Abstract: Background　Subclinical synovitis refers to synovitis found under ultrasound or nuclear magnetic resonance，and no signs of joint swelling are found in clinical physical examination. Studies have shown that subclinical synovitis joints in patients with rheumatoid arthritis （RA） still have radiological progression of bone erosion，suggesting that subclinical synovitis joints are still in disease activity.Objective　To investigate the clinical features of subclinical synovitis measured with ultrasound in RA.Methods　In this clinical trial，a total of 132 outpatients and inpatients with RA receiving treatment from Department of TCM Rheumatology，China-Japan Friendship Hospital from April 2017 to May 2018 were enrolled.We used clinical physical examination and ultrasound to evaluate 28 joints including the metacarpophalangeal joints，proximal interphalangeal joints，wrist joints，elbow joints，shoulder joints and knee joints.The joints that showed no swelling in physical examination，but were detected with subclinical synovitis by ultrasound （i.e. subclinical synovitis joints） were recorded.The number of joints affected with subclinical synovitis in RA patients were analyzed by gender，age，erythrocyte sedimentation rate （ESR），C-reactive protein （CRP），rheumatoid factor （RF），and anti-cyclic citrullinated peptide （CCP） antibody.Results　Among the 132 cases，14 were male and 118 were female；37 were 18-44 years old，53 were 45-59 years old，42 were 60-75 years old；ESR：43 normal cases，89 abnormal cases；CRP：45 normal cases，87 abnormal cases；RF：34 negative cases，56 cases of low titer，42 cases of high titer；anti-CCP antibody：33 negative cases，17 cases of low titer，82 cases of high titer.Number of joints with subclinical synovitis：106 patients were found with subclinical synovitis and other 26 without.Gender，age，levels of ESR，CRP and RF were not associated with the number of joints with subclinical synovitis in RA patients（P>0.05）．High titer of anti-CCP antibody was associated with more joints affected with subclinical synovitis while negative and low titer of anti-CCP antibodies were not（P<0.05）．Conclusion　High titer of anti-CCP antibody is associated with subclinical synovitis in RA to various degrees，suggesting that in addition to clinical physical examination，ultrasound examination is needed for RA patients with high titer of anti-CCP antibody in order to assess the disease activity of RA intensively.

Key words: Arthritis, rheumatoid；Synovitis；Ultrasonography；Anti-cyclic citrullinated peptide antibody

摘要： 背景　亚临床滑膜炎指在超声或核磁共振下发现滑膜炎，而在临床体格检查中未发现关节肿胀。研究表明类风湿关节炎（RA）患者亚临床滑膜炎的关节具有骨破坏放射学进展，提示亚临床滑膜炎关节依旧处于疾病活动状态。目的　探究RA超声下亚临床滑膜炎的临床特征。方法　选取2017年4月—2018年5月于中日友好医院中医风湿病科住院及门诊就诊的RA患者132例。分别采用临床体格检查及超声的方法评价掌指关节、近端指间关节、腕关节、肘关节、肩关节、膝关节包含的28关节，记录临床体格检查未发现关节肿胀而超声下发现滑膜炎的关节（即亚临床滑膜炎关节），并分析不同性别、年龄、红细胞沉降率（ESR）、C反应蛋白（CRP）、类风湿因子（RF）、抗环瓜氨酸肽（CCP）抗体RA患者亚临床滑膜炎关节数目。结果　132例RA患者中，男14例，女118例；18~44岁37例，45~59岁53例，60~75岁42例；ESR：正常43例，异常89例；CRP：正常45例，异常87例；RF：阴性34例，低滴度阳性56例，高滴度阳性42例；抗CCP抗体：阴性33例，低滴度阳性17例，高滴度阳性82例。亚临床滑膜炎数目：无亚临床滑膜炎患者26例，有亚临床滑膜炎患者106例。不同性别、年龄、ESR、CRP、RF患者亚临床滑膜炎关节数目比较，差异无统计学意义（P>0.05）；抗CCP抗体高滴度阳性患者亚临床滑膜炎关节数目多于抗CCP抗体阴性、低滴度阳性患者（P<0.05）。结论　抗CCP抗体高滴度阳性与RA患者亚临床滑膜炎的发生存在一定关系，提示该类患者除进行临床体格检查外，宜进行超声下亚临床滑膜炎的评估。

关键词: 关节炎, 类风湿；滑膜炎；超声检查；抗环瓜氨酸肽抗体