Rheumatology Department, Medical University of Plovdiv, Plovdiv, Bulgaria.
Rheumatology Clinic, University Hospital 'Kaspela', 64 Sofia str, block 2, eight floor, 4002, Plovdiv, Bulgaria.
Rheumatol Int. 2018 Oct;38(10):1891-1899. doi: 10.1007/s00296-018-4131-0. Epub 2018 Aug 18.
To assess the role of musculoskeletal ultrasound as a predictor for the achievement of DAS28 remission in patients with rheumatoid arthritis (RA). One hundred and forty-one patients underwent physical and ultrasound examination at five visits (at baseline and after 1, 3, 6 and 12 months). Patients were divided into two groups according to the type of treatment, which involved synthetic (sDMARDs) and biologic (bDMARDs) disease-modifying antirheumatic drugs. Ultrasound assessment of the wrist, second and third metacarpophalangeal, second and third proximal interphalangeal joint, second and fifth metatarsophalangeal joint (the German US7 score) was performed on gray scale (GS) and on power Doppler ultrasound (PDUS). The rate of clinical remission and clinical and sonographic predictors for the achievement of DAS28 remission at month 12 were assessed. In the sDMARDs group at month 12, 43.6% of the patients achieved DAS28 remission, 5.1%-SDAI, 3.8%-CDAI, and 3.8%-Boolean remission. In the bDMARDs group, 49.2% achieved DAS28 remission, 6.3%-SDAI, 4.8%-CDAI, and 4.8%-Boolean remission. Predictors for DAS28 clinical remission in the sDMARDs group were low baseline DAS28 (p = 0.002), short disease duration (p = 0.007) and lower baseline PDUS score (p = 0.038). In the bDMARDs group low baseline DAS28 (p < 0.001) and PDUS score (p = 0.035) predicted DAS28 remission. Shorter disease duration, lower baseline DAS28 and PDUS scores are associated with a higher probability of achieving DAS28 remission at month 12 in patients with RA. Musculoskeletal ultrasound and in particular the German US7-scoring system may be used as a predictor for the achievement of clinical remission in RA patients.
评估肌肉骨骼超声作为类风湿关节炎 (RA) 患者达到 DAS28 缓解的预测因子的作用。141 名患者在 5 次就诊时（基线时以及 1、3、6 和 12 个月后）接受了体格检查和超声检查。根据治疗类型，患者分为两组，包括合成（sDMARDs）和生物（bDMARDs）疾病修饰抗风湿药物。对手腕、第二和第三掌指关节、第二和第三近端指间关节、第二和第五跖趾关节（德国 US7 评分）进行灰阶 (GS) 和功率多普勒超声 (PDUS) 超声评估。评估了第 12 个月时临床缓解率和临床及超声预测因子对 DAS28 缓解的影响。在 sDMARDs 组，第 12 个月时 43.6%的患者达到 DAS28 缓解，5.1%-SDAI、3.8%-CDAI 和 3.8%-Boolean 缓解。在 bDMARDs 组，49.2%的患者达到 DAS28 缓解，6.3%-SDAI、4.8%-CDAI 和 4.8%-Boolean 缓解。sDMARDs 组 DAS28 临床缓解的预测因子是基线 DAS28 低（p=0.002）、疾病病程短（p=0.007）和基线 PDUS 评分低（p=0.038）。在 bDMARDs 组，低基线 DAS28（p<0.001）和 PDUS 评分（p=0.035）预测 DAS28 缓解。RA 患者的疾病病程更短、基线 DAS28 和 PDUS 评分更低与第 12 个月时达到 DAS28 缓解的可能性更高相关。肌肉骨骼超声，特别是德国 US7 评分系统，可作为 RA 患者达到临床缓解的预测因子。
