From the Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital, Lausanne; Service of Rheumatology, Geneva University Hospital, Geneva; Department of Rheumatology, Zurich University Hospital; Swiss Clinical Quality Management (SCQM) Foundation, Zurich; Ultrasound Centre Rheumatology (UZR), Basel; Department of Rheumatology, Immunology and Allergology, Inselspital; Osteo Rheuma, Bern; Service of Rheumatology, Hôpital neuchâtelois, Neuchâtel, Switzerland.
P. Zufferey, MD, Service of Rheumatology, Musculoskeletal Department, Lausanne University Hospital; A. Scherer, PhD, SCQM Foundation; M.J. Nissen, MBBS, FRACP, Service of Rheumatology, Geneva University Hospital; A. Ciurea, MD, Department of Rheumatology, Zurich University Hospital; G. Tamborrini, MD, Ultrasound Centre Rheumatology (UZR); B. Möller, Prof, Department of Rheumatology, Immunology and Allergology, Inselspital; L. Brulhart, MD, Service of Rheumatology, Hôpital neuchâtelois; M. Toniolo, MD, Department of Rheumatology, Zurich University Hospital; S. Blumhardt, MD, Department of Rheumatology, Zurich University Hospital; H.R. Ziswiler, MD, Osteo Rheuma.
J Rheumatol. 2018 Jul;45(7):887-894. doi: 10.3899/jrheum.161193. Epub 2018 Jan 15.
Several studies have suggested that patients with rheumatoid arthritis (RA) presenting with ultrasound (US) synovitis despite clinical remission have more subsequent flares than those who show both clinical and sonographic remission. The objective of our study was to investigate whether these results could be translated to a real-life setting.
We compared the time from the first US performed in clinical remission to loss of remission (defined by a DAS28 > 2.6 or the need for stepping up treatment with disease-modifying antirheumatic drugs) within the Swiss Clinical Quality Management cohort of patients with RA, and we adjusted for relevant confounders. Analyses were repeated for different definitions of US-detected synovitis (US+) using greyscale, Doppler, and combined modes based on previously validated scores, and they were adjusted for relevant confounders.
There were 318 RA patients with 378 remission phases included. Loss of clinical remission was observed in 60% of remission phases. Residual US synovitis was associated with a shorter duration of clinical remission (median 2-5 mos) and a moderately increased hazard ratio (HR) for loss of remission (HR 1.2-1.5), with the highest HR for the combined US score. The association between US+ and loss of remission was strongest when the US measurement had taken place early in remission (shorter median duration of 6-20 mos) and when followup time was limited to the first 3 or 6 months (most HR between 2-4).
US-detected synovitis, particularly when US is performed early in clinical remission, has a moderate predictive power for loss of remission in a real-life setting.
几项研究表明，尽管临床缓解，但仍存在超声（US）滑膜炎的类风湿关节炎（RA）患者比那些同时表现出临床和超声缓解的患者有更多后续发作。我们的研究目的是探讨这些结果是否可以转化为实际情况。
我们比较了在瑞士临床质量管理队列中 RA 患者的首次临床缓解后至缓解丧失（定义为 DAS28>2.6 或需要用疾病修饰抗风湿药物进行治疗升级）的时间，并且我们对相关混杂因素进行了调整。我们根据先前验证的评分，使用灰度、多普勒和组合模式对不同的 US 检测滑膜炎（US+）定义进行了分析，并对相关混杂因素进行了调整。
共有 318 例 RA 患者，包括 378 个缓解期。60%的缓解期出现临床缓解丧失。残留的 US 滑膜炎与临床缓解期持续时间较短（中位数 2-5 个月）和缓解丧失的中度增加危险比（HR）相关（HR 1.2-1.5），其中联合 US 评分的 HR 最高。当 US 测量在缓解早期进行时（中位数持续时间为 6-20 个月），并且随访时间限制在最初的 3 或 6 个月内（HR 大多在 2-4 之间），US+与缓解丧失之间的关联最强。
在实际情况下，US 检测到的滑膜炎，特别是在临床缓解早期进行时，对缓解丧失具有中度预测能力。
