使用数据驱动方法开发类风湿关节炎超声关节炎评分的第一步。
First step in the development of an ultrasound joint inflammation score for rheumatoid arthritis using a data-driven approach.
机构信息
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Ann Rheum Dis. 2016 Aug;75(8):1444-51. doi: 10.1136/annrheumdis-2015-207572. Epub 2015 Jun 17.
OBJECTIVES
To develop and validate candidate sets of joints and tendons for assessment of ultrasound (US) joint inflammation in rheumatoid arthritis (RA).
METHODS
Patients were included in one of two cohorts from 2010 to June 2013: disease-modifying antirheumatic drug naïve early RA or established RA starting/switching biologics. An extensive US examination was performed by experienced sonographers using a validated grey-scale (GSUS) and power Doppler (PDUS) semiquantitative scoring system with scores 0-3 for both GSUS and PDUS in 36 joints and four tendons. We performed factor analysis in the early RA US data and selected candidate joint/tendon sets based on these results. The proportion of information in the total US scores retained in these candidate sets was assessed by R(2) from linear regression analysis. Finally, the candidate sets and previously proposed joint scores were tested in the established RA cohort, and we also evaluated the sensitivity to change with standardised response means.
RESULTS
227 patients with early RA and 212 patients with established RA were included. We identified two candidate sets of joints/tendons: candidate set A consisted of seven joints/two tendons (meatacarpophalangeal 1 (MCP1), MCP2, proximal interphalangeal 3, radiocarpal, elbow, metatarsophalangeal 1 (MTP1), MTP2, tibialis posterior tendon, extensor carpi ulnaris tendon) and set B of nine joints/two tendons (MCP5 and MTP5 added to set A). Unilateral reduced scores retained 78%-85% of the information in total score, while bilateral reduced scores retained 89%-93%, and both sets performed better than previously proposed reduced joint scores, and similar or slightly better regarding sensitivity to change.
CONCLUSIONS
The reduced GSUS and PDUS scores retained most of the information from the total score and performed well in a validation cohort of established RA.
TRIAL REGISTATION NUMBER
NCT01205854, ACTRN12610000284066.
目的
开发并验证用于评估类风湿关节炎（RA）关节超声（US）炎症的候选关节和肌腱集。
方法
2010 年至 2013 年 6 月期间，患者被纳入两个队列之一：疾病修饰抗风湿药物初治早期 RA 或开始/转换生物制剂的确诊 RA。由经验丰富的超声医师使用经过验证的灰度（GSUS）和功率多普勒（PDUS）半定量评分系统对广泛的 US 进行检查，在 36 个关节和 4 个肌腱中，GSUS 和 PDUS 的评分均为 0-3。我们在早期 RA US 数据中进行了因子分析，并根据这些结果选择候选关节/肌腱集。通过线性回归分析的 R(2)评估这些候选集保留总 US 评分中的信息量的比例。最后，在确诊 RA 队列中测试候选集和先前提出的关节评分，我们还评估了标准反应均值的变化敏感性。
结果
纳入 227 例早期 RA 患者和 212 例确诊 RA 患者。我们确定了两个候选关节/肌腱集：候选集 A 由 7 个关节/2 个肌腱（掌指关节 1（MCP1）、MCP2、近端指间关节 3、桡腕关节、肘、跖趾关节 1（MTP1）、MTP2、跟腱、伸肌腕尺侧肌腱）和候选集 B 由 9 个关节/2 个肌腱（MCP5 和 MTP5 添加到集 A 中）组成。单侧减少评分保留了总评分信息的 78%-85%，而双侧减少评分保留了 89%-93%，两个集均优于先前提出的简化关节评分，且在变化敏感性方面表现相似或稍好。
结论
简化的 GSUS 和 PDUS 评分保留了总评分的大部分信息，在确诊 RA 的验证队列中表现良好。
试验注册号
NCT01205854，ACTRN12610000284066。
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