|
[2011] [FRI0072] ULTRASOUND DEFINED
REMISSION AND ACTIVE DISEASE IN RHEUMATOID ARTHRITIS: ASSOCIATION
WITH CLINICAL AND SEROLOGIC PARAMETERS
C. Dejaco1, C. Duftner2, E.
Wipfler-Freißmuth3, H. Weiss4, M.
Schirmer5 1Rheumatology, Medical University
Graz; 2Internal Medicine, General Hospital Kufstein;
3Internal Medicine, Hospital of The Barmherzige Brüder
Marschallgasse, Graz; 4Radiology, General Hospital of
The Elisabethinen, Klagenfurt; 5Internal Medicine I,
Innsbruck Medical University, Innsbruck,
Austria
Background:
For rheumatoid arthritis (RA) clinical definitions of remission and
active disease are based on composite-index scores. These
definitions, however, lack sensitivity and specificity to predict
the absence of inflammation as shown by sonography. Therefore,
imaging based assessment of disease activity has become more and
more important during the last years.
Objectives: To assess the association of clinical
and/or serological parameters with ultrasound defined remission and
active disease in RA.
Methods: Retrospective analysis of 149 consecutive
RA-patients [mean disease activity score-28 (DAS-28) 4.5 (standard
deviation ± 1.3); mean age 63.7 (±13.4) years; 84.6% female; median
disease duration 18 months] routinely assessed by sonography of the
wrists, metacarpo-phalangeal and proximal inter-phalangeal joints
(=22 joints). Semiquantitative scoring of synovial
hypertrophy/effusion (SH/E) and power Doppler (PD) signals was
performed. Sonographic remission was defined by the absence of
PD-signals. Number of tender (TJ) and swollen joints (SJ), global
assessment of disease activity by the physician (VAS-phys) and
patient (VAS-pt), C-reactive protein (CRP), erythrocyte
sedimentation rate (ESR), duration of morning stiffness (MS) and
health assessment questionnaires (HAQ) were recorded. This study
was accepted by the local ethics committee. Statistical analysis
was performed using SPSS program (version 18.0) and the
Mann-Whitney-U, chi-square tests and logistic regression analysis
were performed as appropriate.
Results: PD-signals as a sign of active disease
were observed in 117 (78.5%) RA-patients. CRP [median 8.2
(interquartile range 21.8) vs. 3.0 (5.3) mg/L,
p<0.001], ESR [25.0 (30.0) vs. 14.0 (12.0) mm/1st
hour, p<0.05] and MS [30.0 (112.0) vs. 12.5 (30.0)
minutes, p<0.05] were higher in patients with
PD-signals than in patients in sonographic remission.
CRP
>5.0mg/L (normal values 0-5.0mg/L), MS
>15min or the combination of both revealed ORs of
5.0 (1.9-13.1, p=0.001), 3.0 (1.2-7.5, p=0.017) or 18.9 (3.8-94.6,
p<0.001), respectively to indicate sonography
defined active disease. The other parameters showed no association
with the presence or absence of PD-signals.
Conclusions: Sonography defined disease activity is
associated with CRP and MS, whereas the other clinical items did
not match this definition.
Disclosure of
Interest: None Declared
Citation: Ann Rheum Dis
2011;70(Suppl3):369
|
超声定义的疾病活动和缓解与临床及血清学参数的相关性
Dejaco C, et al. EULAR 2011. Present
No: FRI0072.
背景:
类风湿关节炎(RA)临床缓解期及活动性疾病的定义是基于复合性指数的评分。然而,
对于预测超声炎症而言，这些定义缺乏相应的敏感性和特异性。因此,在近几年里，基于影像学评估疾病活动度变得越来越重要。
目的:
探究临床或血清学参数与超声定义的疾病活动度的相关性。
方法:
回顾分析149个连续收治的RA病人(DAS28均值为4.5(标准差:
±1.3),平均年龄为63.7岁(±13.4),
女性比例为84.6%,平均病程18个月)，对其进行常规超声检查，包括腕关节、掌指关节以及近端指间关节(每例病人查22个关节)。对滑膜增厚/渗出(SH/E)以及强力多普勒(PD)信号进行半定量评分。超声缓解的定义是未见PD信号。评估指标包括压痛关节计数(TJ)和肿胀关节计数(SJ)、医生(VAS-phys)及病人(VAS-pt)对疾病的全面评估、C反应蛋白(CRP)、红细胞沉降率(ESR)、晨僵持续时间(MS)以及健康评估问卷(HAQ)。本研究得到了当地伦理委员会的核准。利用SPSS软件(18.0版)进行统计分析，Mann-Whitney-U检验、卡方检验以及逻辑回归分析均按标准操作。
结果:
PD信号作为疾病活动的征像，见于117例RA病人(78.5%)。超声活动病人的以下炎性参数值高于超声缓解病人：CRP
[中位数为8.2(四分位距为21.8)
vs 3.0(5.3) mg/dL)(p < 0.001)], ESR [25.0(30.0)
vs
14.0(12.0) mm/h, p < 0.05]，MS
[30.0 (112.0) vs 12.5(30.0) min, p <
0.05]。CRP
> 5.0 mg/L (正常值为0
- 5.0 mg/L)或MS>15min，或者这两个条件均满足，揭示超声疾病活动的风险值(OR)分别为5.0(1.9
- 13.1, p = 0.001)、3.0(1.2
- 7.5, p = 0.017)和18.9
(3.8 - 94.6, p < 0.001)。未发现其它参数与PD信号之间的相关性。
结论:
超声定义的疾病活动与CRP和晨僵时间有相关性，但与其它临床参数无相关性。
|