Reumatologia, Dipartimento di Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Viale del Policlinico 155, 00161 Rome, Italy.
Rheumatology (Oxford). 2012 May;51(5):866-73. doi: 10.1093/rheumatology/ker405. Epub 2011 Dec 30.
Musculoskeletal US can be useful in monitoring RA. It can be time-consuming and there is no consensus in defining the joints to evaluate. We assessed the validity, sensitivity to change and feasibility of a reduced 6-joint US score in patients with RA starting therapy with an anti-TNF agent.
A group of consecutive RA patients starting etanercept were investigated. The patients underwent clinical evaluation, laboratory tests and US assessment at baseline and 3 months. A semi-quantitative score (0-3) was used to evaluate synovial effusion (SE), synovial proliferation (SP) and power Doppler (PD) signal in 12 joints. A process of data reduction, based on the frequency of synovial site involvement by US-SE, US-SP and US-PD signal, was conducted to investigate the validity of a 6-joint US assessment.
Forty-five RA patients were evaluated. A significant decrease in all clinical, serological and 12-joint US parameters was found at follow-up. A significant correlation between changes in the DAS-28 and changes in the US scores in the 12-joint assessment was observed at follow-up (P < 0.001). A reduced 6-joint US score was obtained, including wrist, second MCP and knee joints of both sides, detecting US-SE in 97.78% of patients, US-SP in 100% of patients and positive US-PD in 100% of patients. The 6-joint US score showed a highly significant correlation with changes in DAS-28 (P < 0.001). The 6-joint evaluation was quick and easy to do.
A 6-joint US assessment may be a valid, sensitive-to-change and feasible method for evaluating joint inflammation in RA.
肌肉骨骼超声（US）可用于监测类风湿关节炎（RA）。该方法耗时，且目前对于评估关节尚未达成共识。本研究旨在评估对于开始接受抗 TNF 治疗的 RA 患者，简化的 6 关节 US 评分在评估疗效方面的有效性、灵敏度和可行性。
连续纳入开始接受依那西普治疗的 RA 患者。所有患者在基线和 3 个月时接受临床评估、实验室检查和 US 评估。使用半定量评分（0-3 分）评估 12 个关节的滑膜积液（SE）、滑膜增生（SP）和能量多普勒（PD）信号。基于 US-SE、US-SP 和 US-PD 信号的滑膜受累频率，进行数据简化过程，以评估 6 关节 US 评估的有效性。
共 45 例 RA 患者接受评估。随访时，所有临床、血清学和 12 关节 US 参数均显著降低。随访时 DAS-28 变化与 12 关节 US 评分变化之间存在显著相关性（P<0.001）。获得简化的 6 关节 US 评分，包括腕关节、第二掌指关节和双侧膝关节，97.78%的患者检测到 US-SE，100%的患者检测到 US-SP，100%的患者检测到阳性 US-PD。6 关节 US 评分与 DAS-28 变化高度相关（P<0.001）。6 关节评估快速、简便。
6 关节 US 评估可能是一种有效的、灵敏的、可行的方法，可用于评估 RA 患者的关节炎症。
