Division of Rheumatology, UCSC-Catholic University of Rome, Complesso Integrato Columbus-CIC, Rome, Italy.
Ann Rheum Dis. 2011 Jan;70(1):172-5. doi: 10.1136/ard.2010.129924. Epub 2010 Nov 19.
Treatment of rheumatoid arthritis (RA) should aim at full remission. The aims of this study were to define: (1) how many patients reached ultrasound power Doppler (US-PD) remission in a cohort of patients with early RA (ERA) compared with longstanding RA (LSRA); (2) possible predictors of US-PD remission; and (3) how many patients with and without US-PD remission relapsed after 1 year of follow-up in ERA and LSRA.
48 patients with ERA and 46 with LSRA with disease activity score <1.6 underwent US assessment. Six hand and wrist joints were studied for active synovitis. 56.2% of patients with ERA and 50.0% of those with LSRA fulfilled American College of Rheumatology (ACR) remission criteria.
43.7% of patients with ERA and 17.4% of those with LSRA had no evidence of synovitis at US evaluation. Using a stricter clinical definition of remission (ie, ACR criteria), US evaluation confirmed clinical remission in 66.7% of patients with ERA and 26.1% of those with LSRA. Early disease was predictive of clinical US remission. 20.0% of patients with RA who had a negative PD signal at the US evaluation had a flare during the 12-month follow-up period compared with 47.1% of patients who had a positive PD signal.
US-PD remission occurs in half of patients with ERA and in a minority of patients with LSRA in clinical remission. Early disease seems to be the major determinant of full remission.
类风湿关节炎（RA）的治疗应旨在达到完全缓解。本研究的目的是定义：（1）与长期 RA（LSRA）相比，早期 RA（ERA）患者中有多少患者达到超声动力多普勒（US-PD）缓解；（2）US-PD 缓解的可能预测因素；以及（3）在 ERA 和 LSRA 中，有多少有和没有 US-PD 缓解的患者在 1 年随访后复发。
48 例 ERA 患者和 46 例 LSRA 患者的疾病活动评分<1.6，进行了 US 评估。研究了 6 个手部和腕关节的活跃滑膜炎。56.2%的 ERA 患者和 50.0%的 LSRA 患者符合美国风湿病学会（ACR）缓解标准。
43.7%的 ERA 患者和 17.4%的 LSRA 患者在 US 评估中没有滑膜炎证据。使用更严格的临床缓解定义（即 ACR 标准），US 评估确认 ERA 患者中有 66.7%和 LSRA 患者中有 26.1%达到临床缓解。早期疾病是临床 US 缓解的预测因素。在 US 评估中 PD 信号为阴性的 RA 患者中有 20.0%在 12 个月随访期间出现病情加重，而 PD 信号阳性的患者中有 47.1%出现病情加重。
在临床缓解的 ERA 患者中有一半和 LSRA 患者中有少数患者达到 US-PD 缓解。早期疾病似乎是完全缓解的主要决定因素。
