超声在早期银屑病关节炎中的应用价值

原文

译文

[2011] [THU0188] THE UTILITY OF ULTRASOUND IN EARLY PSORIATIC ARTHRITIS A.P. Nigg1, M. Gruenke1, A.M. Malchus1, J.C. Prinz2, H. Schulze-Koops1 1Department of Rheumatology; 2Department of Dermatology, University of Munich, Germany Background: By reasons of the phenotypic heterogeneity and the absence of reliable disease-specific biochemical markers in early psoriatic arthritis (ePsA) sensitive diagnostic modalities enabling visualization of early inflammatory changes and reliable tools for monitoring the response to therapy are required. In contrast to the growing evidence on musculoskeletal ultrasound (US) in early rheumatoid arthritis (ERA) data on US assessment in ePsA are very limited. Objectives: We initiated a prospective study to evaluate the utility of US in ePsA. The aims of the study were to assess the sensitivity and specificity of US in detection of inflammatory changes in early disease compared to clinical evaluation, conventional radiography and low-field MRI (dominant hand), to analyse the longitudinal correlation between US findings and clinical parameters in patients under treatment and to evaluate the prognostic value of baseline US findings as predictors for radiographic progression and clinical outcome. Methods: Patients with psoriasis suffering from recent onset joint symptoms (duration of symptoms <2 years) being naïve to immunosuppressive treatment were eligible for study inclusion (n=25). Patients were evaluated by US and clinically at baseline and after 3, 6 and 12 months. In each patient a total of 60 joints and 12 enthesial sites were examined by US, fingers and toes were scanned for tenosynovitis. Grey-Scale (GS) and power doppler (PD) US findings were scored separately on a 0-3 semi-quantitative scale. Clinical assessment included a composite ACR joint count of 68 tender and 66 swollen joints, VAS for disease activity and pain, DAS-28CRP, LDI (Leeds dactylitis instrument), MASES, HAQ, EuroQoL-D5, CRP and demographic data. Results: Baseline characteristics: mean duration of symptoms =17 months (± 12), mean TJC(68) =7.4 (± 7.9), mean SJC(66) =0.8 (± 0.9), mean HAQ =0.49 (± 0.55), mean DAS-28-CRP =3.14 (± 1.03). The mean number of joints with US synovitis in each patient was 7.9 (± 6.3). US detected synovitis in 52% of all tender joints and 100% of all swollen joints. 52% of the joints with US synovitis ≥ grade 1 (GSUS) and 30% of the joints showing PD activity were clinically inactive. US joint count correlated strongly with TJC(68) (r =0.84) and DAS-28CRP (r =0.75) and moderately with SJC(66) (r =0.67), HAQ (r =0.67), patient VAS (r =0.62) and physician VAS (r =0.66). US joint count did not correlate with CRP, PASI and duration of symptoms. The US tenosynovitis score strongly correlated with the LDI (r =0.97). Preliminary data have shown significant correlations between changes in the US parameters for synovitis and changes of the clinical paramateres through 3 months of followup. Conclusions: US appears to be an useful instrument in establishing the diagnosis of early PsA and in identifying patients in need for treatment. US is able to detect joint inflammation to a much larger extent than clinically expected, especially the SJC would underestimate disease activity. Inflammatory activity detected by US correlates well with clinical disease activity and functional impairment at baseline as well as longitudinally over the treatment course. The prognostic value of baseline US findings on the clinical and radiographic outcome will be evaluated in the ongoing study. Disclosure of Interest: None Declared Citation: Ann Rheum Dis 2011;70(Suppl3):240

超声在早期银屑病关节炎中的应用价值   Nigg AP, et al. EULAR 2011. Present No: THU0188.   背景: 由于表型异质性以及缺乏可靠的疾病特异性生化标记物，早期银屑病关节炎(ePsA)，临床需要能够可视化地发现早期炎症改变的敏感诊断方法，以及监测治疗应答的可靠工具。早期RA的肌肉骨骼超声数据日益增多，与此截然相反的是，有关ePsA的超声评估还非常有限。 目的: 我们发起了一个前瞻性研究来评估超声在ePsA中的效用。本研究旨在通过与临床评估、传统放射学平片、低场强MRI相比较，来评价超声在早期病程检测炎症变化的敏感性与特异性，纵向分析接受治疗的病人的超声与临床参数之间的相关性，并评估基线超声发现对放射学和临床预后的预测价值。 方法: 本研究入组条件是近期关节病发作(病程< 2年)的银屑病患者，且未用过免疫抑制剂(n = 25)。在基线期、治疗3个月、6个月和12个月，对病人进行超声和临床评估。 每个病人总查60个关节和12个附着点，对手指和脚趾查腱鞘炎。对灰阶超声(GS)、能量多普勒参数(PD)所获图像进行半定量评分(0 - 3)。临床评估包括：ACR疗效评估，包括68个压痛关节以及66个肿胀关节的计数，视觉模拟尺(VAS)记录病人和医生对疾病的全面评估以及病人的疼痛感，DAS28-CRP，LDI(利兹大学指趾炎评估)，MASES，EuroQoL-D5，CRP和人口学数据。结果: 基线特征如下，平均病程为17个月(±12)，TJC均值(68)= 7.4(±7.9)，SJC均值(66)= 0.8(±0.9)，HAQ均值为0.49(±0.55)， DAS28-CRP均值为3.14(±1.03)。每个病人的由超声证实为滑膜炎的关节受累均数为7.9 (6.3)。在所有肿胀关节和52%压痛关节中，超声发现了滑膜炎。超声滑膜炎阳性关节中，52%GSUS评分≥1的关节以及30%PD阳性的关节的临床表现为无炎症活动。超声关节计数与TJC(68)(r = 0.84)以及DAS28-CRP(r = 0.75)呈强相关，与SJC(66)(r = 0.67)、HAQ(r = 0.67)、病人对病情全面评估(r = 0.62)以及医生对病情全面评估(r = 0.66)呈中等度相关。超声关节计数并不与CRP、PASI和病程有相关性。超声腱鞘炎评分与LDI密切相关(r = 0.97)。初步数据分析显示超声滑膜炎参数与临床参数在三个月随访期间的变化值呈显著相关性。 结论: 在确立早期PsA的诊断以及发现需要治疗的病人方面，超声似乎是一个有用的工具。超声可以在比临床评估更大的范围内探测到关节炎症，尤其是SJC可能会低估疾病活动。在基线时以及治疗过程中，超声发现的炎症活动性与临床病情活动度的相关性很好。关于基线期超声发现对临床和放射学结局的预后价值，将在随后的研究中进行探讨。