肌腱端炎相关性关节炎患儿肌腱端炎的检测：触痛测定与超声检查比较。
Detection of enthesitis in children with enthesitis-related arthritis: dolorimetry compared to ultrasonography.
机构信息
Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
出版信息
Arthritis Rheumatol. 2014 Jan;66(1):218-27. doi: 10.1002/art.38197.
OBJECTIVE
To evaluate the distribution of enthesitis and the accuracy of physical examination with a dolorimeter for the detection of enthesitis in children, using ultrasound (US) assessment as the reference standard.
METHODS
We performed a prospective cross-sectional study of 30 patients with enthesitis-related arthritis (ERA) and 30 control subjects. The following tendon insertion sites were assessed by standardized physical examination with a dolorimeter and US: common extensor on the lateral humeral epicondyle, common flexor on the medial humeral epicondyle, quadriceps at the superior patella, patellar ligament at the inferior patella, Achilles, and plantar fascia at the calcaneus.
RESULTS
Abnormal findings on US were detected most commonly at the insertion of the quadriceps (30% [18 of 60 sites]), common extensor (12% [7 of 60]), and Achilles (10% [6 of 60]) tendons. The intrarater reliability of US (kappa statistic) was 0.78 (95% confidence interval [95% CI] 0.63-0.93), and the interrater reliability was 0.81 (95% CI 0.67-0.95). Tenderness as detected by standardized dolorimeter examination had poor positive predictive value for US-confirmed enthesitis. In comparison to controls, patients with ERA reported more pain and had lower pain thresholds at every site, including control sites (P < 0.001 for all comparisons). The interrater reliability of dolorimeter examination for detection of enthesitis was low (κ = 0.49 [95% CI 0.33-0.65]).
CONCLUSION
Compared to US, standardized dolorimeter examination for the detection of enthesitis in children has poor accuracy and reliability. The decreased pain threshold of ERA patients likely contributed to the limited accuracy of the physical examination findings. Further research regarding the utility of US for identifying enthesitis at diagnosis of juvenile idiopathic arthritis, accurately predicting disease progression, and guiding therapeutic decisions is warranted.
目的
通过超声（US）评估作为参考标准，评估压痛计检测儿童附着点炎的附着点分布和准确性。
方法
我们对 30 例附着点炎相关关节炎（ERA）患者和 30 例对照者进行了前瞻性横断面研究。通过压痛计和 US 对以下肌腱附着点进行了评估：外侧肱骨外上髁的普通伸肌、内侧肱骨外上髁的普通屈肌、髌骨上的股四头肌、髌骨下的髌韧带、跟腱和跟骨的足底筋膜。
结果
US 检测到最常见的异常发现是在股四头肌（30%[60 个部位中的 18 个]）、普通伸肌（12%[60 个部位中的 7 个]）和跟腱（10%[60 个部位中的 6 个]）的附着处。US 的组内可靠性（kappa 统计量）为 0.78（95%置信区间[95%CI] 0.63-0.93），组间可靠性为 0.81（95%CI 0.67-0.95）。压痛计检查确定的压痛对 US 确认的附着点炎的阳性预测值较差。与对照组相比，ERA 患者报告的疼痛更多，并且在每个部位（包括对照部位）的疼痛阈值均较低（所有比较均 P <0.001）。压痛计检查检测附着点炎的组间可靠性较低（κ=0.49[95%CI 0.33-0.65]）。
结论
与 US 相比，压痛计检查用于检测儿童附着点炎的准确性和可靠性较差。ERA 患者的疼痛阈值降低可能导致体格检查结果的准确性有限。需要进一步研究 US 在幼年特发性关节炎诊断时识别附着点炎、准确预测疾病进展和指导治疗决策方面的应用价值。
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