Kuo Daniel, Morris Nicolette T, Kaeley Gurjit S, Ben-Artzi Ami, Brook Jenny, Elashoff David A, Ranganath Veena K
David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
College of Medicine, University of Florida, Jacksonville, FL, USA.
Clin Rheumatol. 2021 Mar;40(3):1077-1084. doi: 10.1007/s10067-020-05340-9. Epub 2020 Aug 15.
Musculoskeletal ultrasound quantifies the total synovial inflammatory burden in rheumatoid arthritis (RA) but is time consuming when scanning numerous joints. This study evaluated a novel patient-centered method for constructing a longitudinal ultrasound score in RA patients.
Fifty-four RA patients starting intravenous tocilizumab were evaluated with power Doppler ultrasound (PDUS) of 34 joints and DAS28-ESR was assessed at baseline and weeks 4, 12, 16, and 24. The sentinel joint score (SJS) was derived from the reduced subset of joints with PDUS ≥ 1 at baseline. Total PDUS (tPDUS) score and US7 were also calculated. Changes in tPDUS and SJS were correlated. Effect sizes were calculated for tPDUS, SJS, and US7. The proportion of "flipped" joints without baseline PDUS signal that later developed PDUS signal was estimated.
At baseline, 1236/1829 joints scanned (67.5%) did not have PDUS signal. The proportion of "flipped" joints at 24 weeks was 5.6% for ≥ 1, 2.9% for ≥ 2, and 1.0% for = 3 PD. tPDUS and SJS scores were highly correlated (r = 0.91 to 0.97). Overall the effect sizes for tPDUS, SJS, and US7 increased over 24 weeks, where SJS was the highest (SJS 1.00 4-week, 1.07 12-week, 1.26 24-week) and tPDUS and US7 were comparable (tPDUS 0.32 4-week, 0.52 12-week, 0.84 24-week; US7 0.23 4-week, 0.52 12-week, 0.74 24-week).
In RA patients starting a biologic, scanning only joints with baseline PDUS signal can substantially reduce the number of joints requiring follow-up scanning by 67.5% and improves feasibility. "Flipped" joints are infrequently seen after starting therapy.
ClinicalTrials.gov NCT01717859 Key messages • Only a small percent of joints develop power Doppler signal after baseline scanning. • Changes in the SJS correlate well with changes in clinical activity measured by DAS28-ESR over time. • The SJS effect size is higher than total PDUS and US7 scores, and may improve examination feasibility.
肌肉骨骼超声可量化类风湿关节炎（RA）患者的滑膜炎症总负荷，但扫描多个关节时耗时较长。本研究评估了一种以患者为中心的新方法，用于构建RA患者的纵向超声评分。
对54例开始静脉注射托珠单抗的RA患者进行34个关节的能量多普勒超声（PDUS）检查，并在基线、第4、12、16和24周评估DAS28-ESR。哨兵关节评分（SJS）源自基线时PDUS≥1的关节简化子集。还计算了总PDUS（tPDUS）评分和US7评分。tPDUS和SJS的变化进行相关性分析。计算tPDUS、SJS和US7的效应量。估计无基线PDUS信号但后来出现PDUS信号的“翻转”关节比例。
基线时，1829个扫描关节中有1236个（67.5%）无PDUS信号。24周时，≥1个“翻转”关节的比例为5.6%，≥2个为2.9%，=3个为1.0%。tPDUS和SJS评分高度相关（r = 0.91至0.97）。总体而言，tPDUS、SJS和US7的效应量在24周内增加，其中SJS最高（SJS第4周为1.00，第12周为1.07，第24周为1.26），tPDUS和US7相当（tPDUS第4周为0.32，第12周为0.52，第24周为0.84；US7第4周为0.23，第12周为0.52，第24周为0.74）。
在开始使用生物制剂的RA患者中，仅扫描有基线PDUS信号的关节可使需要随访扫描的关节数量大幅减少67.5%，并提高可行性。开始治疗后很少见到“翻转”关节。
ClinicalTrials.gov NCT01717859 关键信息 • 基线扫描后只有一小部分关节出现能量多普勒信号。 • SJS的变化与DAS28-ESR测量的临床活动随时间的变化密切相关。 • SJS效应量高于总PDUS和US7评分，可能提高检查可行性。
