Devauchelle-Pensec Valerie, Berthelot Jean M, Jousse Sandrine, Samjee Isabelle, Josseaume Thierry, Colin Danielle, Chalés Gerard, Thorel Jean B, Hoang Sylvie, Martin Antoine, Youinou Pierre, Le Goff Paul, Saraux Alain
Unit of Rheumatology, Cavale Blanche Hospital, CHU Brest, Brest, France.
J Rheumatol. 2006 Aug;33(8):1511-5.
To evaluate the ability of baseline hand radiographs to predict the diagnosis 2 years later in a cohort of patients with early arthritis.
A total of 258 patients with arthritis onset within the previous year were evaluated. At baseline, all patients underwent a standardized evaluation including laboratory tests and radiographs. Hand radiographs were read by a blinded observer who used a standardized procedure for detecting features of crystal deposition diseases and rheumatoid arthritis (RA). After 30 +/- 11.3 months, the final diagnosis was established by a panel of rheumatologists. All radiographs were evaluated.
Significant associations were found between radiographic features and a clinical diagnosis of RA, calcium pyrophosphate dihydrate (CPPD) arthritis, and hydroxyapatite arthritis. No radiographic abnormalities suggesting psoriatic arthritis or gout were seen. The sensitivities of hand radiographs for diagnosing CPPD or hydroxyapatite arthritis ranged from 80% to 100%. Baseline hand radiographs suggested the final diagnosis in 31/258 patients, including 21 (22.5%) of the 93 patients with RA, 10 of the 11 (91%) patients with CPPD or hydroxyapatite deposition disease, and none of the patients with other disorders. Sensitivity was 29%, specificity 86.5%, positive predictive value 61%, and negative predictive value 63%.
In our cohort of patients with recent arthritis, the overall performance of hand radiographs in predicting a diagnosis 2 years later was modest. However, they had an excellent diagnostic value for calcium deposition diseases.
评估基线手部X光片对一组早期关节炎患者两年后诊断结果的预测能力。
对总共258例在前一年发病的关节炎患者进行评估。在基线时,所有患者均接受了包括实验室检查和X光片检查在内的标准化评估。手部X光片由一名不知情的观察者阅读,该观察者采用标准化程序来检测晶体沉积疾病和类风湿关节炎(RA)的特征。在30±11.3个月后,由一组风湿病专家确定最终诊断。对所有X光片进行了评估。
在X光片特征与RA、焦磷酸钙二水合物(CPPD)关节炎及羟基磷灰石关节炎的临床诊断之间发现了显著关联。未发现提示银屑病关节炎或痛风的X光片异常。手部X光片诊断CPPD或羟基磷灰石关节炎的敏感性为80%至100%。基线手部X光片在258例患者中提示了最终诊断,其中包括93例RA患者中的21例(22.5%)、11例CPPD或羟基磷灰石沉积疾病患者中的10例,以及其他疾病患者中无一例。敏感性为29%,特异性为86.5%,阳性预测值为61%,阴性预测值为63%。
在我们这组近期患有关节炎的患者中,手部X光片对两年后诊断结果的总体预测表现一般。然而,它们对钙沉积疾病具有出色的诊断价值。