Institute of Rheumatology, University of Belgrade Medical School, Resavska 69, 11000 Belgrade, Serbia.
Rheumatology (Oxford). 2012 Jan;51(1):120-8. doi: 10.1093/rheumatology/ker255. Epub 2011 Nov 8.
To investigate the construct validity and reliability of US DAS compared with 28-joint DAS (DAS-28) in assessing joint inflammation and in prediction of structural damage in patients with RA.
Ninety patients with active RA were prospectively recruited and followed up during the 6 months of treatment. The patients underwent clinical, laboratory and X-ray assessment, along with blinded power Doppler US (PDUS) and grey-scale (GS) US (GSUS) examination at baseline and 6 months. A subgroup of 25/90 randomly assigned patients underwent MRI examination of their hands at baseline. A PDUS examination of 22 joints and GSUS examination for effusion/hypertrophy (E/H) of 28 joints were performed by two independent examiners, blinded to clinical findings. E/H was qualitatively assessed as absent or present, and PD signal was semi-quantitatively graded from 0 to 3. PDUS score for synovitis in 22 joints and GS score for E/H in 28 joints were included in US DAS calculation. Clinical scoring, PDUS and GSUS inter-observer reliability were evaluated.
Strong correlation was found between US DAS and standard assessment of disease activity such as the DAS-28, ESR and CRP levels. Correlation between US DAS and patients' and physicians' visual analogue scale of activity was moderate, whereas correlations of US DAS with Health Assessment Questionnaire - Disability Index (HAQ-DI) and Short Form 36 Health Survey (SF-36) were weak to moderate. US DAS correlated with X-ray, MRI and US parameters and rates of joint damage.
US DAS better anticipated future joint damage than standard DAS-28.
探究超声 DAS 与 28 关节 DAS（DAS-28）评估关节炎症和预测 RA 患者结构损伤的结构效度和可靠性。
前瞻性招募 90 例活动性 RA 患者，并在 6 个月的治疗期间进行随访。患者在基线和 6 个月时进行临床、实验室和 X 线评估，以及盲法功率多普勒超声（PDUS）和灰阶超声（GSUS）检查。25/90 名随机分配的患者亚组在基线时接受手部 MRI 检查。由两名独立的检查者对 22 个关节进行 PDUS 检查和 28 个关节的 E/H（积液/肥厚）的 GSUS 检查，两位检查者均对临床发现不知情。E/H 通过定性评估为存在或不存在，PD 信号从 0 到 3 进行半定量分级。将 22 个关节的 PDUS 滑膜炎评分和 28 个关节的 E/H 的 GS 评分纳入 US DAS 计算中。评估临床评分、PDUS 和 GSUS 观察者间可靠性。
US DAS 与疾病活动的标准评估（如 DAS-28、ESR 和 CRP 水平）之间存在强相关性。US DAS 与患者和医生活动视觉模拟量表之间的相关性为中度，而 US DAS 与健康评估问卷残疾指数（HAQ-DI）和简明 36 健康调查（SF-36）之间的相关性为弱到中度。US DAS 与 X 线、MRI 和 US 参数以及关节损伤率相关。
与标准 DAS-28 相比，US DAS 能更好地预测未来的关节损伤。
