Department of Ultrasound, Peking University People's Hospital, Beijing, China.
Department of Ultrasound, Peking University People's Hospital, Beijing, China
J Investig Med. 2022 Feb;70(2):391-395. doi: 10.1136/jim-2021-001885. Epub 2021 Sep 13.
Regarding the persistence of subclinical synovitis, the concept of ultrasound remission has been proposed in addition to clinical remission. However, there have been no studies that explored the different time points of ultrasound remission to predict non-progressive structural damage. Given this, the aim of our study is to explore whether early ultrasound remission in patients with rheumatoid arthritis (RA) has predictive value for non-progressive structural damage in the subsequent 12 months. Sixty-one patients with RA were prospectively studied. Synovial hypertrophy, power Doppler (PD) signal, and bone erosions of bilateral wrists, metacarpophalangeal joints I-V, and proximal interphalangeal joints II-III were assessed by ultrasonography at baseline and at 3, 6, and 12 months. Ultrasound remission was defined as no PD signal. Clinical remission was defined as Disease Activity Score in 28 Joints <2.6. Ultrasonography-detected joint damage progression was defined as increase in bone erosion score of ≥1 in the subsequent 12 months. Baseline ultrasonographic factors were not significantly correlated with progressive ultrasonography-detected joint damage in patients with RA at 12 months (all p>0.05). Ultrasound remission at 3 and 6 months was significantly correlated with non-progressive ultrasonography-detected structural damage at 12 months (p=0.006 and p=0.004), with relatively low sensitivity and high specificity. Clinical remission at 3 months was significantly correlated with non-progression of ultrasonography-detected structural damage at 12 months (p=0.029), with relatively low sensitivity and moderate specificity. Ultrasound remission at 3 and 6 months has high specificity in predicting non-progressive structural damage in patients with RA at 12 months; however, the sensitivity is limited.
关于亚临床滑膜炎的持续存在，除了临床缓解外，还提出了超声缓解的概念。然而，还没有研究探讨超声缓解的不同时间点来预测非进展性结构损伤。鉴于此，我们的研究旨在探讨类风湿关节炎（RA）患者的早期超声缓解是否对随后 12 个月的非进展性结构损伤具有预测价值。前瞻性研究了 61 例 RA 患者。基线时和 3、6 和 12 个月时，通过超声评估双侧腕关节、掌指关节 I-V 和近端指间关节 II-III 的滑膜肥厚、功率多普勒（PD）信号和骨侵蚀情况。超声缓解定义为无 PD 信号。临床缓解定义为 28 关节疾病活动度评分<2.6。超声检测到的关节损伤进展定义为随后 12 个月骨侵蚀评分增加≥1。基线超声因素与 RA 患者 12 个月时的进展性超声检测关节损伤无显著相关性（均 p>0.05）。3 个月和 6 个月时的超声缓解与 12 个月时的非进展性超声检测结构损伤显著相关（p=0.006 和 p=0.004），敏感性较低，特异性较高。3 个月时的临床缓解与 12 个月时的超声检测结构损伤无进展显著相关（p=0.029），敏感性较低，特异性中等。3 个月和 6 个月时的超声缓解在预测 RA 患者 12 个月时的非进展性结构损伤方面具有较高的特异性；然而，敏感性有限。
