播已漸漸提高，但要確診卻沒有那麼容易。拜醫療科技進步之賜，類風溼性關節炎已可經由骨骼肌肉超音波診斷，和傳統X光影像不同之處，在於骨骼肌肉超音波能提供關節滑膜、肌腱、韌帶、肌肉和骨頭表面的影像，同時可以就受試者的運動情況做動態的評估，進一步了解關節發炎的程度。
骨骼肌肉超音波 早期診斷追蹤治療
臺北市立聯合醫院和平婦幼院區過敏免疫風濕科主治醫師蔡明學說，骨骼肌肉超音波在類風濕性關節炎的應用，最主要有：
1. 早期診斷：在偵測早期類風濕性關節炎方面上，超音波比臨床檢查更敏感。
2. 疾病監測：藉由超音波影像學上的變化，可以追蹤類風濕性關節炎活性和對治療後的反應。
3. 預後評估：在疾病早期若偵測到骨侵蝕代表預後不佳，使臨床醫師早期且積極地使用疾病修飾抗風濕藥物治療類風濕性關節炎。
4. 介入性治療：關節液抽吸和關節內注射是診斷和治療類風濕性關節炎的實作項目。
即時動態影像 準確定位病灶
蔡明學醫師指出，傳統診斷類風濕性關節炎的方法是利用觸診的方式，找出體表骨骼作為定位標的，進行關節液抽吸和關節內注射，但常規觸診有困難的關節或是較小的關節，利用這種方法容易造成診斷和治療失敗。使用超音波導引，透過即時動態影像，可以準確定位病灶位置，增加診斷和治療的成功機率。
蔡明學表示，骨骼肌肉超音波有許多優點，包括具有可近性、無輻射性、費用相對便宜，且能動態追蹤疾病變化，具有早期診斷、評估疾病活性和追蹤治療反應的有效工具。隨著骨骼肌肉超音波與類風濕性關節炎相關研究持續發表，以及臨床醫師孰悉度不斷提升，將來骨骼肌肉超音波很可能成為類風濕性關節炎診斷及治療準則的一部分。
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In recent years, the public's awareness of rheumatoid arthritis has gradually increased through media education and online information dissemination, but it is not so easy to diagnose. Thanks to advances in medical technology, rheumatoid arthritis has been diagnosed via skeletal muscle ultrasound, which differs from traditional X-ray images in that skeletal muscle ultrasound provides joint synovial membranes, tendons, ligaments, muscles and bone surfaces. The image can also be dynamically evaluated on the subject's exercise to further understand the extent of joint inflammation.
Skeletal muscle ultrasound early diagnosis and treatment
Cai Mingxue, an attending physician at the Department of Allergy and Immunology, Department of Hepatic and Child Health, Taipei City United Hospital, said that the most important applications of skeletal muscle ultrasound in rheumatoid arthritis are:
1. Early diagnosis: Ultrasound is more sensitive than clinical examination in detecting early rheumatoid arthritis.
2. Disease surveillance: Rheumatoid arthritis activity and response to treatment can be tracked by changes in ultrasound imaging.
3. Prognostic assessment: If bone erosion is detected in the early stages of the disease, the prognosis is poor, allowing clinicians to use rheumatoid arthritis early and aggressively with disease-modifying antirheumatic drugs.
4. Interventional therapy: Joint fluid aspiration and intra-articular injection are the implementation projects for the diagnosis and treatment of rheumatoid arthritis.
Instant motion image Accurate location of lesions
Dr. Cai Mingxue pointed out that the traditional method of diagnosing rheumatoid arthritis is to use the method of palpation to find the surface bone as the target, for joint fluid aspiration and intra-articular injection, but the conventional palpation has difficulty in the joint or Smaller joints can easily lead to diagnosis and treatment failure using this method. Using ultrasound guidance, through instant motion images, you can accurately locate the lesion and increase the chances of success in diagnosis and treatment.
According to Cai Mingxue, skeletal muscle ultrasound has many advantages, including being close-to-close, non-radiative, relatively inexpensive, and capable of dynamically tracking disease changes, with an effective tool for early diagnosis, assessment of disease activity, and tracking of treatment response. As skeletal muscle ultrasound and rheumatoid arthritis related research continues to be published, and clinicians continue to improve, skeletal muscle ultrasound is likely to become part of the diagnostic and therapeutic guidelines for rheumatoid arthritis.
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