Ko Chi-Hua, Chen Jia-Feng, Cheng Tien-Tsai, Lai Han-Ming, Chen Ying-Chou
Department of Rheumatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
J Investig Med. 2018 Feb;66(2):325-328. doi: 10.1136/jim-2017-000558. Epub 2017 Sep 20.
This study aimed to evaluate the risk of ultrasound-detected synovitis after antitumor necrosis factor (TNF) tapering in patients with rheumatoid arthritis. We recruited patients with rheumatoid arthritis who accepted TNF tapering. Gray-scale synovitis and power Doppler score in bilateral wrists at the dorsal radiolunate joint were evaluated. We defined a sum of bilateral wrist scores of ≥2 as sonographic inflammation. Logistical regression analysis was used to adjust for confounding factors. One hundred and twenty-two patients who received a tapered dose of anti-TNF were enrolled, of whom 96 (78%) had ultrasound-detected synovitis and 26 had no inflammation. There were no significant differences in age, gender, body mass index, antinuclear antibodies, rheumatoid factor or anticitrullinated protein antibodies between the inflammation and non-inflammation groups. Moderate tapering of anti-TNF (tapering 50%) was more common in the patients with ultrasound-detected synovitis than mild tapering (tapering 25%) (68.8% vs 38.5%, p=0.005). After adjusting for age, body mass index, gender and a 28-joint Disease Activity Score, the moderate tapering group still had a higher risk of ultrasound-detected synovitis (OR 5.786, 95% CI 1.986 to 16.852; p=0.001); that is, the moderate tapering group had a 5.786 times higher risk of developing sonographic inflammation than the mild tapering group. The dose of biological tapering was the major determinant of ultrasound synovitis. Patients with moderate tapering had a higher risk of synovitis than those with mild tapering. We recommend not tapering by more than 25% to reduce subclinical inflammation and future joint damage.
本研究旨在评估类风湿关节炎患者抗肿瘤坏死因子（TNF）减量后超声检测到滑膜炎的风险。我们招募了接受TNF减量的类风湿关节炎患者。评估双侧腕背侧桡月关节的灰阶滑膜炎和能量多普勒评分。我们将双侧腕关节评分总和≥2定义为超声炎症。采用逻辑回归分析来调整混杂因素。122例接受抗TNF减量治疗的患者入组，其中96例（78%）经超声检测到滑膜炎，26例无炎症。炎症组和非炎症组在年龄、性别、体重指数、抗核抗体、类风湿因子或抗瓜氨酸化蛋白抗体方面无显著差异。与轻度减量（减量25%）相比，中度减量（减量50%）的抗TNF治疗在超声检测到滑膜炎的患者中更为常见（68.8%对38.5%，p=0.005）。在调整年龄、体重指数、性别和28关节疾病活动评分后，中度减量组超声检测到滑膜炎的风险仍然较高（比值比5.786，95%置信区间1.986至16.852；p=0.001）；也就是说，中度减量组发生超声炎症的风险比轻度减量组高5.786倍。生物制剂减量的剂量是超声滑膜炎的主要决定因素。中度减量的患者比轻度减量的患者发生滑膜炎的风险更高。我们建议减量不超过25%，以减少亚临床炎症和未来的关节损伤。
