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
NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds.
Rheumatol Adv Pract. 2021 Nov 15;5(3):rkab086. doi: 10.1093/rap/rkab086. eCollection 2021.
To evaluate the relationship between clinical examination/US synovitis in DMARD-naïve early PsA.
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.
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.
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.
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。
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。
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。
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。
