Naredo E, Gamero F, Bonilla G, Uson J, Carmona L, Laffon A
Department of Rheumatology and Research Unit, Hospital de la Princesa, Madrid, Spain.
Clin Exp Rheumatol. 2005 Nov-Dec;23(6):881-4.
To investigate the validity of reduced joint counts for ultrasonographic (US) assessment of joint inflammatory activity in patients with rheumatoid arthritis (RA).
Ninety-four patients with RA were included. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels were recorded for each patient. The presence of tenderness, swelling and a subjective swelling score from 0 to 3 were assessed by two rheumatologists who reached consensus in 60 joints examined in each patient. All patients underwent an US examination by a third blinded rheumatologist, using power Doppler (PD). US joint effusion, synovitis and PD signal were graded from 0 to 3 in the 60 joints. A 60-joint count and index for effusion, synovitis and PD signal were recorded. A 6-, 10-, 16-, 18-, and two 12-joint counts and indices for US parameters that included the most frequently US involved joints were calculated for each patient.
A 12-joint assessment for effusion, synovitis and PD signal, including bilateral wrist, second and third MCP, second and third PIP of hands and knee joints highly correlated with corresponding 60-joint US counts and indices. This reduced-joint US evaluation showed a similar correlation with clinical and laboratory parameters of disease activity to corresponding 60-joint assessment.
We propose that a 12-joint evaluation may be a useful tool for US assessment of overall joint inflammatory activity in RA.
探讨减少关节计数用于超声（US）评估类风湿关节炎（RA）患者关节炎症活动度的有效性。
纳入94例RA患者。记录每位患者的C反应蛋白（CRP）和红细胞沉降率（ESR）水平。由两名风湿科医生评估压痛、肿胀情况以及0至3分的主观肿胀评分，他们在检查每位患者的60个关节时达成共识。所有患者由第三位不知情的风湿科医生使用能量多普勒（PD）进行超声检查。对60个关节的超声关节积液、滑膜炎和PD信号进行0至3级分级。记录60个关节的积液、滑膜炎和PD信号的计数及指数。为每位患者计算6个、10个、16个、18个关节以及两个12个关节的计数及指数，这些关节计数及指数所包含的关节是超声检查中最常受累的关节。
对积液、滑膜炎和PD信号进行12个关节的评估，包括双侧腕关节、第二和第三掌指关节、手部的第二和第三近端指间关节以及膝关节，与相应的60个关节超声计数及指数高度相关。这种减少关节数的超声评估与疾病活动度的临床和实验室参数的相关性，与相应的60个关节评估相似。
我们提出12个关节的评估可能是超声评估RA患者整体关节炎症活动度的有用工具。
