Aydın Sibel Zehra, Castillo-Gallego Concepcion, Nam Jackie, Freeston Jane, Horton Sarah, Wakefield Richard J, Emery Paul
Division of Rheumatology, University of Ottawa School of Medicine, Ottawa, Canada.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Eur J Rheumatol. 2017 Jun;4(2):118-121. doi: 10.5152/eurjrheum.2017.160091. Epub 2017 Jun 1.
We aimed to compare the ultrasound findings of patients fulfilling the 1987 ACR [OLD-rheumatoid arthritis (RA)] and the new ACR/EULAR (NEW-RA) classification criteria to examine the impact of the new criteria on disease characteristics, particularly disease duration.
A total of 2730 hands, wrists, elbows, knees, ankles, and foot joints of 105 consecutive patients with inflammatory arthritis, i.e., 82 patients fulfilling the RA criteria (60 patients, OLD-RA; 22 patients, NEW-RA alone) and 23 patients with undifferentiated arthritis, were scanned using ultrasound. Synovitis, erosions, and power Doppler (PD) findings were scored using a scale of 0-3 and scores form each joint were added up to calculate synovitis, PD and erosion scores for each patient.
OLD-RA and NEW-RA patients had similar swollen joint count, tender joint count, acute-phase response, patient global, and disease activity assessment 28 scores. The disease duration was longer in OLD-RA patients [30 (3-179) months] than in NEW-RA patients [16 (0-45) months; p=0.009]. Both the groups had similar synovitis and PD scores, whereas erosion scores were higher in OLD-RA patients than in NEW-RA patients (p=0.009). Patients with undifferentiated arthritis were older than those with RA and had fewer swollen joints than NEW-RA patients [0 (0-4) vs. 2 (0-9); p=0.017]. All other disease activity parameters were similar in both NEW-RA and OLD-RA patients. Both the synovitis (p=0.006) and erosion (p=0.007) scores were lower in patients with undifferentiated arthritis than in OLD-RA patients, despite the scores being similar to those in NEW-RA patients.
The new ACR/EULAR RA criteria enabled the classification of patients with similar disease activity (by clinical assessment and ultrasound) but with less damage. A similar disease activity should ensure suitability for an intervention, and a shorter duration and less damage should improve the outcome with patient benefit.
我们旨在比较符合1987年美国风湿病学会（旧标准——类风湿关节炎（RA））和新的美国风湿病学会/欧洲抗风湿病联盟（新标准——RA）分类标准的患者的超声检查结果，以研究新标准对疾病特征的影响，尤其是疾病持续时间。
对105例连续的炎性关节炎患者的2730个手部、腕部、肘部、膝部、踝部和足部关节进行超声检查，其中82例符合RA标准（60例为旧标准——RA；22例仅符合新标准——RA），23例为未分化关节炎患者。滑膜炎、侵蚀和能量多普勒（PD）表现采用0 - 3分评分，每个关节的评分相加计算每位患者的滑膜炎、PD和侵蚀评分。
旧标准——RA和新标准——RA患者的肿胀关节数、压痛关节数、急性期反应、患者整体情况及疾病活动度评估28分相似。旧标准——RA患者的疾病持续时间[30（3 - 179）个月]长于新标准——RA患者[16（0 - 45）个月；p = 0.009]。两组的滑膜炎和PD评分相似，而旧标准——RA患者的侵蚀评分高于新标准——RA患者（p = 0.009）。未分化关节炎患者比RA患者年龄大，且肿胀关节比新标准——RA患者少[0（0 - 4）对2（0 - 9）；p = 0.017]。新标准——RA和旧标准——RA患者的所有其他疾病活动参数相似。未分化关节炎患者的滑膜炎（p = 0.006）和侵蚀（p = 0.007）评分均低于旧标准——RA患者，尽管与新标准——RA患者的评分相似。
新的美国风湿病学会/欧洲抗风湿病联盟RA标准能够对疾病活动度相似（通过临床评估和超声检查）但损伤较小的患者进行分类。相似的疾病活动度应确保适合进行干预，较短的病程和较小的损伤应能改善预后，使患者受益。
