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[2011] [SAT0062] MAXIMAL IDENTIFICATION OF WRIST SYNOVITIS USING ULTRASOUND IN RHEUMATOID ARTHRITIS: WHICH IS THE OPTIMUM JOINT COMPARTMENT TO IMAGE? J. Freeston1,2, J. Nam1, A.K. Brown3, H. Keen4, E.M.J. Vital1, E. Villeneuve1, E.M.A. Hensor1, P. Emery1, P.G. Conaghan1, R.J. Wakefield1 1LIMM Section of Musculoskeletal Disease, University of Leeds; 2NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds; 3Rheumatology, York Hospital NHS Trust, York, United Kingdom; 4Rheumatology, University of Western Australia, Perth, Australia Background: Ultrasound (US) assessment in rheumatoid arthritis (RA) typically includes the different wrist compartments which are frequently involved in both early and established disease. However, there is minimal data published on the prevalence of synovitis between these compartments and consequently there is no current consensus as to which wrist compartment(s) should be imaged for maximal identification of synovitis. Objectives: To compare US semi-quantitative (SQ) scores from a disease spectrum (both of disease duration and activity) of RA patients and healthy controls in order to assess prevalence of synovitis by compartment scanned. Methods: We assessed US images from 361 patients: 213 with 'early RA' (median disease duration 6 months, mean DAS28CRP 4.37) and 148 with 'established RA' (median disease duration 7 years, mean DAS28CRP 3.63 but ranging from 6.46 in 42 patients with active disease to 2.50 in 105 patients in remission). Data on 10 healthy controls were also analysed. The following wrist compartments were scanned: radio-carpal joint (RCJ), ulna-carpal joint (UCJ) and midline inter-carpal joint (ICJ). Synovitis was defined according to the EULAR-OMERACT US group definition. Where bilateral wrists were scanned, the most affected side was used for analysis, and in the event of equal activity, the dominant side was used. Grey scale (GS) and power Doppler (PD) images were obtained using a Philips HDI 5000 machine employing a 15-7 MHz hockey stick transducer and scored using an SQ 0-3 scale for each parameter. Results: Cochran's Q test was used to look for an overall effect across the 3 wrist compartments for varying degrees of US activity (GS≥1, GS≥2, PD≥1 and PD≥2). A significant association was found for GS≥1 and PD≥2. Pairwise comparisons (McNemar's test) identified a significantly higher disease prevalence for the ICJ compared to the RCJ for GS≥1 and to both the RCJ and UCJ for PD≥2. In controls, GS was most prevalent at the ICJ (40% with GS≥2) but no PD activity was seen in any compartment. Sensitivity and specificity of the ICJ for identifying activity in the RCJ and/or UCJ is shown in the table.
Conclusions: In RA patients and controls the ICJ identified the most disease, showing high sensitivity and specificity. These findings suggest that the ICJ offers the most useful assessment both in clinical trials and practice where time constraints require only one wrist compartment to be scanned. Disclosure of Interest: None Declared
Citation: Ann Rheum Dis 2011;70(Suppl3):542 |
超声检查腕骨间关节有助于最大程度地发现RA腕骨间滑膜炎 Freeston J, et al. EULAR 2011. Present No: SAT0062. 背景: 超声评估类风湿关节炎(RA)通常包括腕关节的不同分区，早期和长病程患者常见这些间隔的受累。然而，这些间隔的滑膜炎发生率却是少有报道，而且目前对于哪些分区应该接受影像学检查以期最大可能发现滑膜炎也缺乏相应共识。 目的: 对不同疾病谱(疗程和活动性)病人以及健康对照进行超声半定量评分，以评估腕关节不同分区滑膜炎的累及率。 方法: 我们对361例病人的超声影像学进行了评估。其中有213例“早期RA”病人(中位数病程为6个月，DAS-CRP均值为4.37)，以及148例“长病程RA”(中位数病程为7年，DAS-CRP均值为3.63，其中42例活动性病人的DAS-CRP评分均值为6.46，105例缓解病人的DAS28-CRP均值为2.50)。同时也分析了10例健康对照组的数据。 对下列腕关节分区进行扫描：桡掌关节(RCJ)，尺掌关节(UCJ)以及正中线掌骨间关节(ICJ)。滑膜炎的定义采用EULAR-OMERACT超声小组的定义。扫描双侧腕关节，但仅分析受累最重一侧。如果两侧病变活动度相同，则分析优势手一侧。采用飞利浦HDI 5000获取灰阶(GS)与多普勒影像，该仪器配备了15-7 MHz曲棍球球棍式传感器，每种评估参数均用半定量评分(0~3)。 结果: 利用考科蓝Q检验寻找超声所测不同疾病活动度(GS≥1, GS≥2, PD≥1以及PD≥2)对于3个腕关节分区的总体效应。分析发现有显著相关性的是GS≥1和PD≥2。配对分析(McNemar检验)发现GS≥1的ICJ受累率显著高于RCJ确定疾病的发病率明显高于RCJ，PD≥2的ICJ受累率显著高于RCJ和UCJ。 在对照者中,ICJ的GS阳性率最高(GS≥2占40%)，但各个分区均未见PD活性。 ICJ阳性表现对于发现RJC和/或UCJ受累的敏感性和特异性列在表格中。 结论: 在RA病人和对照者中，ICJ可见于大多数病人，从而有较高的敏感性和特异性。由于耗时限制，临床只能检查腕关节的一个分区。本研究结果提示影像学检查ICJ对于临床试验和常规诊疗都是最重要的。
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