Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei.
Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Yunlin, Taiwan.
J Clin Rheumatol. 2021 Dec 1;27(8):e412-e417. doi: 10.1097/RHU.0000000000001499.
The aim of this study was to compare ultrasound (US) grading and laboratory measures in patients with rheumatoid arthritis.
Two-hundred four patients with rheumatoid arthritis who received US evaluation for synovitis were included after excluding those using tocilizumab. Ultrasound grading of synovial hypertrophy (SH) and power Doppler (PD) at the most severe site were recorded. An assessment of the correlation of laboratory measures and US grading was conducted by reviewing the electronic medical records.
High-titer anti-cyclic citrullinated peptide (anti-CCP) antibodies positivity was associated with SH grade ≥2 (odds ratio [OR], 6.00; 95% confidence interval [CI], 1.78-20.2) and PD grade ≥2 (OR, 5.56; 95% CI, 1.82-16.9). Recent C-reactive protein (CRP) levels ≥0.3 mg/dL were associated with SH grade ≥2 (OR, 3.13; 95% CI, 1.38-7.10) and PD grade ≥2 (OR, 2.38; 95% CI, 1.31-4.31). Anti-CCP antibody levels correlated with US scores better than the levels of CRP with higher Spearman ρ correlation coefficients. Most of the patients with recent CRP levels <0.3 mg/dL had US synovitis. In logistic regression, high levels of anti-CCP antibodies and CRP were both independently associated with SH grade ≥2 and PD grade ≥2.
Higher levels of anti-CCP antibodies and CRP may predict synovitis on US, whereas discrepancies existed between inflammatory markers and US grading. These findings suggest that US has a role in the comprehensive assessment of disease activity, especially for patients with high-titer positive anti-CCP antibodies.
本研究旨在比较类风湿关节炎患者的超声（US）分级和实验室指标。
排除使用托珠单抗的患者后，共纳入 204 例接受 US 评估滑膜炎的类风湿关节炎患者。记录最严重部位的滑膜肥厚（SH）和功率多普勒（PD）的超声分级。通过查阅电子病历，评估实验室指标与 US 分级的相关性。
高滴度抗环瓜氨酸肽（anti-CCP）抗体阳性与 SH 分级≥2（比值比 [OR]，6.00；95%置信区间 [CI]，1.78-20.2）和 PD 分级≥2（OR，5.56；95% CI，1.82-16.9）相关。近期 C 反应蛋白（CRP）水平≥0.3mg/dL 与 SH 分级≥2（OR，3.13；95% CI，1.38-7.10）和 PD 分级≥2（OR，2.38；95% CI，1.31-4.31）相关。与 CRP 相比，抗 CCP 抗体水平与 US 评分的相关性更好，Spearman ρ 相关系数更高。大多数近期 CRP 水平<0.3mg/dL 的患者均存在 US 滑膜炎。在逻辑回归中，高水平的抗 CCP 抗体和 CRP 均与 SH 分级≥2 和 PD 分级≥2独立相关。
较高水平的抗 CCP 抗体和 CRP 可能预示着 US 下的滑膜炎，而炎症标志物与 US 分级之间存在差异。这些发现表明，US 在疾病活动的综合评估中具有重要作用，尤其是对于高滴度阳性抗 CCP 抗体的患者。
