[EULAR文摘] 超声滑膜炎和腱鞘炎对已获临床缓解患者病情复发的预测

标签：eular文摘; 超声评估; 病情预测; 腱鞘炎

超声滑膜炎和腱鞘炎对已获临床缓解患者病情复发的预测

Bellis E, et al. EULAR 2015. Present ID:OP0217.

背景:类风湿关节炎(RA)的治疗目标是缓解。在临床缓解中可能持续有亚临床炎症从而导致病情复发以及关节破坏的进展。肌骨超声(MSUS)是克服临床评估指标缺陷的一个良好工具。针对超声滑膜炎已发表了很多研究,而未见对腱鞘炎的报道。

目的:拟评估超声滑膜炎(S)与腱鞘炎(T)对已获临床缓解RA患者在未来6个月随访中病情复发的相关性。

方法:本研究(STARTER)是由意大利风湿病协会(ISR)推动的一项多中心队列研究。通过操作者间可信度练习确定了本研究的超声操作者。对连续随诊的临床缓解RA患者进行全面的临床评估以及超声灰阶(GS)和能力多普勒超声(PD)检查,超声检查包括腕、MCP、PIP和屈/伸肌腱的腱鞘。随访6月病情复发的定义: 1)ΔDAS28>1.2,或者ΔDAS28>0.6且DAS28>3.2; 2)药物治疗发生了调整; 3)病情复发问卷(FQ)的基线评分<4而随访过程中ΔFQ>4。病情复发与超声滑膜炎与腱鞘炎(GS-T/-S, PD-T/-S)的相关性,在校正预设混淆因素后,通过逻辑回归进行分析,并计算比值比(OR)和95%CI。

结果:本研究纳入427例患者,男性113例(26.5%),平均年龄56.6岁(SD:13.4),平均病程7.3年(四分位距(IQR):3.8-13.5),平均缓解期12个月(IQR:8-24),类风湿因子阳性287例(67.4%), DAS28均值2.2(SD:0.8), HAQ中位数0.125(IQR: 0-0.375), 322例(75.4%)应用DMARD, 183例(42.9%)应用生物制剂,应用糖皮质激素有187例(43.8%)。198例(/373, 53.1%)有超声灰阶腱鞘炎,能量多普勒腱鞘炎见于88例(/372, 23.7%)。270例(/368, 73.4%)有灰阶滑膜炎, PD滑膜炎见于171例(/372, 46.5%)。超声参数与病情复发的相关性请参见下表。

结论:本研究显示多普勒超声滑 膜炎对DAS28定义的病情复发有预测作用,而多普勒腱鞘炎与患者自测复发以及症状加重之间的相关性更具特异性。由此,建议对临床缓解RA患者应行超声检查腱鞘炎以利于治疗决策。

表.超声参数与各种复发定义的相关性

*校正年龄、性别、病程、缓解期长、其它累及肌肉和骨骼的共患病、RF、ACPA、DMARDs、生物制剂、糖皮质激素(口服和针剂)、NSAIDs。粗体和红色字体代表比值比达到统计学显著意义。

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原文链接或参见以下信息。

Ann Rheum Dis 2015;74:153 doi:10.1136/annrheumdis-2015-eular.4927

• Oral Presentations

OP0217 Ultrasound-Detected Synovitis and Tenosynovitis Independently Associate with Flare in Patients with Rheumatoid Arthritis in Clinical Remission

1. E. Bellis¹, 
2. C.A. Scirè², 
3. G. Carrara², 
4. A. Adinolfi³, 
5. A. Batticciotto⁴, 
6. A. Bortoluzzi⁵,
7. G. Cagnotto⁶, 
8. M. Caprioli⁷, 
9. M. Canzoni⁸, 
10. F.P. Cavatorta⁹, 
11. O. De Lucia¹⁰, 
12. V. Di Sabatino³,
13. A. Draghessi¹¹, 
14. G. Filippou³, 
15. I. Farina⁵, 
16. M.C. Focherini¹², 
17. A. Gabba¹³, 
18. M. Gutierrez¹¹,
19. L. Idolazzi¹⁴, 
20. F. Luccioli¹⁵, 
21. P. Macchioni¹⁶, 
22. M.S. Massarotti¹⁷, 
23. C. Mastaglio¹⁸, 
24. L. Menza¹⁸,
25. M. Muratore¹⁹, 
26. S. Parisi²⁰, 
27. V. Picerno³, 
28. M. Piga²¹, 
29. R. Ramonda²², 
30. B. Raffeiner²²,
31. D. Rossi²³, 
32. S. Rossi⁶, 
33. P. Rossini²⁴, 
34. G. Sakellariou⁶, 
35. C. Scioscia²⁵, 
36. C. Venditti²⁶, 
37. A. Volpe²⁷,
38. M. Matucci-Cerinic²⁸, 
39. A. Iagnocco²⁹ 
40. on behalf of MSUS Study Group of SIR

