Goossens Julia, Coustet Baptiste, Palazzo Elisabeth, Dieudé Philippe, Ottaviani Sébastien
Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris; and AP-HP, Service de Rhumatologie, Hôpital Bichat, Paris, France.
Clin Exp Rheumatol. 2019 Jan-Feb;37(1):49-54. Epub 2018 Jun 7.
Body mass index (BMI) might affect rheumatoid arthritis (RA) outcomes. Clinical assessment of swollen joint count (SJC) might also be affected by obesity in terms of obesity-related excess adipose tissue. In this study, we compared ultrasonography (US) and clinical examination in assessing the effect of BMI on RA disease activity assessment.
This was a single-centre study including RA (ACR/EULAR criteria) patients. US assessment was performed by one trained rheumatologist blinded to clinical data. US synovitis was defined as grey-scale score ≥2 and/or power Doppler score ≥1. The primary outcome measure was difference in SJC (ΔSJC) between clinical and US assessment (US-clinical examination). The secondary outcome was to evaluate the difference between clinical and US assessment of the Disease Activity Score in 28 joints (ΔDAS28) in the 3 BMI subgroups according to the WHO classification.
We included 76 RA patients (mean age 53.8 ± 11.8 years; 67% female). Overall, 28 (36.8%), 33 (43.4%) and 15 (19.7%) were normal weight, overweight and obese, respectively. Baseline characteristics did not differ between the 3 BMI subgroups. US-determined SJC was significantly higher than clinical-determined SJC for overweight and obese RA patients: p=0.001 and p=0.049, respectively. The DAS28 was higher with US than clinical examination within the overweight group only (p=0.002). One-way analysis of variance (ANOVA) revealed a significant difference between ΔDAS28 among the 3 BMI subgroups (p=0.046).
In high BMI RA patients both SJC and DAS28 seem to be undervalued by clinical assessment when compared to US.
体重指数（BMI）可能会影响类风湿关节炎（RA）的预后。就肥胖相关的多余脂肪组织而言，肿胀关节计数（SJC）的临床评估也可能受到肥胖的影响。在本研究中，我们比较了超声检查（US）和临床检查在评估BMI对RA疾病活动度评估的影响方面的差异。
这是一项单中心研究，纳入了符合RA（美国风湿病学会/欧洲抗风湿病联盟标准）的患者。US评估由一位对临床数据不知情的训练有素的风湿病学家进行。US滑膜炎定义为灰阶评分≥2和/或能量多普勒评分≥1。主要结局指标是临床评估与US评估（US-临床检查）之间SJC的差异（ΔSJC）。次要结局是根据世界卫生组织分类评估3个BMI亚组中28个关节疾病活动评分（ΔDAS28）的临床评估与US评估之间的差异。
我们纳入了76例RA患者（平均年龄53.8±11.8岁；67%为女性）。总体而言，体重正常、超重和肥胖的患者分别有28例（36.8%）、33例（43.4%）和15例（19.7%）。3个BMI亚组的基线特征无差异。对于超重和肥胖的RA患者，US确定的SJC显著高于临床确定的SJC：分别为p=0.001和p=0.049。仅在超重组中，US检查的DAS28高于临床检查（p=0.002）。单因素方差分析（ANOVA）显示3个BMI亚组之间的ΔDAS28存在显著差异（p=0.046）。
与US相比，在高BMI的RA患者中，临床评估似乎低估了SJC和DAS28。
