A Novel Ultrasonographic Synovitis Scoring System Suitable for Analyzing Finger Joint Inflammation in Rheumatoid Arthritis
A Novel Ultrasonographic Synovitis Scoring System Suitable for Analyzing Finger Joint Inflammation in Rheumatoid Arthritis
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DOI：
10.1002/art.20939
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发表时间：
2005-03-01
影响因子：
--
通讯作者：
Backhaus, Marina
中科院分区：
文献类型：
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作者：
Scheel, Alexander K.;Hermann, Kay-Geert A.;Backhaus, Marina
客观的。开发适合评估活动性类风湿关节炎 (RA) 患者林格关节炎症的超声 (US) 滑膜炎评分系统，并将半定量 US 评分与定量 US 测量进行比较。方法。对 10 名健康受试者的第二至第五掌指 (MCP) 和近端指间 (PIP) 关节的掌侧和背侧以及 46 名 RA 患者临床上受影响较严重的手进行了超声检查。十名患者还接受了磁共振成像（MRI）检查。根据半定量方法对滑膜炎进行测量、标准化和评分。对两种方法（半定量 US 评分、定量 US）进行比较，并使用受试者工作特征 (ROC) 曲线分析确定统计截止值。将 MRI 结果与半定量 US 评分和定量 US 结果进行比较。确定了 6 个关节组合的最佳 US 评分方法（ROC 曲线分析）。结果。滑膜炎最常见于手掌近端区域（86% 的受影响关节）。我们发现各个 PIP 关节之间或各个 MCP 关节之间没有显着差异，这表明每个关节组内的所有手指在统计计算中应同等对待，尽管每个关节组作为一个整体应单独处理。对于 MCP 关节（敏感性 94%，特异性 89%）和 PIP 关节（敏感性 90%，特异性 88%），区分“健康”和“病理”的最佳截止点均为 0.6 分钟。半定量 US 分数和定量 US 测量之间没有显着差异。使用“4 个手指之和”（第二至第五个 MCP 和 PIP 关节）和“3 个手指之和”（第二至第四个 MCP 和 PIP 关节）方法获得了关节组合的最佳结果。 MRI 结果与半定量 US 评分的比较显示出高度一致性。结论。美国对指关节滑膜炎的评估通过关注掌侧并应用半定量分级而不是定量测量来大大简化。对于基于RA患者滑膜炎的治疗效果评估，我们建议在纵向试验中使用“三指总和”法。
Objective. To develop an ultrasonographic (US) synovitis scoring system suitable for evaluation of ringer joint inflammation in patients with active rheumatoid arthritis (RA) and to compare semiquantitative US scoring with quantitative US measurements.Methods. US was performed at the palmar and dorsal sides of the second through fifth metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in 10 healthy subjects and in the clinically more affected hand in 46 RA patients. Ten patients additionally underwent magnetic resonance imaging (MRI). Synovitis was measured, standardized, and scored according to a semiquantitative method. The 2 methods (semiquantitative US scoring, quantitative US) were compared and statistical cutoffs were identified using receiver operating characteristic (ROC) curve analysis. MRI results were compared with semiquantitative US scoring and quantitative US results. The optimal US scoring method from 6 joint combinations was identified (ROC curve analysis).Results. Synovitis was most frequently detected in the palmar proximal area (86% of affected joints). We found no significant differences between individual PIP joints or between individual MCP joints, indicating that all fingers within each of these joint groups should be treated equally for statistical calculations, although each joint group as a whole should be treated separately. The optimal cutoff point to distinguish between "health" and "pathology" was 0.6 min both for MCP joints (sensitivity 94%, specificity 89%) and for PIP joints (sensitivity 90%, specificity 88%). There was no significant difference between semiquantitative US scores and quantitative US measurements. The best results for joint combinations were achieved using the "sum of 4 fingers" (second through fifth MCP and PIP joints) and "sum of 3 fingers" (second through fourth MCP and PIP joints) methods. Comparison of MRI results with semiquantitative US scores revealed high concordance.Conclusion. US evaluation of finger joint synovitis call be considerably simplified by focusing on the palmar side and by applying semiquantitative grading instead of quantitative measurements. For evaluation of treatment efficacy based on synovitis in RA patients, we recommend using the "sum of 3 fingers" method in longitudinal trials.