Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004 Kanagawa, Japan.
Rheumatol Int. 2012 May;32(5):1327-33. doi: 10.1007/s00296-011-1802-5. Epub 2011 Feb 4.
To evaluate the responsiveness of power Doppler ultrasonography (PDUS) in comparison with conventional measures of disease activity and structural damage in rheumatoid arthritis (RA) patients receiving tocilizumab (TCZ). Seven RA patients with active arthritis were enrolled in the study and prospectively monitored for 12 months. They were treated with TCZ (8 mg/kg) every 4 weeks as monotherapy or in combination with disease-modifying antirheumatic drugs (DMARDs). Clinical, laboratory, and ultrasound examinations were conducted at baseline, 1, 3, 6, 9, and 12 months. Power Doppler (PD) signals were graded from 0 to 3 in 24 joints, and total PD score was calculated as the sum of scores of individual joints. One-year radiographic progression of the hands was estimated by using Genant-modified Sharp scoring. The averages of the clinical parameters rapidly improved, and all patients achieved good response within 6 months based on standard 28-joint Disease Activity Score (DAS28). Although the average total PD score declined in parallel with clinical improvement, radiography of the hands showed progression of destruction in the joints where PD signals remained, even among clinical responders. ΔSharp score correlated with the time-integrated value (TIV) of total PD scores (Δtotal Sharp score: r = 0.77, P = 0.04; Δerosion: r = 0.78, P = 0.04; Δjoint-space narrowing (JSN): r = 0.75, P = 0.05), but not with TIVs of clinical parameters including DAS28. PDUS can independently evaluate disease activity in RA patients receiving TCZ and is superior to DAS28, especially in predicting joint destruction.
评估在接受托珠单抗（TCZ）治疗的类风湿关节炎（RA）患者中，与疾病活动和结构损伤的常规指标相比，能量多普勒超声（PDUS）的反应性。研究纳入了 7 例活动性关节炎的 RA 患者，并进行了为期 12 个月的前瞻性监测。他们接受 TCZ（8mg/kg）每 4 周治疗，单药或联合改善病情抗风湿药物（DMARDs）治疗。在基线、1、3、6、9 和 12 个月时进行临床、实验室和超声检查。在 24 个关节中对 PD 信号进行 0 至 3 级分级，计算各关节评分总和作为总 PD 评分。通过使用 Genant 改良的Sharp 评分来估计手部的 1 年放射学进展。临床参数的平均值迅速改善，所有患者在 6 个月内根据标准 28 关节疾病活动评分（DAS28）达到良好反应。尽管总 PD 评分的平均值与临床改善平行下降，但在 PD 信号持续存在的关节中，手部放射学显示出破坏的进展，即使在临床应答者中也是如此。ΔSharp 评分与总 PD 评分的时间积分值（Δtotal Sharp score：r=0.77，P=0.04；Δerosion：r=0.78，P=0.04；Δjoint-space narrowing（JSN）：r=0.75，P=0.05）相关，但与包括 DAS28 在内的临床参数的 TIV 无关。PDUS 可独立评估接受 TCZ 治疗的 RA 患者的疾病活动情况，优于 DAS28，特别是在预测关节破坏方面。
