Epis Oscar, Scioscia Crescenzio, Locaputo Antonia, Cappelli Antonella, Maier Armin, Rocchetta Pier Andrea, Tomietto Paola, Perin Antonella, Rigon Chiara, Santo Leonardo, Casilli Oriana, Lapadula Giovanni, Bruschi Eleonora
Rheumatology Unit, A.O. Ospedale Niguarda Cà Granda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Sezione di Reumatologia, Dip. Interdisciplinare di Medicina, Università degli Studi 'Aldo Moro', Piazza Giulio Cesare 11, 70124, Bari, Italy.
Clin Rheumatol. 2016 Aug;35(8):1923-1929. doi: 10.1007/s10067-016-3331-9. Epub 2016 Jun 20.
In rheumatoid arthritis (RA), treatment response is generally assessed using standard clinical disease activity measures. However, ultrasound has become increasingly popular among rheumatologists to monitor disease activity and response. The purpose of this analysis of ECOgraphic evaluation for STaging ARthritis (ECOSTAR) study data was to determine how ultrasound affects clinicians' decisions about changing treatment in RA. ECOSTAR was an observational, cohort study conducted between March 2010 and December 2012 at nine clinical centers in Italy in RA patients being considered for treatment change. After clinical evaluation of each patient, patients underwent diagnostic ultrasound (US) investigations and each patient was given a total echography score using a combination of scores for joint effusion, synovial hypertrophy, and power Doppler. The US results were provided to the clinicians and the influence of US on the clinicians' treatment choices were recorded. Ninety-five patients screened for study inclusion had confirmed RA (mean age 53.9 years; mean disease duration 8.9 years). Therapy changes were made by clinicians according to the hand and wrist joint US scores: score 0 appeared to have no influence on clinicians' decision to modify treatment, scores >0-3 were associated with a numerically higher estimated probability of not changing therapy than changing therapy, and scores >3 had a greater influence on the clinician to modify therapy and an increased probability of the clinician changing therapy versus not changing therapy. Ultrasonography scores appear to influence treatment decisions in patients with RA, with clinicians appearing less likely to alter treatment regimens in patients with low ultrasound scores and more likely to change treatment regimens when higher scores are obtained. Further research is warranted.
在类风湿关节炎（RA）中，通常使用标准的临床疾病活动指标来评估治疗反应。然而，超声在风湿病学家中越来越受欢迎，用于监测疾病活动和反应。本项对关节炎超声分期评估（ECOSTAR）研究数据的分析目的是确定超声如何影响临床医生对RA患者治疗调整的决策。ECOSTAR是一项观察性队列研究，于2010年3月至2012年12月在意大利的九个临床中心对考虑进行治疗调整的RA患者开展。在对每位患者进行临床评估后，患者接受诊断性超声（US）检查，并使用关节积液、滑膜增生和能量多普勒评分的组合为每位患者给出一个总超声评分。超声检查结果提供给临床医生，并记录超声对临床医生治疗选择的影响。95名筛查纳入研究的患者确诊为RA（平均年龄53.9岁；平均病程8.9年）。临床医生根据手部和腕关节超声评分进行治疗调整：评分为0似乎对临床医生调整治疗的决策没有影响，评分>0 - 3与不改变治疗相比，估计不改变治疗的概率在数值上更高，评分>3对临床医生调整治疗有更大影响，且临床医生改变治疗与不改变治疗相比概率增加。超声检查评分似乎会影响RA患者的治疗决策，临床医生在超声评分低的患者中改变治疗方案的可能性较小，而在获得较高评分时更有可能改变治疗方案。有必要进行进一步研究。
