Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany.
Arthritis Res Ther. 2022 Aug 5;24(1):183. doi: 10.1186/s13075-022-02874-y.
There is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet. Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score.
RA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. dorsal regions (chi-square test). The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. Analyses were also performed separately for early and established RA.
A total of 435 patients (N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). The dorsal vs. palmar side of the wrist by GS/PD (p < 0.001) and the palmar side of the finger joints by PD (p < 0.001) were more frequently pathologic. The reduced US7 score (GS/PD: palmar MCP2, dorsal wrist, EDC and ECU, only PD: dorsal MCP2) showed therapy response (SRM 0.433) after 6 months and retained 76% of the full US7 score's information. No major differences between the groups of early and established RA could be detected.
The wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level.
目前，针对患者层面的类风湿关节炎（RA）监测，尚未形成国际公认的最佳超声评分方法。本研究旨在重新评估 US7 评分以确定最常见的病理性和反应性关节/肌腱区域，并对其进行优化，以促进国际共识的形成。此外，我们还旨在评估疾病持续时间对评分表现的影响。
在开始/改变 DMARD 治疗后的 3 个月和 6 个月，使用 US7 评分对 RA 患者进行灰阶（GS）和能量多普勒（PD）超声检查。采用 Friedman 检验和 Cochrane-Q 检验分别分析病理性关节/肌腱区域的出现频率及其对治疗的反应性，包括掌侧和背侧区域的比较（卡方检验）。通过标准化反应均值（SRM）/线性回归评估不同简化评分的反应性以及原始 US7 评分保留的信息量。此外，还分别对早期和已确诊的 RA 患者进行了分析。
共纳入 435 例患者（N=138 例早期 RA）（年龄 56.5（标准差 13.1）岁，病程 8.2（9.1）年，女性占 80%）。GS/PD 滑膜炎/肌腱炎最常累及背侧腕关节、掌侧 MCP2、伸指肌腱（EDC）和尺侧腕伸肌腱（ECU）（腕关节：45%/43%；MCP2：35%/28%；EDC：30%/11%和 ECU：25%/11%），且在治疗 6 个月内明显变化（所有 p 值均≤0.003，GS/PD）。GS/PD 下背侧腕关节与掌侧腕关节（p<0.001）和 PD 下掌侧指间关节（p<0.001）更易出现病理性变化。简化的 US7 评分（GS/PD：掌侧 MCP2、背侧腕关节、EDC 和 ECU，仅 PD：背侧 MCP2）在 6 个月后显示出治疗反应（SRM 0.433），保留了原始 US7 评分 76%的信息。早期和已确诊的 RA 患者之间未发现明显差异。
在早期和已确诊的 RA 患者中，腕关节、MCP2、EDC 和 ECU 肌腱最常出现病理性变化，并对治疗有反应，因此应将其纳入患者层面的 RA 监测综合评分中。
