University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Nationwide Children's Hospital, Columbus, Ohio.
Arthritis Care Res (Hoboken). 2023 Aug;75(8):1815-1820. doi: 10.1002/acr.25073. Epub 2023 Feb 21.
To determine the frequency of subclinical synovitis on musculoskeletal ultrasonography (MSUS) in juvenile idiopathic arthritis (JIA) and correlate patient- and provider-reported outcome measures with MSUS synovitis.
JIA patients with an active joint count (AJC) of >4 underwent a 42-joint MSUS performed at baseline and 3 months. B-mode and power Doppler images were obtained and scored (range 0-3) for each of the 42 joints. Outcomes evaluated included physician global assessment of disease activity (PhGA), patient global assessment of disease activity (PtGA), patient pain, Childhood Health Assessment Questionnaire (C-HAQ), and AJC. Subclinical synovitis was defined as synovitis detected by MSUS only. Generalized estimation equations were used to test the relationship between clinical arthritis (positive/negative) and subclinical synovitis (positive/negative). Spearman's correlation coefficients (r ) were calculated to determine the association between MSUS synovitis and patient- and physician-reported outcomes.
In 30 patients, subclinical synovitis was detected in 30% of joints. Clinical arthritis of the fingers, wrists, and knee joints was significantly associated with MSUS synovitis in these joints. PtGA and the C-HAQ had a moderate (r = 0.44, P = 0.014) to weak (r = 0.37, P = 0.045) correlation with MSUS synovitis. There was a statistically significant strong correlation between MSUS synovitis and PhGA (r = 0.61, P = 0.001), but a weak correlation with AJC (r = 0.37, P = 0.048) at the follow-up visit.
Subclinical synovitis was commonly observed in this cohort of JIA patients. The fair-to-moderate correlation of MSUS synovitis with patient- and provider-reported outcomes suggests that MSUS assesses a different, possibly more objective, domain not determined by traditional JIA outcome measurements.
确定幼年特发性关节炎(JIA)患者肌肉骨骼超声(MSUS)下亚临床滑膜炎的频率,并将患者和提供者报告的结果测量指标与 MSUS 滑膜炎相关联。
JIA 患者的活跃关节计数(AJC)>4,在基线和 3 个月时进行 42 关节 MSUS。获得 B 模式和功率多普勒图像,并对每个 42 个关节进行评分(范围 0-3)。评估的结果包括医生对疾病活动的总体评估(PhGA)、患者对疾病活动的总体评估(PtGA)、患者疼痛、儿童健康评估问卷(C-HAQ)和 AJC。亚临床滑膜炎定义为仅通过 MSUS 检测到的滑膜炎。使用广义估计方程来检验临床关节炎(阳性/阴性)与亚临床滑膜炎(阳性/阴性)之间的关系。计算 Spearman 相关系数(r)来确定 MSUS 滑膜炎与患者和医生报告的结果之间的关联。
在 30 名患者中,30%的关节检测到亚临床滑膜炎。手指、手腕和膝关节的临床关节炎与这些关节的 MSUS 滑膜炎显著相关。PtGA 和 C-HAQ 与 MSUS 滑膜炎呈中度(r=0.44,P=0.014)至弱(r=0.37,P=0.045)相关性。MSUS 滑膜炎与 PhGA 之间存在统计学上显著的强相关性(r=0.61,P=0.001),但与 AJC 仅存在弱相关性(r=0.37,P=0.048)在随访时。
在本 JIA 患者队列中,经常观察到亚临床滑膜炎。MSUS 滑膜炎与患者和提供者报告的结果之间的相关性适中至良好,这表明 MSUS 评估了一个不同的、可能更客观的、不确定的领域,而不是由传统的 JIA 结果测量来确定。