PD血流信号预测早期RA侵蚀性骨损害

原文

译文

OP0030

VASCULAR SIGNAL AS SEEN ON POWER DOPPLER ULTRASOUND PREDICTS EROSIVE CHANGE IN EARLY RHEUMATOID ARTHRITIS

D. Sreerangaiah ^1,*, P. Charles ¹, S. Abraham ¹, A. Fox ¹, C. McClinton ¹, M. Ho ², P. C. Taylor ¹

¹Kennedy Institute of Rheumatology, Imperial College, London, ²AstraZeneca R&D, AstraZeneca Ltd, Loughborough, United Kingdom

Background: Rheumatoid arthritis (RA) is a heterogenous disease characterized by the presence of synovial inflammation and proliferation, which if unchecked may lead to cartilage and bone erosion with eventual joint damage. Hypertrophic synovium in the active phase of erosive disease is metabolically active and maintenance and growth of proliferating tissue requires the formation of new blood vessels which deliver nutrients as well as facilitating the recruitment of inflammatory cells. Power Doppler ultrasound enables detection of such vascular tissue in the inflamed joint, and may therefore represent a useful tool in early RA for prediction of those patients most likely to have progressive joint destruction if treated with conventional synthetic DMARDs alone.

Objectives: To study the use of power Doppler ultrasound as a predictor of erosive progression in early rheumatoid arthritis.

Methods: 50 patients taking part in an ongoing prospective study of prognostic markers in early seropositive RA underwent 2D high frequency grey scale US, PDUS of 10 MCP joints, and 3D PDUS of 10 MCP joints at 0 and 12 months. A single operator carried out all scans with a GE Logiq 9 scanner, using a multi-frequency linear probe (7-12MHz) and 4D16L3D probe, under standardized settings. 2D images were scored for erosions at the MCP joints at each visit, and also scored qualitatively for vascularity and also quantitatively using a digitalised pixel counter. 3D images were scored qualitatively for vascularity and also quantitatively where synovial power Doppler signal was calculated in mm³

Results: At baseline, median DAS 28 was 4.06 with16 patients demonstrating a total of 39 erosions at the MCP joints. At 12 months 36 patients had a total of 123 erosions at the MCP joints. A statistically significant, strongly positive correlation was found between baseline total MCP 3D power Doppler volume (PDV) and erosive progression on high frequency grey scale ultrasound, (Spearman rank correlation coefficient 0.59, 95% CI 0.37 - 0.75 p < 0.0001). On 2D images, a strongly positive correlation was found between measures of vascularity at baseline and progression of erosive disease at 12 months, (Spearman rank 0.54, 95% CI 0.30 - 0.72, p<0.001 for both qualitative and quantitative cumulative transverse and longitudinal scores). Measures of baseline vascularity correlated better with erosive progression than CRP (Spearman rank 0.44, 95% CI 0.17 - 0.64, p = 0.0015) and DAS 28 (Spearman rank 0.30, 95% CI 0.017 - 0.54, p = 0.03), although these correlations were still significant. Functional measures of disease activity at baseline such as HAQ score, Patient global visual analogue scale and Belza fatigue score did not correlate with erosive progression of disease at 12 months.

Conclusions: Erosive progression at the MCP joints in seropositive early RA is strongly correlated with baseline vascular signal seen in MCP joints on 3D and 2D power Doppler ultrasound. These findings strongly implicate vascular tissue in the erosive phase of disease and may permit future stratification of patients into treatment strategies based on risk of tissue destruction.

PD血流信号预测早期RA侵蚀性骨损害

D. Sreerangaiah , EULAR 2011. Present No: OP0030

背景:类风湿性关节炎(RA)是一种异质性疾病,其特点是滑膜炎症和增生,如果不控制会导致软骨和骨侵蚀最终破坏关节。侵蚀性疾病的活动期中肥厚性滑膜炎代谢活跃并持续维持和生长增生组织所需要的新生血管,后者提供营养运输并促进炎性细胞聚集。能量多普勒超声能检测炎症关节中的血管组织,因而可以在早期仅用传统合成DMARDs治疗的RA中预测那些患者最有可能发生进行性关节破坏。

目的:探讨多普勒超声用于预测早期类风湿性关节炎的侵蚀性进展的作用。

方法:随机选择50例正在参加一项前瞻性预后标记研究的早期血清学阳性RA患者，进行0和12个月的2D高频灰阶US, 10个MCP关节的PDUS,以及10个MCP关节的3D PDUS。所有检测均由1个操作员完成，应用GE Logiq 9扫描器,多频线性探头(7-12MHz ) 和4D16L3D探头,标准化设置。2D图像对每次访视时MCP关节的侵蚀部位进行评分，并对血管化进行定性和数码计算器定量。3D图像也对血管化进行定性，对能量多普勒超声信号的滑膜炎也进行定量并以mm3计算。

结果:基线时,有16例患者出现MCP关节的39处侵蚀，平均DAS 28 为4. 06。12个月时，有36例患者出现MCP关节123处侵蚀。基线水平时总MCP 3D多普勒量(PDV)与高频灰阶超声中的侵蚀进展呈显著正相关 (Spearman等级相关系数0.59,95%可信区间0.37 - 0.75 p < 0.0001)。2D图像上,基线水平的血管化与12个月是的侵蚀进展显著相关 (定性和定量的累积纵、横向分数，Spearman等级0.54,95%可信区间为0.30 - 0.72,p < 0.001)。基线血管化的与侵蚀进展的相关性要优于CRP(Spearman等级0.44,95%可信区间为0.17 - 0.64,p = 0.0015)和DAS 28（Spearman等级0.30,95%可信区间为0.017 - 0.54,p = 0.03),虽然这些相关性都有显著意义。基线水平时疾病活动的功能指标如HAQ积分、病人整体视觉模拟评分和Belza疲劳积分与12个月时的侵蚀进展不相关。

结论: 血清阳性的早期RA患者中MCP关节的侵蚀性进展与基线水平时2D和3D多普勒超声中探测到的血管信号强相关。这些发现高度提示疾病侵蚀阶段中的血管组织可以评估患者组织破坏的，从而对治疗策略进行分类。