Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis
Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis
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DOI：
10.1002/art.23682
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发表时间：
2008-08-01
影响因子：
--
通讯作者：
Garrido, Jesus
中科院分区：
文献类型：
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作者：
Naredo, Esperanza;Moeller, Ingrid;Garrido, Jesus
Objective.评价能量多普勒超声（PDUS）监测类风湿关节炎（RA）患者对肿瘤坏死因子（TNF）阻断剂反应的有效性、反应性和预测价值。在25个西班牙中心前瞻性招募了367例RA患者，获得了278例患者的完整临床、实验室和PDUS数据。患者在基线和抗TNF治疗1、3、6和12个月后进行临床、实验室和PDUS评估，并在基线和12个月时进行手和脚的放射学评估。每次访视时记录28个关节的疾病活动性评分（DAS 28）。PDUS检查包括28个关节的86个关节内和关节周围部位。对所有滑膜部位的超声滑液（SF）、滑膜肥大（SH）和PD信号进行评分。获得SF、SH和PD信号的US计数和指数。通过估计观察者内变异性的最小可检测差异（SDD）来评估PDUS变量变化的敏感性。在随访评估时发现DAS 28和PDUS参数的显著平行改善（受试者内访视间变化P < 0.0005）。PDUS参数的SDD低于整个随访期间的平均变化。PD信号和类风湿因子（RF）的超声关节计数时间积分值与放射学侵蚀进展相关（R = 0.64），PD信号、RF和红细胞沉降率的超声关节计数时间积分值与放射学总评分进展相关（R = 0.59）。这些结果表明，PDUS是一种有效的方法，用于监测抗TNF治疗RA的反应，PDUS获得的结果是可重复的，敏感的变化。PDUS结果可能对放射学结果具有预测价值。
Objective. To evaluate the validity, responsiveness, and predictive value of power Doppler ultrasonography (PDUS) monitoring of response to tumor necrosis factor (TNF) blocking agents in rheumatoid arthritis (RA).Methods. Three hundred sixty-seven RA patients were prospectively recruited at 25 Spanish centers; complete clinical, laboratory, and PDUS data were obtained on 278 patients. The patients underwent clinical, laboratory, and PDUS assessment at baseline and after 1, 3, 6, and 12 months of anti-TNF treatment, and radiographic assessment of the hands and feet at baseline and 12 months. The Disease Activity Score in 28 joints (DAS28) was recorded at each visit. PDUS examination included 86 intraarticular and periarticular sites in 28 joints. US synovial fluid (SF), synovial hypertrophy (SH), and PD signal were scored in all synovial sites. US count and index for SF, SH, and PD signal were obtained. Sensitivity to change of the PDUS variables was assessed by estimating the smallest detectable difference (SDD) from the intraobserver variability.Results. A significant parallel improvement in DAS28 and PDUS parameters was found at followup assessment (P < 0.0005 for within-subject between-visit changes). The SDD for PDUS parameters was lower than the mean changes throughout followup. Time-integrated values of US joint count for PD signal and rheumatoid factor (RF) showed predictive value in relation to progression of radiographic erosion (R = 0.64), and time-integrated values of US joint count for PD signal, RF, and erythrocyte sedimentation rate were predictors of progression of the total radiographic score (R = 0.59).Conclusion. These findings indicate that PDUS is a valid method for monitoring response to anti-TNF therapy in RA; results obtained by PDUS are reproducible and sensitive to change. PDUS findings may have predictive value in relation to radiologic outcome.