Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama 236-0004, Japan.
Mod Rheumatol. 2013 May;23(3):456-65. doi: 10.1007/s10165-012-0690-1. Epub 2012 Jul 18.
Although "clinical remission" has been a realistic goal of treatment in rheumatoid arthritis (RA), there is evidence that subclinical synovitis is associated with ongoing structural damage even after clinical remission is achieved. In the study reported here, we assessed whether ultrasonography (US) can predict progressive joint destruction during clinical remission of RA.
Thirty-one patients with RA in clinical remission based on the disease activity score in 28 joints were recruited for this study. Bilateral wrists and all of the metacarpophalangeal and proximal interphalangeal (PIP) joints were examined by power Doppler (PD) ultrasonography (US), and the PD signals were scored semiquantitatively in each joint. The total PD score was calculated as the sum of individual scores for each joint.
Among 22 RA patients who maintained clinical remission during the 2-year follow-up period, seven showed radiographic progression. Radiographic progression was strongly associated with total PD score at entry, with all patients showing radiographic progression having a total PD score of ≥ 2 at entry and none of the patients with a total PD score of ≤ 1 showing any radiographic progression. There was no significant association of therapeutic agents with progressing or non-progressing cases.
PD-US detects synovitis causing joint destruction even when the patient is in clinical remission. Thus, remission visible on US is essential to reach "true remission" of RA.
虽然“临床缓解”一直是类风湿关节炎（RA）治疗的现实目标，但有证据表明，即使在达到临床缓解后，亚临床滑膜炎仍与持续的结构损伤有关。在本研究中，我们评估了超声（US）是否可以预测 RA 临床缓解期间的进行性关节破坏。
本研究招募了 31 名基于 28 关节疾病活动评分处于临床缓解期的 RA 患者。对双侧腕关节和所有掌指关节（MCP）和近端指间关节（PIP）进行能量多普勒（PD）超声（US）检查，并对每个关节的 PD 信号进行半定量评分。总 PD 评分计算为每个关节的个体评分之和。
在 22 名在 2 年随访期间保持临床缓解的 RA 患者中，有 7 名出现放射学进展。放射学进展与基线时的总 PD 评分强烈相关，所有出现放射学进展的患者基线时的总 PD 评分均≥2，而总 PD 评分≤1 的患者均未出现任何放射学进展。治疗药物与进展或非进展病例之间无显著相关性。
PD-US 可检测到导致关节破坏的滑膜炎，即使患者处于临床缓解期。因此，US 可见的缓解对于达到 RA 的“真正缓解”至关重要。
