Hensor Elizabeth M A, McKeigue Paul, Ling Stephanie F, Colombo Marco, Barrett Jennifer H, Nam Jackie L, Freeston Jane, Buch Maya H, Spiliopoulou Athina, Agakov Felix, Kelly Stephen, Lewis Myles J, Verstappen Suzanne M M, MacGregor Alexander J, Viatte Sebastien, Barton Anne, Pitzalis Costantino, Emery Paul, Conaghan Philip G, Morgan Ann W
Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds.
NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds.
Rheumatology (Oxford). 2019 Mar 1;58(8):1400-9. doi: 10.1093/rheumatology/kez049.
Imaging of joint inflammation provides a standard against which to derive an updated DAS for RA. Our objectives were to develop and validate a DAS based on reweighting the DAS28 components to maximize association with US-assessed synovitis.
Early RA patients from two observational cohorts (n = 434 and n = 117) and a clinical trial (n = 59) were assessed at intervals up to 104 weeks from baseline; all US scans were within 1 week of clinical exam. There were 899, 163 and 183 visits in each cohort. Associations of combined US grey scale and power Doppler scores (GSPD) with 28 tender joint count and 28 swollen joint count (SJC28), CRP, ESR and general health visual analogue scale were examined in linear mixed model regressions. Cross-validation evaluated model predictive ability. Coefficients learned from training data defined a re-weighted DAS28 that was validated against radiographic progression in independent data (3037 observations; 717 patients).
Of the conventional DAS28 components only SJC28 and CRP were associated with GSPD in all three development cohorts. A two-component model including SJC28 and CRP outperformed a four-component model (R2 = 0.235, 0.392, 0.380 vs 0.232, 0.380, 0.375, respectively). The re-weighted two-component DAS28CRP outperformed conventional DAS28 definitions in predicting GSPD (Δtest log-likelihood <-2.6, P < 0.01), Larsen score and presence of erosions.
A score based on SJC28 and CRP alone demonstrated stronger associations with synovitis and radiographic progression than the original DAS28 and should be considered in research on pathophysiological manifestations of early RA. Implications for clinical management of RA remain to be established.
关节炎症成像提供了一个标准，据此可得出类风湿关节炎（RA）更新后的疾病活动度评分（DAS）。我们的目的是通过重新权衡DAS28的组成部分以最大化与超声评估滑膜炎的相关性，来开发并验证一种DAS。
来自两个观察性队列（n = 434和n = 117）以及一项临床试验（n = 59）的早期RA患者，从基线起每隔一段时间进行评估，最长至104周；所有超声扫描均在临床检查的1周内进行。每个队列分别有899次、163次和183次就诊。在线性混合模型回归中，研究了超声灰阶和能量多普勒评分（GSPD）总和与28个压痛关节计数、28个肿胀关节计数（SJC28）、CRP、ESR以及一般健康视觉模拟量表之间的关联。交叉验证评估模型预测能力。从训练数据中得出的系数定义了一个重新加权的DAS28，并在独立数据（3037次观察；717名患者）中根据放射学进展进行验证。
在所有三个开发队列中，传统DAS28组成部分中仅SJC28和CRP与GSPD相关。一个包含SJC28和CRP的双组分模型优于四组分模型（R2分别为0.235、0.392、0.380，对比0.232、0.380、0.375）。重新加权的双组分DAS28CRP在预测GSPD（Δ检验对数似然值 < -2.6，P < 0.01）、Larsen评分和侵蚀存在方面优于传统DAS28定义。
仅基于SJC28和CRP的评分与滑膜炎及放射学进展的关联比原始DAS28更强，在早期RA病理生理表现研究中应予以考虑。对RA临床管理的影响仍有待确定。
