Vlad Violeta, Berghea Florian, Micu Mihaela, Varzaru Luminita, Bojinca Mihai, Milicescu Mihaela, Ionescu Ruxandra, Naredo Esperanza
Clinical Hospital Sf. Maria Bucharest, Romania.
Clinical Hospital Sf. Maria Bucharest; "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.
Med Ultrason. 2015 Sep;17(3):352-60. doi: 10.11152/mu.2013.2066.173.viv.
To investigate by ultrasonography (US) in a cohort of active RA patients starting biologic therapy the responsiveness of tenosynovitis of wrist and hands compared to the responsiveness of synovitis in a 6 month period follow-up, to compare the responsiveness of finger flexor tenosynovitis with the responsiveness of wrist extensor tenosynovitis and to describe the subclinical synovitis and tenosynovitis in RA patients in clinical remission.
Fifty seven patients with active RA starting biologic therapy were included. Clinical, laboratory, and US evaluations were performed at baseline, 1, and 6 months. US evaluation included wrist and MCPs 2-5 joints, bilaterally for synovitis and extensor tendons compartments 2, 4, and 6 and finger flexors 2-5 for tenosynovitis. Eighteen US scores based on semiquantitative or binary grades were calculated at each visit. Responsiveness of synovitis and tenosynovitis scores was calculated using the standardized response mean (SRM).
The responsiveness of US tenosynovitis was lower comparing with the responsiveness of US synovitis but both showed large effect of therapy. Furthermore, tenosynovitis responsiveness was similar to CRP responsiveness (SRM -0.90). Finger flexors tenosynovitis showed a higher responsiveness than extensor tenosynovitis on GS (-0.94 compared to -0.63) and a lower SRM on PD (-0.56 compared to -0.85). Tenosynovitis scores remission was overlapping clinical remission according to CDAI and SDAI in 100% of cases. Overall there was less subclinical tenosynovitis than subclinical synovitis at final visit according to clinical activity indices.
Tenosynovitis US scoring in RA may be as good as synovitis scoring for characterization of disease activity and responsiveness.
通过超声检查（US），在一组开始生物治疗的活动性类风湿关节炎（RA）患者中，研究手腕和手部腱鞘炎在6个月随访期内的反应性与滑膜炎反应性的比较，比较手指屈肌腱腱鞘炎与手腕伸肌腱腱鞘炎的反应性，并描述临床缓解的RA患者中的亚临床滑膜炎和腱鞘炎。
纳入57例开始生物治疗的活动性RA患者。在基线、1个月和6个月时进行临床、实验室和超声评估。超声评估包括双侧手腕和第2 - 5掌指关节（MCPs）的滑膜炎，以及伸肌腱2、4和6区和手指屈肌2 - 5区的腱鞘炎。每次就诊时计算18个基于半定量或二元分级的超声评分。使用标准化反应均值（SRM）计算滑膜炎和腱鞘炎评分的反应性。
与超声滑膜炎的反应性相比，超声腱鞘炎的反应性较低，但两者均显示出较大的治疗效果。此外，腱鞘炎反应性与CRP反应性相似（SRM -0.90）。在GS评分上，手指屈肌腱腱鞘炎比伸肌腱腱鞘炎显示出更高的反应性（-0.94对比-0.63），而在PD评分上SRM较低（-0.56对比-0.85）。根据CDAI和SDAI，100%的病例中腱鞘炎评分缓解与临床缓解重叠。根据临床活动指数，在最后一次就诊时，总体上亚临床腱鞘炎比亚临床滑膜炎少。
在RA中，超声腱鞘炎评分在疾病活动度和反应性的特征描述方面可能与滑膜炎评分一样好。
