Ziegelasch Michael, Eloff Emma, Hammer Hilde B, Cedergren Jan, Martinsson Klara, Reckner Åsa, Skogh Thomas, Magnusson Mattias, Kastbom Alf
Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Front Med (Lausanne). 2021 Mar 23;8:653994. doi: 10.3389/fmed.2021.653994. eCollection 2021.
Anti-citrullinated protein antibodies (ACPA) often precede onset of rheumatoid arthritis (RA) by years, and there is an urgent clinical need for predictors of arthritis development among such at-risk patients. This study assesses the prognostic value of ultrasound for arthritis development among ACPA-positive patients with musculoskeletal pain. We prospectively followed 82 ACPA-positive patients without clinical signs of arthritis at baseline. Ultrasound at baseline assessed synovial hypertrophy, inflammatory activity by power Doppler, and erosions in small joints of hands and feet. We applied Cox regression analyses to examine associations with clinical arthritis development during follow-up (median, 69 months; range, 24-90 months). We also compared the ultrasound findings among the patients to a control group of 100 blood donors without musculoskeletal pain. Clinical arthritis developed in 39/82 patients (48%) after a median of 6 months (range, 1-71 months). One or more ultrasound erosions occurred in 13/82 patients (16%), with none in control subjects ( < 0.001). Clinical arthritis development was more common among patients with baseline ultrasound erosions than those without (77 vs. 42%, = 0.032), and remained significant in a multivariable Cox regression analysis that included previously described prognostic factors (HR 3.9, 95% CI 1.6-9.4, = 0.003). Ultrasound-detected tenosynovitis was more frequent among the patients and associated with clinical arthritis development in a univariable analysis (HR 2.5, 95% CI 1.1-5.7, = 0.031), but did not remain statistically significant in multivariable analysis. Thus, bone erosions detected by ultrasound are independent predictors of clinical arthritis development in an ACPA-positive at-risk population. Regional Ethics Committee in Linköping, Sweden, Dnr M220-09. Registered 16 December 2009, https://etikprovningsmyndigheten.se/.
抗瓜氨酸化蛋白抗体（ACPA）通常在类风湿性关节炎（RA）发病前数年就已出现，临床上迫切需要针对这类高危患者关节炎发展的预测指标。本研究评估了超声检查对于ACPA阳性且有肌肉骨骼疼痛患者关节炎发展的预后价值。我们前瞻性地随访了82例基线时无关节炎临床体征的ACPA阳性患者。基线超声检查评估滑膜增生、能量多普勒检测的炎症活动以及手足小关节的侵蚀情况。我们应用Cox回归分析来研究随访期间（中位数为69个月；范围为24 - 90个月）与临床关节炎发展的相关性。我们还将患者的超声检查结果与100名无肌肉骨骼疼痛的献血者组成的对照组进行了比较。39/82例患者（48%）在中位数为6个月（范围为1 - 71个月）后出现临床关节炎。13/82例患者（16%）出现一处或多处超声侵蚀，而对照组无一例出现（<0.001）。基线超声有侵蚀的患者中临床关节炎发展比无侵蚀的患者更常见（77%对42%，P = 0.032），并且在纳入先前描述的预后因素的多变量Cox回归分析中仍然显著（风险比3.9，95%置信区间1.6 - 9.4，P = 0.003）。超声检测到的腱鞘炎在患者中更常见，并且在单变量分析中与临床关节炎发展相关（风险比2.5，95%置信区间1.1 - 5.7，P = 0.031），但在多变量分析中未保持统计学显著性。因此，超声检测到的骨侵蚀是ACPA阳性高危人群临床关节炎发展的独立预测指标。瑞典林雪平地区伦理委员会，编号M220 - 09。于2009年12月16日注册，https://etikprovningsmyndigheten.se/ 。
