Nozaki Yuji, Ri Jinhai, Sakai Kenji, Shiga Toshihiko, Inoue Asuka, Nagare Yasuaki, Funauchi Masanori, Matsumura Itaru
a Department of Hematology and Rheumatology , Kindai University School of Medicine , Osaka , Japan.
Immunol Med. 2018 Sep;41(3):129-135. doi: 10.1080/25785826.2018.1531192. Epub 2018 Nov 17.
Ultrasound (US) is more sensitive and reliable than a clinical examination, and is better correlated with the disease activity in rheumatoid arthritis (RA). We conducted the present study to assess the value of US as a screening tool to predict therapeutic responses in RA patients treated with anti-tumor necrosis factor (TNF) drugs.
We retrospectively analyzed the cases of 86 consecutive RA patients who were classified by their DAS28-CRP scores at the 54th week. We assessed two US findings (i.e., the synovial hypertrophy index [SHI] and synovial vascularization) by grey-scale imaging and the Doppler synovitis index (DSI).
When we applied cut-off points determined by a ROC curve analysis, patients with a lower total SHI (≤34) or DSI (≤7) at baseline were significantly more likely to reach remission (44 patients, 51.2%) as shown by the DAS28-CRP at 54 weeks. On the basis of these cut-off values, we dichotomized all variables and performed a logistic regression analysis using the 54-weeks data; the only predictive factors of remission with anti-TNF therapy were the patients' baseline DAS28-CRP ≤2.7 as low disease activity/remission, and the SHI.
An ultrasound assessment would be a highly useful predictor of the achievement of clinical remission.
超声（US）比临床检查更敏感、可靠，且与类风湿关节炎（RA）的疾病活动度相关性更好。我们开展本研究以评估超声作为预测接受抗肿瘤坏死因子（TNF）药物治疗的RA患者治疗反应的筛查工具的价值。
我们回顾性分析了86例连续RA患者的病例，这些患者根据第54周时的DAS28-CRP评分进行分类。我们通过灰阶成像评估两项超声检查结果（即滑膜肥厚指数[SHI]和滑膜血管化）以及多普勒滑膜炎指数（DSI）。
当我们应用通过ROC曲线分析确定的截断点时，如第54周时的DAS28-CRP所示，基线时总SHI较低（≤34）或DSI较低（≤7）的患者达到缓解的可能性显著更高（44例患者，51.2%）。基于这些截断值，我们将所有变量进行二分，并使用第54周的数据进行逻辑回归分析；抗TNF治疗缓解的唯一预测因素是患者基线DAS28-CRP≤2.7作为低疾病活动度/缓解，以及SHI。
超声评估将是临床缓解实现的高度有用的预测指标。
