Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup.
Center for Rheumatology and Spine Diseases, Rigshospitalet.
Rheumatology (Oxford). 2022 Feb 2;61(2):723-733. doi: 10.1093/rheumatology/keab384.
To investigate the association between clinical joint tenderness and intra- and periarticular inflammation as assessed by ultrasound and MRI in patients with active PsA and to explore if the associations differ according to patient-reported outcomes (PROs) and structural damage.
Forty-one patients with active PsA and hand involvement had 76/78 joints examined for swelling/tenderness and ultrasound and MRI of 24 and 12 finger joints, respectively. Synovitis, tenosynovitis, periarticular inflammation and erosions were assessed using OMERACT definitions and scoring systems. Correlation between imaging inflammation sum-scores (intra-and periarticular) and tender/swollen joint counts were calculated using Spearman's rho, agreement at joint level was examined using prevalence and bias adjusted kappa (PABAK). Subgroup analyses explored the influence of PROs and radiographic erosive disease on these associations.
No significant correlations were found between tender or swollen joint counts and imaging inflammation sum-scores (rho = -0.31-0.38). In patients with higher level of overall pain, disability and lower self-reported mental health, a tendency towards negative correlations were found. At joint level, intra- and periarticular imaging inflammatory lesions had slight agreement with joint tenderness (PABAK = 0.02-0.19) and slight to moderate with swelling (PABAK = 0.16-0.54). For tender joints, agreement with imaging inflammation was even weaker in patients with either high overall pain scores, high disability scores, and/or non-erosive disease.
Joint tenderness had low association with imaging signs of inflammation in PsA patients, particularly in patients with high self-reported pain, disability and low mental health, indicating that tenderness is influenced by other parameters than local inflammation.
探讨活动性银屑病关节炎（PsA）患者的临床关节触痛与超声和 MRI 评估的关节内和关节周围炎症之间的关系，并探讨这些关联是否因患者报告的结局（PROs）和结构损伤而不同。
41 例手部受累的活动性 PsA 患者共 76/78 个关节接受肿胀/触痛检查，24 和 12 个手指关节分别接受超声和 MRI 检查。使用 OMERACT 定义和评分系统评估滑膜炎、腱鞘炎、关节周围炎症和侵蚀。使用 Spearman's rho 计算影像学炎症总评分（关节内和关节周围）与压痛/肿胀关节计数之间的相关性，使用流行率和偏倚调整kappa（PABAK）检验关节水平的一致性。亚组分析探讨了 PROs 和放射学侵蚀性疾病对这些关联的影响。
压痛或肿胀关节计数与影像学炎症总评分之间无显著相关性（rho=-0.31-0.38）。在总体疼痛水平较高、残疾程度较高和自我报告心理健康水平较低的患者中，存在负相关的趋势。在关节水平，关节内和关节周围影像学炎症病变与关节压痛具有轻微一致性（PABAK=0.02-0.19），与肿胀具有轻微至中度一致性（PABAK=0.16-0.54）。对于压痛关节，在总体疼痛评分高、残疾评分高和/或无侵蚀性疾病的患者中，影像学炎症与压痛的一致性更弱。
在 PsA 患者中，关节触痛与影像学炎症表现相关性较低，特别是在自我报告疼痛、残疾和心理健康水平较高的患者中，这表明压痛受局部炎症以外的其他参数影响。
