Micheroli Raphael, Scherer Almut, Bürki Kristina, Zufferey Pascal, Nissen Michael J, Brulhart Laure, Möller Burkhard, Ziswiler Hans-Rudolf, Ciurea Adrian, Tamborrini Giorgio
Department of Rheumatology, Zurich University Hospital, Zurich, Switzerland.
Statistics Group, SCQM Foundation, Zurich, Switzerland.
J Ultrason. 2022 Feb 8;22(88):e21-e27. doi: 10.15557/JoU.2022.0004. eCollection 2022 Mar.
The role of US-detected tenosynovitis (USTS) in the management of rheumatoid arthritis remains controversial. The aim of this study was to investigate whether tenosynovitis can predict a flare in rheumatoid arthritis patients in remission in a real-life cohort.
Rheumatoid arthritis patients from the Swiss Clinical Quality Management cohort were included in this study if they were in clinical remission, defined by 28-joint disease activity score (DAS28-ESR) <2.6, and had an available B-mode tenosynovitis score. The patients were stratified according to the presence or absence of tenosynovitis (USTS+ vs. USTS-). Cox proportional hazard models were used for time-to-event analysis until the loss of remission, after adjustment for multiple confounders. The impact of baseline US performed early in remission and the advent of flares at different fixed time periods after baseline were investigated in sensitivity analysis.
Tenosynovitis was detected in 10% of 402 rheumatoid arthritis patients in remission. At baseline, USTS+ patients in remission had significantly higher DAS28-ESR (mean (SD): USTS- 1.8 (0.5) versus USTS+ 2.0 (0.5); = 0.0019) and higher additional disease activity parameters, such as physician global assessment, and simplified- and clinical-disease activity index. Joint synovitis detected by B-mode US was associated with tenosynovitis (mean (SD) 7.2 (6.3) in USTS- versus 9.0 (5.4) in USTS+, respectively; = 0.02). A disease flare was observed in 69% of remission phases, with no differences in the time to loss of remission between USTS+ and USTS- groups.
While US-detected tenosynovitis was associated with higher disease activity parameters in rheumatoid arthritis patients in clinical remission, it was not able to predict a flare.
超声检测到的腱鞘炎（USTS）在类风湿关节炎管理中的作用仍存在争议。本研究的目的是调查腱鞘炎是否能预测现实生活队列中处于缓解期的类风湿关节炎患者病情复发。
瑞士临床质量管理队列中的类风湿关节炎患者若处于临床缓解期（根据28关节疾病活动评分（DAS28-ESR）<2.6定义）且有可用的B型超声腱鞘炎评分，则纳入本研究。患者根据是否存在腱鞘炎（USTS+与USTS-）进行分层。在调整多个混杂因素后，使用Cox比例风险模型进行事件发生时间分析，直至缓解期丧失。在敏感性分析中，研究了缓解早期进行的基线超声检查以及基线后不同固定时间段病情复发的影响。
402例处于缓解期的类风湿关节炎患者中，10%检测到腱鞘炎。基线时，处于缓解期的USTS+患者的DAS28-ESR显著更高（均值（标准差）：USTS-为1.8（0.5），USTS+为2.0（0.5）；P = 0.0019），且其他疾病活动参数更高，如医生整体评估、简化疾病活动指数和临床疾病活动指数。B型超声检测到的关节滑膜炎与腱鞘炎相关（USTS-组均值（标准差）为7.2（6.3），USTS+组为9.0（5.4）；P = 0.02）。69%的缓解期出现病情复发，USTS+组和USTS-组在缓解期丧失时间上无差异。
虽然超声检测到的腱鞘炎与临床缓解期的类风湿关节炎患者更高的疾病活动参数相关，但它无法预测病情复发。
