Evaluation of a Novel 7-Joint Ultrasound Score in Daily Rheumatologic Practice: A Pilot Project
Evaluation of a Novel 7-Joint Ultrasound Score in Daily Rheumatologic Practice: A Pilot Project
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DOI：
10.1002/art.24646
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发表时间：
2009-09-15
期刊：
影响因子：
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通讯作者：
Schmidt, W. A.
中科院分区：
文献类型：
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作者：
Backhaus, M.;Ohrndorf, S.;Schmidt, W. A.
Objective.介绍一种新的标准化超声评分的基础上的7个关节的临床优势手和脚（德国US 7评分）实施日常风湿病的做法。超声评分包括临床优势手和足的以下关节：腕关节、第二和第三掌指关节和近端指间关节以及第二和第五跖趾关节。通过灰阶（GS）和能量多普勒（PD）超声对滑膜炎和滑膜/腱鞘血管进行半定量（0-3级）评分。对存在的腱鞘炎和糜烂进行评分。GS滑膜炎评分范围为0-27，PD滑膜炎评分范围为0-39，GS腱鞘炎评分范围为0-7，PD腱鞘炎评分范围为0-21，糜烂评分范围为0-14。关节炎患者在基线时和疾病缓解抗风湿药物（DMARD）和/或肿瘤坏死因子α（TNF α）抑制剂治疗开始或改变后3个月和6个月进行检查。检测C-反应蛋白水平、红细胞沉降率、类风湿因子、抗环瓜氨酸肽、28个关节疾病活动性评分（DAS 28）和手足X线片。120例类风湿性关节炎（91%）和银屑病关节炎（9%）患者（76%为女性）入组。在52例病例（43%）中，基线时在X线摄影中观察到糜烂。患者接受DMARDs（41%）、DMARDs加TNF α抑制剂（41%）或TNF α抑制剂单药治疗（18%）。基线时，平均DAS 28为5.0，GS超声中滑膜炎评分为8.1，PD超声中为3.3。治疗6个月后，DAS 28显著下降至3.6（A = 1.4），GS和PD超声评分分别显著下降至5.5（-32%）和2.0（-39%）。德国US 7评分是一个可行的工具，用于检查关节炎患者的日常风湿病学实践，因为它显着反映了治疗反应。
Objective. To introduce a new standardized ultrasound score based on 7 joints of the clinically dominant hand and foot (German US7 score) implemented in daily rheumatologic practice.Methods. The ultrasound score included the following joints of the clinically dominant hand and foot: wrist, second and third metacarpophalangeal and proximal interphalangeal, and second and fifth metatarsophalangeal joints. Synovitis and synovial/tenosynovial vascularity were scored semiquantitatively (grade 0-3) by gray-scale (GS) and power Doppler (PD) ultrasound. Tenosynovitis and erosions were scored for presence. The scoring range was 0-27 for GS synovitis, 0-39 for PD synovitis, 0-7 for GS tenosynovitis, 0-21 for PD tenosynovitis, and 0-14 for erosions. Patients with arthritis were examined at baseline and after the start or change of disease-modifying antirheumatic drug (DMARD) and/or tumor necrosis factor alpha (TNF alpha) inhibitor therapy 3 and 6 months later. C-reactive protein level, erythrocyte sedimentation rate, rheumatoid factor, anti-cyclic citrullinated peptide, Disease Activity Score in 28 joints (DAS28), and radiographs of the hands and feet were performed.Results. One hundred twenty patients (76% women) with rheumatoid arthritis (91%) and psoriatic arthritis (9%) were enrolled. In 52 cases (43%), erosions were seen in radiography at baseline. Patients received DMARDs (41%), DMARDs plus TNF alpha inhibitors (41%), or TNF alpha inhibitor monotherapy (18%). At baseline, the mean DAS28 was 5.0 and the synovitis scores were 8.1 in GS ultrasound and 3.3 in PD ultrasound. After 6 months of therapy, the DAS28 significantly decreased to 3.6 (A = 1.4), and the GS and PD ultrasound scores significantly decreased to 5.5 (-32%) and 2.0 (-39%), respectively.Conclusion. The German US7 score is a viable tool for examining patients with arthritis in daily rheumatologic practice because it significantly reflects therapeutic response.