Diakonhjemmet Hospital, Oslo, Norway.
Diakonhjemmet Hospital, Oslo, Norway, and Hospital of Southern Norway Trust, Kristiansand, Norway.
Arthritis Care Res (Hoboken). 2020 Jan;72(1):27-35. doi: 10.1002/acr.23815.
The tender joint count (TJC) is included in composite disease activity scores (CDAS) (the Disease Activity Score in 28 joints, the Clinical Disease Activity Index, and the Simplified Disease Activity Index). The impact of having predominantly tender joints was explored by use of the Tender-Swollen Joint Count Difference (TSJD), and ultrasound (US) provided a measure of joint inflammation. The current study aimed to explore the cross-sectional and longitudinal associations between the TSJD and a spectrum of outcome measures, including US scores in patients with established rheumatoid arthritis (RA) during follow-up and while receiving treatment with biologic disease-modifying antirheumatic drugs (bDMARDs).
This was an observational study of 209 patients with established RA consecutively included upon initiation of bDMARD treatment and followed-up with clinical, laboratory, and comprehensive US examinations at 0, 1, 2, 3, 6, and 12 months. Patients were categorized into 2 groups: those with predominantly tender joints (TSJD >0) and those with predominantly swollen joints (TSJD ≤0). Statistical analyses included Pearson's correlation coefficient, an independent samples t-test, and regression analyses.
The TJC had high correlations only with patient-reported outcomes (PROMs) (P < 0.001). Levels from CDAS and PROMs were significantly higher (P < 0.001) at all visits in patients with TSJD >0 compared to those with TSJD <0. Laboratory markers and assessor's global visual analog scale scores were similar, and US sum scores were significantly lower (P < 0.001-0.03). The baseline TSJD positively predicted levels of all CDAS at 6 months (P < 0.001-0.019) but was a negative predictor of US sum scores (gray-scale and power Doppler) at 6 and 12 months (P < 0.001).
Patients with predominantly tender joints had higher CDAS but lower levels of inflammation as defined by US. These findings indicate that inclusion of the TJC in the CDAS may contribute to misleading information about inflammatory activity.
压痛关节数（TJC）包含在复合疾病活动评分（CDAS）中（28 个关节疾病活动评分、临床疾病活动指数和简化疾病活动指数）。通过使用压痛-肿胀关节数差值（TSJD）来探讨主要为压痛关节的影响，而超声（US）则提供了关节炎症的测量方法。本研究旨在探讨 TSJD 与一系列结局指标的横断面和纵向关联，包括接受生物改善病情抗风湿药物（bDMARD）治疗的已确诊类风湿关节炎（RA）患者在随访期间和治疗期间的 US 评分。
这是一项观察性研究，共纳入 209 例连续接受 bDMARD 治疗的已确诊 RA 患者，在 0、1、2、3、6 和 12 个月时进行临床、实验室和全面 US 检查。患者分为两组：主要为压痛关节（TSJD>0）和主要为肿胀关节（TSJD≤0）。统计分析包括 Pearson 相关系数、独立样本 t 检验和回归分析。
TJC 仅与患者报告的结局（PROM）高度相关（P<0.001）。与 TSJD<0 的患者相比，TSJD>0 的患者在所有访视时的 CDAS 和 PROM 水平均显著升高（P<0.001）。实验室标志物和评估者的整体视觉模拟量表评分相似，而 US 总分显著降低（P<0.001-0.03）。基线 TSJD 可预测 6 个月时所有 CDAS 的水平（P<0.001-0.019），但可预测 6 和 12 个月时 US 总分（灰度和能量多普勒）的水平（P<0.001）。
主要为压痛关节的患者 CDAS 水平较高，但 US 定义的炎症水平较低。这些发现表明，TJC 纳入 CDAS 可能会导致关于炎症活动的误导性信息。
