Ultrasonography shows significant improvement in wrist and ankle tenosynovitis in rheumatoid arthritis patients treated with adalimumab
Ultrasonography shows significant improvement in wrist and ankle tenosynovitis in rheumatoid arthritis patients treated with adalimumab
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DOI：
10.3109/03009742.2010.517549
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发表时间：
2011-01-01
影响因子：
2.1
通讯作者：
Kvien, T. K.
中科院分区：
文献类型：
--
作者：
Hammer, H. B.;Kvien, T. K.
目的：腱鞘炎在类风湿关节炎（RA）中很常见，但对其抗炎治疗反应的认识有限。本研究使用超声检查腱鞘炎的分布和对抗肿瘤坏死因子的反应性方法：在基线和开始阿达木单抗治疗后1、3、6和12个月对20例RA患者进行了检查，以及灰度（GS）和能量多普勒（PD）US评分除了评估28关节疾病活动评分（DAS 28）外，还进行了腕关节和踝关节肌腱的半定量范围0-3），结果：腕部尺侧腕伸肌（ECU）、踝部胫后肌腱（TB）和趾长屈肌（FDL）是最常见的炎症部位。在基线/12个月随访时，GS的肌腱数量减少的中位总分为5/0.5（p < 0.001），PD为4/0（p < 0.05），随访期间US评分的降低幅度与所有肌腱的总分相同。肌腱数量减少的GS或PD评分总和的标准化反应均值（SRM）较高（范围为-0.53至-0.93）比所有肌腱的总评分（-0.23至-0.74），并显示出比CRP更大的反应性（-0.10至-0.43）和ESR（-0.03 to -0.71）.结论：ECU、TB和FDL肌腱的双侧评估与所有肌腱的总分一样敏感，并且建议将这种减少的肌腱数量的评分包括在RA患者随访的US评分中。
Objective: Tenosynovitis is common in rheumatoid arthritis (RA) but knowledge is limited regarding its response to anti-inflammatory treatment. This study used ultrasonography (US) to examine the distribution and responsiveness of tenosynovitis to anti-tumour necrosis factor (anti-TNF) treatment in RA patients.Methods: Twenty patients with RA were examined at baseline and 1, 3, 6, and 12 months after starting adalimumab treatment, and grey-scale (GS) and power Doppler (PD) US scoring (semi-quantitative range 0-3) of wrist and ankle tendons was performed in addition to assessment of the 28-joint Disease Activity Score (DAS28), C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).Results: The extensor carpi ulnaris (ECU) tendon in the wrists and the closely related tendons tibialis posterior (TB) and flexor digitorum longus (FDL) in the ankles were most often inflamed. Median sum scores for this reduced number of tendons at baseline/12-month follow-up were 5/0.5 for GS (p < 0.001) and 4/0 for PD (p < 0.05), with reductions in the US scores during follow-up as large as those found for sum scores of all tendons. The standardized response means (SRMs) for sum GS or PD scores of the reduced number of tendons were higher (range -0.53 to -0.93) than for the sum scores of all tendons (-0.23 to -0.74), and showed larger responsiveness than CRP (-0.10 to -0.43) and ESR (-0.03 to -0.71).Conclusion: Bilateral assessments of ECU, TB, and FDL tendons were as sensitive to change as the sum scores of all tendons, and scoring of this reduced number of tendons is suggested to be included in US scorings for follow-up of RA patients.