简短报告：挤还是不挤，这是个问题！通过在早期类风湿关节炎中增加跖趾关节挤压试验来优化28关节疾病活动评分。

Brief Report: to squeeze or not to squeeze, that is the question! Optimizing the disease activity score in 28 joints by adding the squeeze test of metatarsophalangeal joints in early rheumatoid arthritis.

作者信息

de Jong P H, Weel A E, de Man Y A, Huisman A M, Gerards A H, van Krugten M V, Luime J J, Hazes J M

机构信息

Erasmus University Medical Center, Rotterdam, The Netherlands.

出版信息

Arthritis Rheum. 2012 Oct;64(10):3095-101. doi: 10.1002/art.34568.

DOI:10.1002/art.34568

PMID:22673898

Abstract

OBJECTIVE

To optimize use of the Disease Activity Score in 28 joints (DAS28) in early rheumatoid arthritis (RA) by adding the "squeeze test" of forefeet.

METHODS

The squeeze test is used to examine bilateral compression pain (BCP) across the metatarsophalangeal (MTP) joints. For this study, data for patients participating in the Treatment in the Rotterdam Early Arthritis Cohort study, an ongoing clinical trial that evaluates different induction therapies in patients with early RA, were randomly divided into 2 subsets. In subset 1 (149 patients and 819 disease activity assessments), the mathematical function of the DAS28-squeeze was constructed using a linear regression model with the DAS as the dependent variable and the DAS28 and squeeze test as the independent variables. A DAS28-BCP disease state was also constructed, in which DAS28 disease state categorizations were upgraded one state if the result of the squeeze test was positive. In subset 2 (153 patients and 754 assessments), concordance in disease states between the DAS28, DAS28-squeeze, and DAS28-BCP disease states was compared, using both the DAS and Boolean-defined remission criteria as reference.

RESULTS

Agreement between the DAS and the DAS28-squeeze (82%) was significantly higher than agreement between the DAS and the DAS28 (76%). When we assessed the group of patients who had arthritis of the forefeet only (22 patients and 46 assessments), overall agreement between the DAS and the DAS28 was 40%, while agreement between the DAS and the DAS28-squeeze was 59% and that between the DAS and the DAS28-BCP disease state was 65%. Furthermore, the specificities of the DAS28-squeeze and the DAS28-BCP (80% and 81%, respectively) were higher than that of the DAS28 (76%), while the sensitivities of the DAS28, DAS28-squeeze, and DAS28-BCP to identify true remission according to the Boolean criteria were 88%, 87%, and 81%, respectively.

CONCLUSION

Adding the squeeze test of forefeet to the DAS28 has value for dependably classifying the disease state in patients with early RA.

摘要

目的

通过增加前足“挤压试验”来优化28关节疾病活动评分（DAS28）在早期类风湿关节炎（RA）中的应用。

方法

挤压试验用于检查跖趾（MTP）关节双侧压痛（BCP）。在本研究中，参与鹿特丹早期关节炎队列研究（一项评估早期RA患者不同诱导治疗方法的正在进行的临床试验）的患者数据被随机分为两个子集。在子集1（149例患者和819次疾病活动评估）中，以DAS为因变量、DAS28和挤压试验为自变量，使用线性回归模型构建DAS28-挤压的数学函数。还构建了DAS28-BCP疾病状态，如果挤压试验结果为阳性，则将DAS28疾病状态分类提升一级。在子集2（153例患者和754次评估）中，以DAS和布尔定义的缓解标准为参考，比较DAS28、DAS28-挤压和DAS28-BCP疾病状态之间疾病状态的一致性。

结果

DAS与DAS28-挤压之间的一致性（82%）显著高于DAS与DAS28之间的一致性（76%）。当我们评估仅患有前足关节炎的患者组（22例患者和46次评估）时，DAS与DAS28之间的总体一致性为40%，而DAS与DAS28-挤压之间的一致性为59%，DAS与DAS28-BCP疾病状态之间的一致性为65%。此外，DAS28-挤压和DAS28-BCP的特异性（分别为80%和81%）高于DAS28的特异性（76%），而根据布尔标准，DAS28、DAS28-挤压和DAS28-BCP识别真正缓解的敏感性分别为88%、87%和81%。