超声表现可预测抗 CCP 抗体阳性且无临床滑膜炎的患者进展为炎症性关节炎。
Ultrasound findings predict progression to inflammatory arthritis in anti-CCP antibody-positive patients without clinical synovitis.
机构信息
University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, UK.
Leeds Teaching Hospitals NHS Trust, NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
出版信息
Ann Rheum Dis. 2016 Dec;75(12):2060-2067. doi: 10.1136/annrheumdis-2015-208235. Epub 2016 Jan 22.
OBJECTIVES
To determine whether ultrasound can identify anti-cyclic citrullinated peptide (anti-CCP) antibody-positive patients without clinical synovitis (CS) who progress to inflammatory arthritis (IA).
METHODS
In a prospective study, anti-CCP-positive patients without CS underwent ultrasound imaging of 32 joints (wrists, metacarpophalangeal joints, proximal interphalangeal joints and metatarsophalangeal joints (MTPs)) and were monitored for the development of IA. Associations between baseline ultrasound findings (grey scale (GS), power Doppler (PD) and erosions) and (1) progression to IA and (2) development of CS within an individual joint were measured.
RESULTS
Consecutive anti-CCP-positive patients (n=136; mean age 51 years, 100 women) were followed up for median of 18.3 months (range 0.1-79.6). At baseline 96% had GS, 30% had PD and 21% had one or more erosions. IA developed in 57 patients (42%) after median of 8.6 months (range 0.1-52.4). Ultrasound abnormalities (GS ≥2, PD ≥1 or erosion ≥1) were found in 86% at baseline compared with 67% of non-progressors (χ=6.3, p=0.012). Progression to IA was significantly higher in those with ultrasound findings in any joint (excluding MTPs for GS) (GS ≥2: 55% vs 24%, HR (95% CI) 2.3 (1.0 to 4.9), p=0.038; PD ≥2: 75% vs 32%, 3.7 (2.0 to 6.9), p<0.001 and erosion ≥1: 71% vs 34%, 2.9 (1.7 to 5.1), p<0.001). Furthermore, progression occurred earlier with PD ≥2 (median 7.1 vs 52.4 months) and erosion ≥1 (15.4 vs 46.5). At the individual joint level, the trend for progression to CS was more significant for GS and PD (GS ≥2: 26% vs 3%, 9.4 (5.1 to 17.5), p<0.001; PD ≥2: 55% vs 4%, 31.3 (15.6 to 62.9), p<0.001).
CONCLUSION
Ultrasound features of joint inflammation may be detected in anti-CCP-positive patients without CS. Ultrasound findings predict progression (and rate of progression) to IA, with the risk of progression highest in those with PD signal.
TRIAL REGISTRATION NUMBER
NCT02012764; Results.
目的
确定超声是否可以识别无临床滑膜炎（CS）但抗环瓜氨酸肽（抗-CCP）抗体阳性的患者，这些患者进展为炎症性关节炎（IA）。
方法
在一项前瞻性研究中，抗-CCP 阳性且无 CS 的患者接受 32 个关节（腕关节、掌指关节、近端指间关节和跖趾关节（MTPs））的超声成像，并监测其 IA 的发展情况。测量基线超声表现（灰阶（GS）、能量多普勒（PD）和侵蚀）与（1）进展为 IA 和（2）单个关节内 CS 发展之间的关联。
结果
连续的抗-CCP 阳性患者（n=136；平均年龄 51 岁，100 名女性）中位随访 18.3 个月（范围 0.1-79.6）。基线时 96%有 GS，30%有 PD，21%有一个或多个侵蚀。中位时间为 8.6 个月（范围 0.1-52.4）后，57 名患者（42%）出现了 IA。与非进展者相比（GS≥2：86% vs 67%），基线时在任何关节（排除 MTP 关节的 GS）中均发现了超声异常（GS≥2：55% vs 24%，HR（95%CI）2.3（1.0 至 4.9），p=0.038；PD≥2：75% vs 32%，3.7（2.0 至 6.9），p<0.001 和侵蚀≥1：71% vs 34%，2.9（1.7 至 5.1），p<0.001）。此外，PD≥2（中位时间 7.1 个月 vs 52.4 个月）和侵蚀≥1（中位时间 15.4 个月 vs 46.5 个月）的进展更早。在单个关节水平，GS 和 PD 进展为 CS 的趋势更为显著（GS≥2：26% vs 3%，9.4（5.1 至 17.5），p<0.001；PD≥2：55% vs 4%，31.3（15.6 至 62.9），p<0.001）。
结论
在无 CS 的抗 CCP 阳性患者中可能检测到关节炎症的超声特征。超声表现可预测 IA 的进展（和进展速度），PD 信号阳性患者的进展风险最高。
试验注册号
NCT02012764；结果。
Zotero 插件