-Author Affiliations

1. ¹Osp.Mauriziano, Torino
2. ²SIR, Milan
3. ³University of Siena, Siena
4. ⁴H Sacco, Milan
5. ⁵A.O.U. S.Anna, Ferrara
6. ⁶Osp. S.Matteo
7. ⁷Istituto di Cura Città di Pavia, Pavia
8. ⁸A.O. S.Andrea, Roma
9. ⁹A.O.U. S.Chiara, Trento
10. ¹⁰G.Pini, Milan
11. ¹¹Università delle Marche, Jesi
12. ¹²Osp. Infermi, Rimini
13. ¹³A.O.U. di Cagliari, Cagliari
14. ¹⁴Osp. Civile Maggiore, Verona
15. ¹⁵University of Perugia, Perugia
16. ¹⁶Arcispedale S.M.Nuova, Reggio Emilia
17. ¹⁷Humanitas, Rozzano
18. ¹⁸Moriggia-Pelascini, Gravedona
19. ¹⁹Osp. Galateo, Lecce
20. ²⁰A.O.Città della Salute e della Scienza, Torino
21. ²¹Osp. Cagliari, Cagliari
22. ²²University of Padua, Padova
23. ²³Osp. G.Bosco, Torino
24. ²⁴P.O.Destra Secchia, Pieve di Coriano
25. ²⁵University of Bari, Bari
26. ²⁶A.O. Rummo, Benevento
27. ²⁷A.O.U.P.S.Chiara, Trento
28. ²⁸University of Florence, Firenze
29. ²⁹Sapienza University, Roma, Italy

Abstract

Background Remission is the target of treatment in rheumatoid arthritis (RA). In clinically-defined remission, subclinical disease activity may persist leading to flare and joint damage progression. Musculoskeletal ultrasonography (MSUS) is a good candidate to overcome the limitations of clinimetric indexes. The role of MSUS synovitis is well-known in the literature but no data are available for tenosynovitis.

Objectives The study aims to evaluate the association between US synovitis (S) and tenosynovitis (T) and 6-month flare in RA patients in clinical remission.

Methods The STARTER study is a multicentre cohort study promoted by the Italian Society for Rheumatology. Ultrasonographers were selected by an inter-reader reliability exercise. Consecutive patients with RA and clinical remission underwent a full clinical evaluation and Grey Scale (GS) and power Doppler (PD) US exam (assessing -S and -T) at wrists, MCP, PIP and extensor/flexor tendon sheets. Six-month flare was defined as: 1) increase of >1.2 or >0.6 if final DAS28>3.2; 2) change in treatment; 3) change of >4 points in the flare questionnaire (FQ) if FQ<4 at baseline. The relationships between presence of GS-T/-S, PD-T/-S were evaluated by logistic models, presented as odds ratios (OR) and 95%CI, adjusted for pre-specified confounders.

Results A total of 427 patients were included in the analyses: 113 (26.5%) men, mean (SD) age 56.6 (13.4), median (IQR) disease duration 7.3 (3.8-13.5) years, median (IQR) remission duration 12 (8-24) months, RF positive 287 (67.4%), mean (SD) DAS28 2.2 (0.8), median (IQR) HAQ 0.125 (0-0.375), on DMARDs 322 (75.4%), on biologics 183 (42.9%), on glucocorticoids 187 (43.8%). GS-T was present in 198/373 (53.1%) patients, PD-T in 88/372 (23.7%) while GS-S in 270/368 (73.4%) and PD-S in 171/372 (46.5%). The association between US variables and flare is reported in the Table.

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Conclusions MSUS PD-S confirms its predictivity on flare defined according to DAS28 definitions while PD-T is more specifically associated with patient-related flare and symptoms exacerbation. US-T should be take into account in the management of RA patients in clinical remission.

Disclosure of Interest None declared