风湿

超声可预测无临床滑膜炎表现但抗CCP阳性的患者炎性关节炎进展

作者:Nam JL 译者:兰大二院朱蓉 来源:中国风湿病公众论坛 日期:2018-02-06
导读

         超声可预测无临床滑膜炎表现但抗CCP阳性的患者炎性关节炎进展

关键字:  超声 | 炎性关节炎 

        摘要: 目的:明确超声预测抗CCP阳性无临床滑膜炎(CS)表现患者发展为炎性关节炎(IA)的可能

        方法:前瞻性研究抗CCP阳性无CS患者的32个关节(腕、掌指、近端指,跖趾关节)超声表现。探究每个患者超声探查基线资料(灰度(GS),能量多普勒(PD),骨破坏)和进展为IA时超声资料的关系,以及每个关节基线资料与发生CS的关系。

        结果:持续随访抗CCP阳性患者(n=136,平均年龄51岁,其中女性100人)至中位数18.3个月(范围0.1-79.6月)。基线资料中96%有GS,30%有PD,21%超过一处骨破坏。经过中位数8.6月(范围0.1-52.4)随访,有57位(42%)患者发展为IA。进展为IA的患者中86%(49名)患者满足RA在2010年诊断标准,均出现CS,基线资料出现超声结果异常(GS≥2,PD≥1,骨破坏≥1),在无进展患者中仅有67% 异常(χ2=6.3,p=0.012)。

        超声探查任何关节发现以下情况进展为IA概率显著增高:(GS≥2:55% vs 24% HR(95%CI)2.3(1.0-4.9),P=0.008;PD ≥2:75% vs 32%, 3.7 (2.0 to6.9), p<0.001 ;骨破坏≥1:71% vs34%, 2.9 (1.7 to 5.1), p<0.001)

        而且对于PD ≥2(中位数7.1vs 52.4 月) 及骨破坏≥1 (15.4 vs 46.5)的患者.,进展发生得更早。

        在个体关节水平,发展为CS的倾向比发展为GS和PD更有意义(GS ≥2: 26%vs 3%, 9.4 (5.1 - 17.5), p<0.001; PD≥2: 55% vs 4%, 31.3 (15.6 - 62.9),p<0.001).

        结论:抗CCP阳性无CS的患者通过关节超声可发现关节炎症特点。超声结果可预测进展为IA的概率,具有PD信号的患者最易进展为IA

        附原文:

        Objectives To determine whetherultrasound can identify anti-cyclic citrullinated peptide (anti-CCP) antibody-positivepatients without clinical synovitis (CS) who progress to inflammatory arthritis(IA). Methods In a prospective study, anti-CCP-positive patients without CSunderwent ultrasound imaging of 32 joints (wrists, metacarpophalangeal joints,proximal interphalangeal joints and metatarsophalangeal joints (MTPs)) and weremonitored for the development of IA. Associations between baseline ultrasoundfindings (grey scale (GS), power Doppler (PD) and erosions) and (1) progressionto IA and (2) development of CS within an individual joint were measured. ResultsConsecutive anti-CCP-positive patients (n=136;mean age 51 years, 100 women)were followed up for median of 18.3 months (range 0.1–79.6). At baseline 96%had GS, 30% had PD and 21% had one or more erosions. IA developed in 57patients (42%) after median of 8.6 months (range 0.1–52.4). Ultrasoundabnormalities (GS≥2, PD ≥1 or erosion ≥1) were found in 86% at baseline compared with 67% of nonprogressors(χ2=6.3, p=0.012). Progression to IA was significantly higher in those withultrasound findings in any joint (excluding MTPs for GS) (GS ≥2: 55% vs 24%, HR (95% CI) 2.3 (1.0 to 4.9), p=0.038; PD ≥2:75% vs 32%, 3.7 (2.0 to 6.9), p<0.001 and erosion≥1: 71% vs 34%, 2.9 (1.7 to 5.1), p<0.001). Furthermore,progression occurred earlier with PD ≥2 (median 7.1 vs52.4 months) and erosion ≥1 (15.4 vs46.5). At theindividual joint level, the trend for progression to CS was more significantfor GS and PD (GS ≥2: 26% vs 3%, 9.4 (5.1 to 17.5),p<0.001; PD ≥2: 55% vs 4%, 31.3 (15.6 to 62.9),p<0.001).Conclusion Ultrasound features of joint inflammation may bedetected in anti-CCP-positive patients without CS. Ultrasound findings predictprogression (and rate of progression) to IA, with the risk of progressionhighest in those with PD signal.

        引自:Nam JL,Hensor EM,Hunt L,Conaghan PG,Wakefield RJ,Emery P.Ultrasound findings predict progression to inflammatoryarthritis in anti-CCP antibody-positive patients without clinical synovitisAnn Rheum Dis.2016 Dec;75(12):2060-2067.

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