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Bildgebende Verfahren in der Rheumatologie: Konventionelle Röntgendiagnostik bei der rheumatoiden Arthritis

Imaging techniques in rheumatology: conventional radiography in rheumatoid arthritis

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Zusammenfassung

Das konventionelle Röntgenbild gilt noch immer als Goldstandard der bildgebenden Verfahren bei der rheumatoiden Arthritis (RA). Es ist unverzichtbar als wichtiges Hilfsmittel bei der Diagnose, Differential-Diagnose, prognostischen Bewertung und Verlaufsbeurteilung der Erkrankung. Besondere Vorteile sind weltweite Verfügbarkeit, Kostengünstigkeit, jahrzehntelange Erfahrung mit der Methode, Archivierbarkeit über lange Zeiträume und damit spätere Kontrollmöglichkeit. Die durch die RA verursachten Destruktionen lassen sich mittels Scoringmethoden quantifizieren. Der so ermittelte Destruktionsgrad korreliert mittelfristig gut mit der funktionellen Beeinträchtigung des Patienten. Die Hemmung der im Röntgenbild erkennbaren Progression ist das wichtigste Merkmal eines Basistherapeutikums. Radiologische Veränderungen gehören auch zu den ACR-Klassifikationskriterien der RA. Mit dem Röntgenbild lässt sich der Knochen mit hoher örtlicher Auflösung besser darstellen als mit allen anderen bildgebenden Verfahren, auf Weichteil- und Knorpelläsionen kann dagegen nur indirekt geschlossen werden. In dieser Übersicht werden Empfehlungen der Kommission bildgebende Verfahren zu den technischen und personellen Voraussetzungen, der Indikationsstellung sowie der praktischen Durchführung gegeben und die bei der RA zu erwartenden Befunde kurz dargestellt.

Summary

Conventional radiography is still regarded the gold standard for imaging techniques in rheumatoid arthritis (RA). It is a very important tool for the diagnosis, the differential diagnosis, and the evaluation of the course and prognosis of the disease. Special advantages of conventional radiography are the worldwide availability and experience with the method over decades and the relatively low costs. Moreover, xrays can be stored and re-evaluated over long periods of time. Joint damage caused by RA can be quantified by means of scoring methods. The amount of destruction correlates well with functional disability over time. The inhibition of damage progression seen on radiographs is the most important characteristic of a DMARD. Typical radiographic changes are part of the ACR classification criteria of RA. Technically, bone structure can be demonstrated with a high local resolution better than with all other imaging techniques, whereas only indirect conclusions can be drawn concerning soft tissue and cartilage lesions. This review includes recommendations given by the “Commission on Imaging Techniques” of the German Society of Rheumatology regarding technical and personal preconditions, costs, indication as well as practical performance of radiography in RA. In addition, radiographic changes that can be expected in RA including destruction and repair are discussed briefly.

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Authors and Affiliations

  1. Rheumaklinik, Evangelisches Fachkrankenhaus, Rosenstr. 2, 40882, Ratingen, Germany

    R. Rau

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  2. G. Lingg
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  3. S. Wassenberg
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  4. C. Schorn
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  5. A. Scherer
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Für die Kommission „Bildgebende Verfahren“ der Deutschen Gesellschaft für Rheumatologie (Sprecher: Rolf Rau, Ratingen)

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Correspondence to R. Rau.

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Rau, R., Lingg, G., Wassenberg, S. et al. Bildgebende Verfahren in der Rheumatologie: Konventionelle Röntgendiagnostik bei der rheumatoiden Arthritis. Z. Rheumatol. 64, 473–487 (2005). https://doi.org/10.1007/s00393-005-0663-2

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  • DOI: https://doi.org/10.1007/s00393-005-0663-2

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