Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
Rheumatology (Oxford). 2014 Mar;53(3):562-9. doi: 10.1093/rheumatology/ket405. Epub 2013 Dec 5.
The aim of this study was to investigate the characteristics of power Doppler (PD) subclinical synovitis in patients with RA who achieve clinical remission free from physical synovitis.
Twenty-nine RA patients were consecutively enrolled. All of the patients had achieved clinical remission [simplified disease activity index (SDAI) 3.3] for at least 6 months at the musculoskeletal ultrasound (MSKUS) examination. Additionally, none of the patients exhibited tender joints at 68 sites or swollen joints at 66 sites. MSKUS of bilateral wrist and finger joints, including the first to fifth MCP joints, the first IP joint and the second to fifth PIP joints, was performed and the findings obtained by grey scale (GS) and PD were graded on a semi-quantitative scale from 0 to 3.
The median disease duration upon the introduction of DMARDs was 3 months and that at MSKUS examination was 21 months. The percentages of patients with PD synovitis in at least one joint were PD grade 1, 58.6%; PD grade 2, 31.0% and PD grade 3, 6.9%. The use of biological agents was low in patients with PD synovitis grade 2 (P < 0.05). The presence of US bone erosion was high by patient (P < 0.05) and by joint (P < 0.0001) with PD synovitis as compared with those without PD synovitis. However, no correlations were found between PD synovitis measures and serum biomarkers, including angiogenesis factors.
PD subclinical synovitis correlates with several clinical characteristics, whereas conventional serum biomarkers are not useful for indicating the presence of subclinical PD synovitis.
本研究旨在探讨处于临床缓解期（无触诊滑膜炎）的类风湿关节炎（RA）患者中，能量多普勒（PD）亚临床滑膜炎的特点。
连续纳入 29 例 RA 患者。所有患者在接受肌肉骨骼超声（MSKUS）检查时均达到临床缓解（简化疾病活动指数[SDAI]3.3）至少 6 个月。此外，68 个触诊关节和 66 个肿胀关节均无压痛或肿胀。对双侧腕关节和手指关节（包括第 1 至第 5 掌指关节、第 1 近端指间关节和第 2 至第 5 近侧指间关节）进行 MSKUS，使用灰阶（GS）和 PD 对滑膜炎进行半定量分级，范围为 0 至 3 分。
引入 DMARDs 时的中位病程为 3 个月，MSKUS 检查时的病程为 21 个月。至少有一个关节存在 PD 滑膜炎的患者百分比为 PD 1 级，58.6%；PD 2 级，31.0%；PD 3 级，6.9%。PD 滑膜炎 2 级患者使用生物制剂的比例较低（P<0.05）。与无 PD 滑膜炎患者相比，有 PD 滑膜炎患者的超声下骨侵蚀存在率更高（患者，P<0.05；关节，P<0.0001）。然而，PD 滑膜炎指标与血管生成因子等常规血清生物标志物之间无相关性。
PD 亚临床滑膜炎与多种临床特征相关，而常规血清生物标志物不能用于提示亚临床 PD 滑膜炎的存在。
