Joint-specific assessment of swelling and power Doppler in obese rheumatoid arthritis patients.
Joint-specific assessment of swelling and power Doppler in obese rheumatoid arthritis patients.
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DOI：
10.1186/s12891-017-1406-7
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发表时间：
2017-03-04
影响因子：
2.3
通讯作者：
Ranganath VK
中科院分区：
文献类型：
--
作者：
Bauer EM;Ben-Artzi A;Duffy EL;Elashoff DA;Vangala SS;Fitzgerald J;Ranganath VK
肥胖类风湿性关节炎（RA）患者的临床肿胀关节检查可能很困难。肌肉骨骼超声（MSUS）对肿胀关节（SJ）的敏感性高于体格检查。本研究的目的是确定能量多普勒（PDUS）和RA的临床SJ之间的关节特异性相关性，包括体重指数（BMI）类别。收集了43例RA患者的横断面临床和实验室数据。9个关节（腕关节、掌指关节2/5个、近端指间关节2/3个、跖趾关节2/5个）行PDUS检查。计算DAS 28和临床疾病活动指数（CDAI）。患者按BMI分类：<25、25-30和>30。采用Kruskal-Wallis检验和卡方检验比较BMI组的人口统计学和临床特征。采用混合效应logistic回归模型评估PDUS和临床SJ之间的关节水平相关性。虽然BMI组之间的人口统计学和临床确定的疾病活动性相似，但PDUS评分存在显著差异（p = 0.02）。以PDUS活性作为滑膜炎的参考标准，以临床SJ作为检验，较高BMI组SJ的阳性预测值显著较低（BMI < 25为0.71，BMI 25-30为0.58，BMI < 30为0.44）（p = 0.02）。logistic模型表明，BMI类别增加导致PDUS阳性可能性降低（OR 0.52，p = 0.03）。这项研究表明，在肥胖的RA患者中，临床评估的SJ不太可能代表真正的滑膜炎（如通过PDUS测量）。当考虑改变治疗时，CDAI/DAS 28计算和临床医生可能高估肥胖RA患者的疾病活动性。本文的在线版本（doi：10.1186/s12891-017-1406-7）包含补充材料，可供授权用户使用。
Clinical swollen joint examination of the obese rheumatoid arthritis (RA) patient can be difficult. Musculoskeletal Ultrasound (MSUS) has higher sensitivity than physical examination for swollen joints (SJ). The purpose of this study was to determine the joint-specific association between power Doppler (PDUS) and clinical SJ in RA across body mass index (BMI) categories. Cross-sectional clinical and laboratory data were collected on 43 RA patients. PDUS was performed on 9 joints (wrist, metacarpalphalangeal 2–5, proximal interphalgeal 2/3 and metatarsalphalangeal 2/5). DAS28 and clinical disease activity index (CDAI) were calculated. Patients were categorized by BMI: <25, 25–30, and >30. Demographic and clinical characteristics were compared across BMI groups with Kruskal-Wallis test and chi-square tests. Joint-level associations between PDUS and clinically SJ were evaluated with mixed effects logistic regression models. While demographics and clinically-determined disease activity were similar among BMI groups, PDUS scores significantly differed (p = 0.02). Using PDUS activity as the reference standard for synovitis and clinically SJ as the test, the positive predictive value of SJ was significantly lower in higher BMI groups (0.71 in BMI < 25, 0.58 in BMI 25–30 and 0.44 in BMI < 30) (p = 0.02). The logistic model demonstrated that increased BMI category resulted in decreased likelihood of PDUS positivity (OR 0.52, p = 0.03). This study suggests that in an obese RA patient, a clinically assessed SJ is less likely to represent true synovitis (as measured by PDUS). Disease activity in obese RA patients may be overestimated by CDAI/DAS28 calculations and clinicians when considering change in therapy. The online version of this article (doi:10.1186/s12891-017-1406-7) contains supplementary material, which is available to authorized users.