超声检查在检测幼年特发性关节炎炎症性病变和结构损伤中的可靠性。
Reliability of ultrasonography to detect inflammatory lesions and structural damage in juvenile idiopathic arthritis.
作者信息
Ventura-Ríos Lucio, Faugier Enrique, Barzola Laura, De la Cruz-Becerra L B, Sánchez-Bringas Guadalupe, García Andrés Rodríguez, Maldonado Rocío, Roth Johannes, Hernández-Díaz Cristina
机构信息
Laboratorio de ultrasonido musculoesquelético y articular, Instituto Nacional de Rehabilitación, Luis Guillermo Ibarra Ibarra, Calzada México-Xochimilco 289, Arenal de Guadalupe, Tlalpan, 14389, Mexico city, Mexico.
Reumatología Pediátrica, Hospital Infantil de México, Mexico city, Mexico.
出版信息
Pediatr Rheumatol Online J. 2018 Sep 17;16(1):58. doi: 10.1186/s12969-018-0275-4.
BACKGROUND
Musculoskeletal Ultrasonography (MSUS) is an important tool for the clinical assessment in Juvenile Idiopathic Arthritis (JIA). The objective of this study was to evaluate the reliability of MSUS to detect elementary lesions: synovitis, tenosynovitis, cartilage damage and bone erosions in the wrist and metacarpal (MCP) joints of patients with JIA.
METHODS
Thirty children in various subgroups of JIA according to ILAR criteria, were included in this cross-sectional study. Clinical data including painful, swollen and limited joints were recorded. Five rheumatologist ultrasonographers, blinded to the clinical evaluation, evaluated the presence of elementary lesions in the wrist and MCP 2 and 3 joints bilaterally. The synovitis was graded in B-Mode and Power Doppler (PD). In addition to descriptive statistics intra- and inter-observer reliability was calculated using Cohen's kappa according to Landis and Koch.
RESULTS
US detected more synovitis than the clinical examination (62% vs 28%, 30% vs 23% and 22% vs 17% in the wrist, second and third MCP joints respectively). The intra-observer concordance for synovitis in all joints was excellent in B-Mode (k 0.84 .63-1.0 p = 0.001), except for MCP 2, where it was good (0.61, IC 95% .34-89, p = 0.001). For both modalities (PD, B-Mode) tenosynovitis, cartilage damage and bone erosions it was also excellent. Regarding synovitis grading the concordance was excellent for all grades (0.83-1.0, IC 95% 0.51.1.0, p = 0.001), except for grade 1 where it was good (0.61, IC 95% 0.43-.83, p = 0.001). Reliability inter-observer for grayscale synovitis (0.67-0.95, IC 95% 0.67-1.0, p = 0.001), tenosynovitis grayscale (0.89, IC 95% 0.78-0.99, p.001), damage cartilage (0.89, IC 95% 0.78-0.99, p = 0.001), PD (0.66, IC 95% 0.39-1.0, p = 0.001). The concordance for grading synovitis was excellent, but for grayscale grade 1 and 2 (.66, IC 95% .53-.74, p = 0.007) and PD grade 1 and 2 (0.63, IC 95% .58-.91, p = 004) was good.
CONCLUSIONS
The intra- and inter-observer reliability of MSUS for inflammatory and structural lesions is good to excellent for the wrist and MCP in patients with JIA.
背景
肌肉骨骼超声检查（MSUS）是幼年特发性关节炎（JIA）临床评估的重要工具。本研究的目的是评估MSUS检测JIA患者手腕和掌指（MCP）关节基本病变（滑膜炎、腱鞘炎、软骨损伤和骨侵蚀）的可靠性。
方法
根据ILAR标准，将30名JIA各亚组的儿童纳入本横断面研究。记录包括疼痛、肿胀和关节活动受限在内的临床数据。5名对临床评估不知情的风湿科超声医师对双侧手腕和MCP 2、3关节的基本病变情况进行评估。滑膜炎采用B超和能量多普勒（PD）分级。除描述性统计外，还根据Landis和Koch的方法，使用Cohen's kappa计算观察者内和观察者间的可靠性。
结果
超声检查发现的滑膜炎比临床检查更多（手腕、第二和第三MCP关节分别为62%对28%、30%对23%和22%对17%）。除MCP 2关节外，所有关节滑膜炎的观察者内一致性在B超模式下极佳（k=0.84，95%CI 0.63-1.0，p=0.001），MCP 2关节为良好（0.61，95%CI 0.34-0.89，p=0.001）。对于两种模式（PD、B超），腱鞘炎、软骨损伤和骨侵蚀的一致性也极佳。关于滑膜炎分级，除1级为良好（0.61，95%CI 0.43-0.83，p=0.001）外，所有分级的一致性均极佳（0.83-1.0，95%CI 0.51-1.0，p=0.001）。灰阶滑膜炎的观察者间可靠性（0.67-0.95，95%CI 0.67-1.0，p=0.001）、灰阶腱鞘炎（0.89，95%CI 0.78-0.99，p<0.001）、软骨损伤（0.89，95%CI 0.78-0.99，p=0.001）、PD（0.66，95%CI 0.39-1.0，p=0.001）。滑膜炎分级的一致性极佳，但灰阶1级和2级（0.66，95%CI 0.53-0.74，p=0.007）和PD 1级和2级（0.63，95%CI 0.58-0.91，p=0.004）为良好。
结论
MSUS对JIA患者手腕和MCP关节炎症和结构病变的观察者内和观察者间可靠性良好至极佳。
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