Department of Rheumatology and Immunology, Medical School, University of Pécs, Hungary.
Institute of Bioanalysis, Medical School, University of Pécs, Hungary.
Clin Exp Rheumatol. 2021 Jul-Aug;39 Suppl 131(4):77-84. doi: 10.55563/clinexprheumatol/cl3bbb. Epub 2021 Mar 17.
We validated the responsiveness of joint count composite indices (JCCIs) in 72 patients with systemic sclerosis (SSc).
Changes in Disease Activity Score of 28 Joints using ESR and CRP (DAS28-ESR, DAS28-CRP), Simplified Disease Activity Index (SDAI) and the Clinical Disease Activity Index (CDAI) were evaluated in a one-year follow-up study. Charts of patients including swollen/tender joint counts, laboratory signs of inflammation, and visual analogue scales referring to disease activity, severity and pain were also blindly categorized by two rheumatologists as improved, unchanged or deteriorated. These categories were used as references for the determination of effect size (ES) and standardised response mean (SRM).
Articular inflammation improved in 15, deteriorated in 12, and remained unchanged in 45 (63%) patients with SSc based on the concordant opinion of two clinical investigators. All four JCCIs were sensitive to changes (ES>1; SRM>1). The correlation between changes in JCCIs and the physicians' evaluation was high (r >0.68; p<0.001). Arthritis was predominantly prone to change in patients with high JCCIs, impaired functional status, anti-RNA polymerase III antibodies and patients on DMARD therapy. Synovitis was more prevalent in patients with early diffuse SSc, and tended to improve during the follow-up.
All four JCCIs were sensitive to changes, if tender/swollen joints were present at baseline. Articular inflammation was most prone to change in patients with high JCCIs, impaired functional status and already decreased health-related quality of life at baseline.
我们验证了关节计数综合指数（JCCI）在 72 例系统性硬化症（SSc）患者中的反应能力。
在一项为期一年的随访研究中，评估了血沉和 C 反应蛋白（DAS28-ESR、DAS28-CRP）、简化疾病活动指数（SDAI）和临床疾病活动指数（CDAI）的 28 个关节疾病活动评分变化。肿胀/压痛关节计数、炎症实验室标志物以及疾病活动、严重程度和疼痛的视觉模拟量表图表也由两位风湿病学家进行盲法分类，分为改善、不变或恶化。这些类别被用作确定效应量（ES）和标准化反应均值（SRM）的参考。
根据两位临床研究人员的一致意见，15 例 SSc 患者的关节炎症得到改善，12 例恶化，45 例（63%）不变。所有四个 JCCI 对变化都很敏感（ES>1；SRM>1）。JCCI 变化与医生评估之间的相关性很高（r>0.68；p<0.001）。JCCI 较高、功能状态受损、抗 RNA 聚合酶 III 抗体和接受 DMARD 治疗的患者，关节炎更容易发生变化。早期弥漫性 SSc 患者的滑膜炎更为常见，且在随访期间趋于改善。
如果基线时存在压痛/肿胀关节，所有四个 JCCI 对变化都很敏感。JCCI 较高、功能状态受损和基线时健康相关生活质量已经下降的患者，关节炎症最容易发生变化。
