Development and Evaluation of a Novel Ultrasound Score for Large Joints in Rheumatoid Arthritis: One Year of Experience in Daily Clinical Practice
Development and Evaluation of a Novel Ultrasound Score for Large Joints in Rheumatoid Arthritis: One Year of Experience in Daily Clinical Practice
复制标题
DOI：
10.1002/acr.21574
复制
发表时间：
2012-05-01
影响因子：
4.7
通讯作者：
Backhaus, Marina
中科院分区：
文献类型：
--
作者：
Hartung, Wolfgang;Kellner, Herbert;Backhaus, Marina
目标。介绍和评价针对类风湿关节炎(RA)患者大关节超声评分的新标准。设计了一种美国评分来确定类风湿性关节炎患者肩部、肘部、髋部和膝关节的炎症程度(风湿学中的大关节超声评分)。采用灰阶超声(GSUS)和能量多普勒超声(PDUS)对滑膜炎症和滑膜血管进行半定量评分(0~3级)。RA患者在开始局部或全身治疗(抗风湿药物[DMARDS]/生物制剂)开始后的3、6和12个月时进行检查。检测28个关节的血沉、抗环瓜氨酸肽抗体和临床疾病活动度评分(DAS28)。分析了199名患者的队列，并对其进行了12个月的随访。基线时，在修改治疗前，患者接受DMARDS(n=131)、DMARDS加生物制剂(n=46)、生物单一治疗(n=8)或不接受DMARD治疗(n=14)。基线时，DAS28评分平均为4.6分，治疗1年后降至3.2分(P<；0.001)。除了肩部和髋部的PDU评分外，所有的US评分在统计学上都有显著的改善。具体地说，膝关节的平均滑膜炎GSUS评分从基线的5.2分下降到12个月后的2.2分。肩关节GSUS评分从2.6降至1.6，肘关节GSUS评分从5.2降至2.6，髋关节GSUS评分从2.2降至0.4(P<；0.05)。SOLAR评分是利用US对RA患者大关节受累情况进行定性和定量评估的可行工具。
Objective. To introduce and evaluate a new standardized ultrasound (US) score developed for large joints in patients with rheumatoid arthritis (RA).Methods. A US score was designed to determine the degree of inflammation in the shoulder, the elbow, the hip, and the knee joint in patients with RA (Sonography of Large Joints in Rheumatology [SOLAR] score). Synovitis and synovial vascularity were scored semiquantitatively (grade 0-3) by gray-scale US (GSUS) and power Doppler US (PDUS). Patients with RA were examined at baseline and 3, 6, and 12 months after initiation of local or systemic therapy (disease-modifying antirheumatic drugs [DMARDs]/biologic agents). Erythrocyte sedimentation rate, anti-cyclic citrullinated peptide antibodies, and the clinical Disease Activity Score in 28 joints (DAS28) were determined.Results. A cohort of 199 patients were analyzed and followed up over 12 months. At baseline, before modification of the therapy, patients received either DMARDs (n = 131), DMARDs plus biologic agents (n = 46), biologic monotherapy (n = 8), or no DMARD therapy (n = 14). At baseline, the mean DAS28 score was 4.6 and decreased to 3.2 after 1 year of therapy (P < 0.001). All US scores demonstrated a statistically significant improvement except for the PDUS scores for the shoulder and the hip. In detail, the mean synovitis GSUS score for the knee decreased from 5.2 at baseline to 2.2 after 12 months of followup. The mean GSUS score for the shoulder fell from 2.6 to 1.6, for the elbow fell from 5.2 to 2.6, and for the hip fell from 2.2 to 0.4 (P < 0.05 for each).Conclusion. The SOLAR score is a feasible tool for the qualitative and quantitative evaluation of large joint involvement in patients with RA using US.