Závada Jakub, Hánová Petra, Hurňáková Jana, Szczuková Lenka, Uher Michal, Forejtová Šárka, Klein Martin, Mann Herman, Olejárová Marta, Růžičková Olga, Šléglová Olga, Hejduk Karel, Pavelka Karel
Institute of Rheumatology, Prague, and Department of Rheumatology, First Faculty of Medicine, Charles University, Na Slupi 4, 12850, Prague, Czech Republic.
Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.
Arthritis Res Ther. 2017 Jan 13;19(1):5. doi: 10.1186/s13075-016-1208-6.
Restoring normal physical functioning is a major therapeutic aim in the management of rheumatoid arthritis (RA). It is unknown, whether the extent of synovial inflammation quantified by musculoskeletal ultrasound (US) can predict current or future capacity for physical functioning. To answer this question we investigated the longitudinal relationship between physical function assessed by the health assessment questionnaire (HAQ) and the German 7-joint ultrasound score (US7S) in a prospective cohort of patients with RA.
Patients with RA (n = 185 (46 with incident and 139 with prevalent disease) were followed for 30.9 ± 9.1 months. Baseline and annual assessments comprised the disease activity score in 28 joints (DAS28), HAQ and US7S. The US7S includes semiquantitative measurements of synovitis assessed by greyscale (GS) and power Doppler (PD) in seven joints of the clinically dominant hand and foot, which are then aggregated in PD and GS synovitis sum-scores (PDsynSS and GSsynSS). A linear mixed-effect model was used to assess the longitudinal relationship between GSsynSS, PDsynSS and HAQ. We used standard and time-lag models to explore the association between HAQ, and GSsynSS, PDsynSS and DAS28 measured at the same time or at the previous visit 12 months ago, respectively.
When the standard model was applied, in univariate analyses HAQ score was positively associated with GSsynSS and PDsynSS with β coefficients significantly higher in incident than in prevalent disease. In multivariate analysis both synSSs were individually no longer significant predictors of HAQ score. When using the time-lag model, after adjustment for the previous DAS28 or HAQ score, both PDsynSS and GSsynSS were significantly and negatively associated with the current HAQ.
US7 PD and GS synovitis sum-scores alone were positively associated with current functional status reflected by the HAQ in patients with RA, and this relationship was stronger in patients with early disease. When combined with the DAS28 or HAQ, US7 PD and GS synovitis sum-scores were predictive of the change in HAQ score over one year.
恢复正常身体功能是类风湿关节炎（RA）管理中的主要治疗目标。尚不清楚通过肌肉骨骼超声（US）量化的滑膜炎症程度是否能够预测当前或未来的身体功能能力。为回答这个问题，我们在一个RA患者的前瞻性队列中研究了通过健康评估问卷（HAQ）评估的身体功能与德国7关节超声评分（US7S）之间的纵向关系。
对185例RA患者（46例新发病例和139例现患病例）进行了30.9±9.1个月的随访。基线和年度评估包括28个关节的疾病活动评分（DAS28）、HAQ和US7S。US7S包括通过灰阶（GS）和能量多普勒（PD）对临床优势手和足的七个关节的滑膜炎进行半定量测量，然后汇总为PD和GS滑膜炎总分（PDsynSS和GSsynSS）。使用线性混合效应模型评估GSsynSS、PDsynSS与HAQ之间的纵向关系。我们使用标准模型和时间滞后模型分别探讨同时或12个月前上次就诊时测量的HAQ与GSsynSS、PDsynSS和DAS28之间的关联。
应用标准模型时，在单变量分析中，HAQ评分与GSsynSS和PDsynSS呈正相关，新发病例的β系数显著高于现患病例。在多变量分析中，两个synSSs均不再是HAQ评分的显著预测因素。使用时间滞后模型时，在调整先前的DAS28或HAQ评分后，PDsynSS和GSsynSS均与当前HAQ显著负相关。
单独的US7 PD和GS滑膜炎总分与RA患者中HAQ反映的当前功能状态呈正相关，且这种关系在早期疾病患者中更强。当与DAS28或HAQ结合时，US7 PD和GS滑膜炎总分可预测HAQ评分在一年内的变化。
