Severe joint deformity and patient global assessment of disease are associated with discrepancies between sonographic and clinical remission: A cross-sectional study of rheumatoid arthritis patients
Severe joint deformity and patient global assessment of disease are associated with discrepancies between sonographic and clinical remission: A cross-sectional study of rheumatoid arthritis patients
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DOI：
10.1080/14397595.2020.1751922
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发表时间：
2020-04-30
影响因子：
2.2
通讯作者：
Fujii, Yasutomo
中科院分区：
文献类型：
--
作者：
Nakabo, Shuichiro;Tsuji, Yuko;Fujii, Yasutomo
目的：尽管最近的临床试验表明，在组水平上不需要超声（US）缓解来实现良好的结局，但目前仍不清楚临床缓解但非US缓解的个体患者（即亚临床超声滑膜炎（SSS）患者）的预后是否有利。然而，对所有患者进行超声检查以识别SSS患者已不再可接受。因此，本研究的目的是阐明经常检测到SSS的条件。方法：总共招募了563名连续的RA患者。对双侧2-5个MCP、腕关节、踝关节和2-5个MTP关节进行超声扫描，并对灰阶和能量多普勒（PD）图像进行半定量评分。临床数据由对US结果不知情的医生获得。计算托珠单抗（TCZ）使用者的改良总Sharp评分（mTSS）变化。结果：共纳入402例患者。SSS在关节畸形更严重的患者中更常见，即使他们处于缓解期。相比之下，高患者总体疾病评估（PtGA）并不反映SSS。此外，PtGA和PD评分之间的关系很弱。尽管TCZ使用者中SSS的发生率较高，但TCZ使用者中SSS的存在并不总是导致mTSS的进展。结论：虽然在严重关节畸形患者中缓解被高估，但由于PtGA高而不符合缓解标准的患者可能会被低估。
Objective: Although recent clinical trials showed that ultrasound (US) remission is not required to achieve good outcomes at the group level, it currently remains unclear whether the prognosis of individual patients in clinical remission, but not US remission, i.e. those with subclinical sonographic synovitis (SSS), is favorable. However, it is no longer acceptable to perform US on all patients in order to identify those with SSS. Therefore, the present study was initiated to elucidate the conditions under which SSS is frequently detected. Methods: In total, 563 consecutive RA patients were recruited. Bilateral 2-5 MCP, wrist, ankle, and 2-5 MTP joints were scanned by US, and Gray scale and Power Doppler (PD) images were scored semi-quantitatively. Clinical data were obtained by physicians who were blind to US results. Changes in the modified Total Sharp Score (mTSS) of tocilizumab (TCZ) users were calculated. Results: A total of 402 patients were included. SSS was more frequently detected in patients with more severe joint deformity, even if they were in remission. In contrast, a high Patient Global Assessment of Disease (PtGA) did not reflect SSS. Furthermore, the relationship between PtGA and PD scores was weak. Although the frequency of SSS was high in TCZ user, the presence of SSS in TCZ users not always results in the progression of mTSS. Conclusions: While remission is overestimated in patients with severe joint deformity, underestimations may occur in those who do not fulfill remission criteria because of a high PtGA.