超声检测类风湿关节炎临床缓解患者残留滑膜炎的患病率及复发和结构进展风险：一项系统评价和荟萃分析
Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis.
作者信息
Nguyen Huong, Ruyssen-Witrand Adeline, Gandjbakhch Frédérique, Constantin Arnaud, Foltz Violaine, Cantagrel Alain
机构信息
Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France.
Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France. Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France. Rheumatology Department, Purpan Hospital, UMR 1027 Inserm, UMR 1027, Université Paul Sabatier Toulouse 3, Toulouse, Rheumatology Department, Pitie Salpetriere Hospital, Paris and UMR 1043, Inserm, CPTP Toulouse Purpan, Toulouse, France.
出版信息
Rheumatology (Oxford). 2014 Nov;53(11):2110-8. doi: 10.1093/rheumatology/keu217. Epub 2014 Jun 13.
OBJECTIVES
The aims of this study were to assess the prevalence of US-detected residual synovitis in patients with RA in clinical remission (CR) and evaluate its predictive value for relapse and structural progression.
METHODS
We performed a systematic literature search of Medline, Embase and rheumatology meeting databases from 1 January 2001 to 28 May 2012. The prevalence of US grey-scale (USGS) signals (synovial hypertrophy or joint effusion) and power Doppler (PD) signals were collected, taking into account CR definitions [44-joint DAS (DAS44), 28-joint DAS (DAS28), SDAI, ACR 1981 or ACR/European League Against Rheumatism 2011], stage of RA (early or long-standing) and US examination (from 5 to 44 joints assessed). A meta-analysis assessing the risk of relapse or structural progression in patients with synovitis involved the Mantel-Haenszel method.
RESULTS
We included 19 studies of 1618 patients, 1369 in remission. The prevalence of USGS positive (USGS+), USGS+/PD negative (PD-), USGS+/PD positive (PD+) and USGS negative (USGS-/PD- was 84%, 41%, 44% and 15%, respectively. The prevalence of USGS+ or USGS+/PD+ was comparable among CR definitions and US methods. The prevalence of USGS+ and USGS+/PD+ was greater for long-standing than early RA (P < 0.001). Meta-analyses of five studies (271 patients), three studies (173 patients) and two studies (798 joints) revealed an association of USGS+/PD+ and risk of relapse [odds ratio (OR) 3.2 (95% CI 1.8, 5.9), P = 0.0001, I(2) = 0%] and structural progression in individual patients [OR 9.13 (95% CI 1.1, 74.3), P = 0.04, I(2) = 43%] and joints [OR 6.95 (95% CI 3.4, 13.9), P < 0.0001, I(2) = 6%] over 1-2 years.
CONCLUSION
US-detected residual synovitis is frequent and predicts the risk of relapse and structural progression in RA patients with CR.
目的
本研究旨在评估临床缓解（CR）的类风湿关节炎（RA）患者中超声检测到的残余滑膜炎的患病率，并评估其对复发和结构进展的预测价值。
方法
我们对2001年1月1日至2012年5月28日期间的Medline、Embase和风湿病会议数据库进行了系统的文献检索。收集了超声灰阶（USGS）信号（滑膜肥厚或关节积液）和能量多普勒（PD）信号的患病率，同时考虑了CR的定义[44关节疾病活动评分（DAS44）、28关节疾病活动评分（DAS28）、简化疾病活动指数（SDAI）、美国风湿病学会1981年标准或美国风湿病学会/欧洲抗风湿病联盟2011年标准]、RA的病程阶段（早期或病程较长）以及超声检查（评估5至44个关节）。一项评估滑膜炎患者复发或结构进展风险的荟萃分析采用了Mantel-Haenszel方法。
结果
我们纳入了19项研究，共1618例患者，其中1369例处于缓解期。USGS阳性（USGS+）、USGS+/PD阴性（PD-）、USGS+/PD阳性（PD+）和USGS阴性（USGS-/PD-）的患病率分别为84%、41%、44%和15%。USGS+或USGS+/PD+的患病率在CR定义和超声检查方法之间具有可比性。病程较长的RA患者中USGS+和USGS+/PD+的患病率高于早期患者（P<0.001）。对五项研究（271例患者）、三项研究（173例患者）和两项研究（798个关节）的荟萃分析显示，USGS+/PD+与1至2年内个体患者的复发风险[比值比（OR）3.2（95%可信区间1.8，5.9），P=0.0001，I²=0%]以及结构进展相关[OR 9.13（95%可信区间1.1，74.3），P=0.04，I²=43%]，在关节层面也与结构进展相关[OR 6.95（95%可信区间3.4，13.9），P<0.0001，I²=6%]。
结论
超声检测到的残余滑膜炎很常见，并可预测临床缓解的RA患者的复发风险和结构进展。
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