在未使用改善病情抗风湿药的早期银屑病关节炎中，超声显示关节肿胀比压痛关节更能准确代表滑膜炎。
Ultrasound shows swollen joints are the better proxy for synovitis than tender joints in DMARD-naïve early psoriatic arthritis.
作者信息
Dubash Sayam R, Alabas Oras A, Michelena Xabier, Garcia-Montoya Leticia, De Marco Gabriele, Merashli Mira, Wakefield Richard J, Emery Paul, McGonagle Dennis, Tan Ai Lyn, Marzo-Ortega Helena
机构信息
NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds.
出版信息
Rheumatol Adv Pract. 2021 Nov 15;5(3):rkab086. doi: 10.1093/rap/rkab086. eCollection 2021.
OBJECTIVE
To evaluate the relationship between clinical examination/US synovitis in DMARD-naïve early PsA.
METHODS
Eligible patients underwent matched clinical/US 44-joint assessment for tender and/or swollen joints (TJ/SJ) and US synovitis [grey scale (GS) ≥ 2 or power Doppler (PD) ≥ 1]. Statistical agreement between TJ/SJ, GS ≥ 2 and PD ≥ 1 was calculated by prevalence-adjusted and bias-adjusted κ (PABAK). To derive probabilities of GS ≥ 2/PD ≥ 1, mixed-effects logistic regression-modelled odds of US synovitis in TJ/SJ were conducted.
RESULTS
In 155 patients, 5616 joints underwent clinical/US examination. Of these joints, 1039 of 5616 (18.5%) were tender, 550 of 5616 (9.8%) were swollen, 1144 of 5616 (20.4%) had GS ≥ 2, and 292 of 5616 (5.2%) had PD ≥ 1. GS ≥ 2 was most prevalent in concomitantly tender and swollen joints [205 of 462 (44%)], followed by swollen non-tender joints [32 of 88 (36.4%)], tender non-swollen joints [148 of 577 (25.7%)] and non-tender non-swollen joints (subclinical synovitis) [759 of 4489 (16.9%)]. Agreement between SJ/PD ≥ 1 was high at the individual joint level (82.6-96.3%, PABAK 0.65-0.93) and for total joints combined (89.9%, PABAK 0.80). SJ/GS ≥ 2 agreement was greater than between TJ/GS ≥ 2 [73.5-92.6% 51.0-87.4% (PABAK 0.47-0.85 PABAK 0.35-0.75), respectively]. Swelling was independently associated with higher odds of GS ≥ 2 [odds ratio (OR) (95% CI); 4.37 (2.62, 7.29); < 0.001] but not tenderness [OR = 1.33 (0.87, 2.06); = 0.192]. Swelling [OR = 8.78 (3.92, 19.66); < 0.001] or tenderness [OR = 3.38 (1.53, 7.50); = 0.003] was independently associated with higher odds of PD ≥ 1.
CONCLUSION
Synovitis (GS ≥ 2 and/or PD ≥ 1) was more likely in swollen joints than in tender joints in DMARD-naïve, early PsA. Agreement indicated that swollen joints were the better proxy for synovitis, adding to greater understanding between clinical and US assessments.
目的
评估初治早期银屑病关节炎（PsA）患者的临床检查/超声滑膜炎之间的关系。
方法
符合条件的患者接受了针对44个关节的匹配临床/超声评估，以检查压痛和/或肿胀关节（TJ/SJ）以及超声滑膜炎[灰阶（GS）≥2或能量多普勒（PD）≥1]。通过患病率调整和偏差调整κ（PABAK）计算TJ/SJ、GS≥2和PD≥1之间的统计一致性。为了得出GS≥2/PD≥1的概率，对TJ/SJ中超声滑膜炎的比值比进行了混合效应逻辑回归建模。
结果
155例患者的5616个关节接受了临床/超声检查。在这些关节中，5616个关节里有1039个（18.5%）有压痛，5616个关节里有550个（9.8%）肿胀，5616个关节里有1144个（20.4%）GS≥2，5616个关节里有292个（5.2%）PD≥1。GS≥2在同时有压痛和肿胀的关节中最为常见[462个中有205个（44%）]，其次是肿胀但无压痛的关节[88个中有32个（36.4%）]、压痛但无肿胀的关节[577个中有148个（25.7%）]以及无压痛无肿胀的关节（亚临床滑膜炎）[4489个中有759个（16.9%）]。在单个关节水平上，SJ/PD≥1之间的一致性较高（82.6 - 96.3%，PABAK 0.65 - 0.93），对于所有关节合并起来也是如此（89.9%，PABAK 0.80）。SJ/GS≥2的一致性高于TJ/GS≥2[分别为73.5 - 92.6%和51.0 - 87.4%（PABAK 0.47 - 0.85和PABAK 0.35 - 0.75）]。肿胀与GS≥2的较高比值比独立相关[比值比（OR）（95%置信区间）；4.37（2.62，7.29）；P < 0.001]，但压痛与之无关[OR = 1.33（0.87，2.06）；P = 0.192]。肿胀[OR = 8.78（3.92，19.66）；P < 0.001]或压痛[OR = 3.38（1.53，7.50）；P = 0.003]与PD≥1的较高比值比独立相关。
结论
在初治早期PsA患者中，肿胀关节比压痛关节更易出现滑膜炎（GS≥2和/或PD≥1）。一致性表明肿胀关节是滑膜炎更好的替代指标，有助于加深对临床和超声评估之间关系的理解。
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