Presence of power Doppler synovitis in rheumatoid arthritis patients with synthetic and/or biological disease-modifying anti-rheumatic drug-induced clinical remission: experience from a Chinese cohort
Presence of power Doppler synovitis in rheumatoid arthritis patients with synthetic and/or biological disease-modifying anti-rheumatic drug-induced clinical remission: experience from a Chinese cohort
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DOI：
10.1007/s10067-014-2634-y
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发表时间：
2014-08-01
影响因子：
3.4
通讯作者：
Zhang, Zhuoli
中科院分区：
文献类型：
--
作者：
Geng, Yan;Han, Jingjing;Zhang, Zhuoli
本研究的目的是评价临床缓解的类风湿关节炎(RA)患者的超声滑膜炎情况。202例类风湿关节炎患者纳入本研究。111名RA患者经合成和/或生物修饰的抗风湿药物(DMARDS)治疗后获得临床缓解。应用能量多普勒超声(PDUS)评价亚临床型滑膜炎。半定量记录PD滑膜炎症。对22个关节区域进行了成像：双侧腕关节、掌指关节(MCP)和近端指间关节(PIP)。PD缓解定义为PD总分为0。对临床缓解的类风湿关节炎患者的亚临床滑膜炎进行评估。分析PD总分与临床/实验室指标的相关性。在111例获得临床缓解的RA患者中，110例(99.1%)、67例(60.4%)、55例(49.5%)、50例(45.0%)和54例(48.6%)分别符合DAS28(CRP)、DAS28(ESR)、CDAI、SDAI和2010年ACR/EULAR缓解标准。然而，只有54例(48.6%)患者获得帕金森病缓解。亚临床滑膜炎分别为57例(51.8%)、30例(44.8%)、22例(40.0%)、19例(38.0%)和18例(33.3%)。相反，在符合所有五项临床缓解标准的41名患者中，有11名(26.8%)有亚临床滑膜炎的证据。在91例未达到临床缓解的患者中，PD总分与肿胀关节数(SJC)、压痛关节数(TJC)、血沉(ESR)、C反应蛋白(CRP)和复杂疾病活动指数(P<；0.01)相关，而与类风湿因子和抗环瓜氨酸肽的滴度无关。57例达到临床缓解期的亚临床滑膜炎患者中，PD总分与SJC、TJC、ESR、CRP及复杂疾病活动指数均无相关性。亚临床滑膜炎的出现在获得临床缓解的患者中很常见。更严格的临床缓解标准可能反映PD滑膜炎的减少。活动期RA患者滑膜PD总分与疾病活动度呈正相关。
The aim of this study was to evaluate the ultrasonographic synovitis in rheumatoid arthritis (RA) patients who reached clinical remission. Two hundred and two RA patients were enrolled into this study. One hundred and eleven RA patients achieved clinical remission with the treatment of synthetic and/or biologic disease-modifying anti-rheumatic drugs (DMARDs). Subclinical synovitis was assessed by power Doppler ultrasonography (PDUS). PD synovitis was semi-quantitatively recorded. Twenty-two joint regions were imaged: bilateral wrists, metacarpophalangeal (MCP) joints, and proximal interphalangeal (PIP) joints. PD remission was defined as a total PD score of 0. The subclinical synovitis in the RA patients who achieved clinical remission was evaluated. The correlations between PD total scores and clinical/laboratory parameters were analyzed. Among the 111 RA patients who achieved clinical remission, 110 (99.1 %), 67 (60.4 %), 55 (49.5 %), 50 (45.0 %), and 54 (48.6 %) patients, respectively, satisfied DAS28 (CRP), DAS28 (ESR), CDAI, SDAI, and 2010 ACR/EULAR remission criteria. However, only 54 (48.6 %) patients achieved PD remission. Subclinical synovitis was detectable in 57 (51.8 %), 30 (44.8 %), 22 (40.0 %), 19 (38.0 %), and 18 (33.3 %) patients accordingly. On the contrary, 11 (26.8 %) out of 41 patients who fulfilled all five clinical remission criteria had evidence of subclinical synovitis. In those 91 patients who did not achieved clinical remission, total PD score was correlated with swollen joint counts (SJC), tender joint counts (TJC), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and complex disease activity indexes (P < 0.01), but not the titers of rheumatoid factor and anti-cyclic citrullinated peptide. Among those 57 patients with subclinical synovitis after reaching clinical remission, no correlation was found between PD total score and SJC, TJC, ESR, CRP, and complex disease activity indexes. Presence of subclinical synovitis is common in patients achieving clinical remission. The stricter clinical remission criteria may reflect less PD synovitis. In patients with active RA, PD total score of synovitis was positively correlated with disease activity.