The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound
The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound
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DOI：
10.1136/annrheumdis-2012-201469
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发表时间：
2013-05-01
影响因子：
27.4
通讯作者：
Szkudlarek, Marcin
中科院分区：
文献类型：
--
作者：
Dougados, Maxime;Devauchelle-Pensec, Valerie;Szkudlarek, Marcin
目的评价滑膜炎（临床与超声（US））预测类风湿关节炎（RA）的结构进展。方法RA患者。研究设计前瞻性，2年随访。收集滑膜炎数据（32个关节（2个腕关节，10个掌指关节，10个近端指间关节，10个跖趾关节））在基线和治疗4个月后，通过临床，超声灰阶（GS-US）和能量多普勒（PD-US）;基线和第2年的X线检查。分析在结构退化和基线滑膜炎的存在，或其持续性，结果在59例患者的1888个关节中，观察到9%的关节结构恶化。基线滑膜炎增加了结构进展的风险：临床与US-GS与US-PD评价的OR分别为2.01（1.36-2.98）p < 0.001 vs 1.61（1.06-2.45）p = 0.026 vs 1.75（1.18-2.58）p = 0.005。基线检查正常的关节（临床或US），在存在滑膜炎的情况下，还观察到其他方式的结构进展概率增加（US-GS和US-PD的OR = 2.16（1.16-4.02）p = 0.015和3.50（1.77-6.95）p < 0.001和2.79（1.35-5.76）p = 0.002）对于临床检查。持续性（与消失）滑膜炎治疗4个月后，也预测随后的结构progress.Conclusions本研究证实了有效性滑膜炎预测随后的结构恶化，无论检查关节的方式，但也表明，临床和超声检查可能是相关的，以最佳的后续结构恶化的风险评估。
Objectives To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA).Methods Patients with RA.Study design Prospective, 2-year follow-up.Data collected Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2.Analysis Measures of association (OR) were tested between structural deterioration and the presence of baseline synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis.Results Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline synovitis increased the risk of structural progression: OR = 2.01 (1.36-2.98) p < 0.001 versus 1.61 (1.06-2.45) p = 0.026 versus 1.75 (1.18-2.58) p = 0.005 for the clinical versus US-GS versus US-PD evaluation, respectively. In the joints with normal baseline examination (clinical or US), an increased probability for structural progression in the presence of synovitis for the other modality was also observed (OR = 2.16 (1.16-4.02) p = 0.015 and 3.50 (1.77-6.95) p < 0.001 for US-GS and US-PD and 2.79 (1.35-5.76) p = 0.002) for clinical examination. Persistent (vs disappearance) synovitis after 4 months of therapy was also predictive of subsequent structural progression.Conclusions This study confirms the validity of synovitis for predicting subsequent structural deterioration irrespective of the modality of examination of joints, but also suggests that both clinical and ultrasonographic examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration.