Center for Rheumatology and Spine Diseases, Center of Head and Orthopaedics, Glostrup, Rigshospitalet, Capital Region, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Rheumatology (Oxford). 2021 Dec 1;60(12):5549-5559. doi: 10.1093/rheumatology/keab276.
To assess the ability of ultrasound to predict successful tapering and successful discontinuation of biological DMARDs (bDMARDs) at the 2-year follow-up in RA patients in sustained remission.
Patients in sustained remission (DAS28-CRP ≤ 2.6) and with no radiographic progression the previous year tapered bDMARDs according to a standardized regime. A total of 119 of these patients were included in this ultrasound substudy. At baseline, clinical assessment, MRI, X-ray and ultrasound of 24 joints were performed. Ultrasound-detected synovitis was defined and scored 0-3 using the OMERACT scoring system at the joint level for both grey-scale and Doppler activity. Sum scores for each ultrasound modality were calculated for 24 joints at the patient level. The final state of treatment was assessed after 2 years. The predictive value of ultrasound measures for successful tapering and discontinuation at the 2-year follow-up was assessed via logistic regression analyses.
Negative IgM-RF [odds ratio (OR) = 0.29, 95% CI: 0.10-0.85; P = 0.024] and lower Doppler sum score of 24 joints (OR = 0.44, 95% CI: 0.15, 0.87; P = 0.014) were independent predictors for successful discontinuation of bDMARDs at the 2-year follow-up. The predictive value of the Doppler sum score was independent of MRI findings. Previous numbers of bDMARDs were predictive of successful tapering (OR = 0.58, 95% CI: 0.35, 0.91; P = 0.018), whereas ultrasound was not. Clinical parameters were not predictive of successful tapering/discontinuation.
Doppler sum score was an independent predictor for successful discontinuation of bDMARDs at the 2-year follow-up-the odds for achieving successful discontinuation decreased by 56% per one-unit increase in Doppler sum score. Ultrasound could not predict successful tapering.
评估超声在预测 RA 患者持续缓解 2 年时成功减少和停止生物 DMARD（bDMARD）的能力。
处于持续缓解（DAS28-CRP≤2.6）且前一年无影像学进展的患者根据标准化方案减少 bDMARD。共有 119 名患者纳入本超声亚研究。基线时进行临床评估、MRI、X 射线和 24 个关节的超声检查。采用 OMERACT 评分系统，在关节水平上对灰阶和多普勒活动进行 0-3 分的定义和评分，以评估超声检测到的滑膜炎。为每个患者的 24 个关节计算每个超声模式的总和评分。2 年后评估最终治疗状态。通过逻辑回归分析评估超声指标对 2 年随访时成功减少和停止治疗的预测价值。
阴性 IgM-RF（比值比[OR] = 0.29，95%置信区间：0.10-0.85；P = 0.024）和较低的 24 个关节多普勒总和评分（OR = 0.44，95%置信区间：0.15，0.87；P = 0.014）是 2 年随访时成功停止 bDMARD 的独立预测因素。多普勒总和评分的预测价值独立于 MRI 发现。先前使用的 bDMARD 数量与成功减少相关（OR = 0.58，95%置信区间：0.35，0.91；P = 0.018），而超声则不然。临床参数不能预测成功减少/停止。
多普勒总和评分是 2 年随访时成功停止 bDMARD 的独立预测因素——多普勒总和评分每增加一个单位，成功停止的几率降低 56%。超声不能预测成功减少。
