Rheumatology Unit, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046 Madrid, Spain.
Rheumatology (Oxford). 2010 Apr;49(4):683-90. doi: 10.1093/rheumatology/kep442. Epub 2010 Jan 4.
To investigate the accuracy of composite scores in classifying RA patients who are in remission using the absence of inflammatory activity detected by ultrasound (US) as a gold standard.
Ninety-seven RA patients who were classified by their rheumatologists as being in remission were studied. Disease activity was assessed by the DAS-28 and simplified disease activity index (SDAI). US examination was performed in mode B and power Doppler (PD) in 42 joints.
Synovial hypertrophy (SH) and PD were present in 92 (94.8%) and 41 (42.3%) patients. If we consider 'remission' to be the absence of joints with PD signal, no differences were found by DAS-28 between patients in remission and those not in remission, although differences were present by SDAI. We then calculated the sensitivity (S), specificity (Sp) and positive likelihood ratio (LR) of different SDAI cut-off points to predict absence of PD signal. SDAI < 5 had an S of 65% (95% CI 52, 76), Sp of 55% (95% CI 39, 69) and LR of 1.45 (95% CI 0.98, 2.15), whereas SDAI < 3.3 had an S of 57% (95% CI 44, 69), Sp of 74% (95% CI 58, 85) and LR of 2.24 (95% CI 1.25, 4.01).
Our results suggest that the SDAI classification of remission is closer to the concept of an absence of inflammatory activity, as defined by the absence of positive PD signal by US.
以超声（US）检测到无炎症活动作为金标准，探究使用综合评分来对处于缓解期的类风湿关节炎（RA）患者进行分类的准确性。
对 97 名被风湿病学家归类为缓解期的 RA 患者进行研究。疾病活动度通过 DAS-28 和简化疾病活动指数（SDAI）进行评估。对 42 个关节进行 B 型超声和能量多普勒（PD）检查。
92 例（94.8%）患者存在滑膜增厚（SH），41 例（42.3%）患者存在 PD 信号。如果我们将“缓解”定义为不存在具有 PD 信号的关节，则 DAS-28 并未发现缓解期患者与未缓解期患者之间存在差异，尽管 SDAI 存在差异。然后，我们计算了不同 SDAI 截断值预测无 PD 信号的灵敏度（S）、特异性（Sp）和阳性似然比（LR）。SDAI＜5 时 S 为 65%（95%CI 52，76），Sp 为 55%（95%CI 39，69），LR 为 1.45（95%CI 0.98，2.15）；而 SDAI＜3.3 时 S 为 57%（95%CI 44，69），Sp 为 74%（95%CI 58，85），LR 为 2.24（95%CI 1.25，4.01）。
我们的研究结果表明，SDAI 缓解分类更接近以 US 检测到无阳性 PD 信号定义的炎症活动缺失的概念。
