[EULAR文摘] 超声腱鞘炎对RA早期诊断的价值

超声腱鞘炎对RA早期诊断的价值

Sahbudin I, et al. EULAR 2015. Present ID: OP0015.

背景：为了预测早期未分化疾病发展为类风湿关节炎(RA),

EULAR类风湿关节炎危险因素研究小组建议寻找新的生物标志物。OMERACT超声任务组最近证实,超声评估RA腱鞘炎(TS)是一种可重复的工具。腱鞘炎是早期RA的常见表现。迄今为止,尚不清楚超声定义的TS对于早期RA的预测作用。

目的：在极早期关节炎(VERA)患者中比较超声定义的腱鞘炎与临床和实验室指标变化对早期RA的预测作用。

方法：共纳入107例患者,他们至少有一个关节有临床明显滑膜炎且症状持续时间≤3个月。在随访18个月时进行临床评估并超声评估多个肌腱。采用1987美国风湿病学院(ACR)分类标准评判患者是否演变为RA。

采用盲法设计,利用灰阶和能量多普勒超声(PD)检查16个肌腱区是否存在腱鞘炎。16个肌腱区包括双侧手指(伸/屈肌室)、手腕(伸/屈肌室)、肩部(肱二头肌肌腱)、踝关节(胫前肌,腓骨肌群,胫后肌)。采用西门子Acuson Antares超声仪和5-13 MHz线阵探头。灰阶和能量多普勒超声的腱鞘炎定义采用OMERACT-超声专责小组建议[1],并记录为二元结果(即”有或无”)。同时,我们比较了超声定义腱鞘炎与临床和血清学变量的预测价值。

结果：43例VERA患者发展为RA, 20例患者演变为非RA的持续性疾病(NRAP)，44例患者的关节炎症状在随访过程中消退。107例患者共计1712个肌腱区域被纳入分析。在基线时,所有患者组均有一或多个腱隔间有腱鞘炎(VERA 86％, NRAP 75％,消退组70％)。但三组患者受累腱鞘分布有显著差异,包括尺侧腕伸肌肌腱(ECU)(VERA54％, NRAP15％,消退组18％, P<0.001)。

关于早期RA预测作用,超声腱鞘炎优于临床变量(晨僵、对称性关节炎和手关节炎等)。

结论：本研究首次表明超声腱鞘炎是早期RA的强预测因子。超声评估手部和尺侧腕伸肌肌腱(ECU)为预测早期RA提供了优化的最小信息。

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表. 临床评估和超声定义腱鞘炎对于早期RA的预测作用

参考文献:

1. Naredo E, D'Agostino MA, Wakefield RJ, et al. Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 2013; 72(8): 1328-34.

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原文链接或参见以下信息。

Ann Rheum Dis 2015;74:69-70 doi:10.1136/annrheumdis-2015-eular.1591

• Oral Presentations

OP0015 Ultrasound-Defined Tenosynovitis is a Strong Predictor of Early Rheumatoid Arthritis

1. I. Sahbudin^1,2, 
2. L. Pickup^1,2, 
3. Z. Cader¹, 
4. A. Abishek¹, 
5. C.D. Buckley^1,3, 
6. G. Allen⁴,
7. P. Nightingale², 
8. P. de Pablo^1,2, 
9. K. Raza^1,3, 
10. A. Filer^1,2

-Author Affiliations

1. ¹Rheumatology Research Group, School of Immunity and Infection, University of Birmingham
2. ²University Hospitals Birmingham NHS Foundation Trust
3. ³Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, Birmingham
4. ⁴Green Templeton College, University of Oxford, Oxford, United Kingdom

Abstract

Background The EULAR Study Group for Risk Factors for Rheumatoid Arthritis (RA) recommends identification of new biomarkers for prediction of RA in early undifferentiated disease. The OMERACT Ultrasound Task Force recently established that US is a reproducible tool for evaluating tenosynovitis (TS) in RA¹, which is a common manifestation of early RA. At present, the value of US-defined TS in the prediction of early RA is unknown.

Objectives To explore the ability of US-defined TS to predict early RA compared with clinical and serological variables in an unselected very early arthritis cohort.

Methods 107 patients with clinically apparent synovitis of at least one joint and symptom duration ≤3 months underwent clinical and multiple tendon US assessments and outcome was determined after 18 months by 1987 American College of Rheumatology criteria.

A blinded US assessment determined the presence of grey scale and Power Doppler (PD) TS at 16 tendon regions: bilateral fingers (extensor and flexor compartments), wrists (extensor and flexor compartments), shoulders (biceps tendon), ankles (anterior extensors, peroneals, posterior tibialis) using a Siemens Acuson Antares scanner and 5–13 MHz linear array transducer. Grey scale and PD TS definition was based on the OMERACT Ultrasound Task Force recommendations¹ and recorded as binary outcomes. We compared the predictive values of US-defined TS with clinical and serological variables.

Results 43 patients developed RA (VERA), 20 patients developed non-RA persistent disease (NRAP) and 44 patients had resolving disease at follow-up. A total of 1712 tendon regions in 107 patients were included in the analysis. All patient groups had evidence of tenosynovitis in one or more tendon compartments during baseline assessment (VERA 86%, NRAP 75%, resolving 70%). There were significant differences in the distribution of tendon involvement between the three groups including the Extensor Carpi Ulnaris tendon (ECU); [VERA 54%, NRAP 15%, resolving 18%; (p<0.001)].

TS ultrasound variables were superior to clinical variables (early morning stiffness, symmetrical arthritis and hand joint arthritis) in the prediction of early RA.

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Conclusions This is the first study to show that US-defined TS is a strong predictor of early RA.

Hand and ECU tendon scanning provides the optimal minimal ultrasound data to predict early RA.

References

1. 1. Naredo E, D'Agostino MA, Wakefield RJ, et al. Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis. Ann Rheum Dis 2013;72(8):1328-34.