Song Yeohan, Kirsch Gabriel, Jarjour Wael
Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
Division of Rheumatology and Immunology, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA.
J Pers Med. 2023 Apr 28;13(5):763. doi: 10.3390/jpm13050763.
Systemic lupus erythematosus (SLE) is a complex autoimmune condition with varied clinical presentations, and musculoskeletal pain is one of the most commonly associated symptoms. However, fibromyalgia (FM) is a prevalent co-existing condition in SLE patients that can also cause widespread pain, and in patients with both conditions, it is often difficult to distinguish the underlying cause of musculoskeletal pain and provide optimal therapy.
A retrospective cohort study was conducted including all adult SLE patients who received musculoskeletal ultrasound (US) examinations for joint pain at the Ohio State University Wexner Medical Center between 1 July 2012, and 30 June 2022. Binary and multiple logistic regression analyses were performed to determine predictors of US-detected inflammatory arthritis as well as improved musculoskeletal pain.
A total of 31 of 72 SLE patients (43.1%) had a co-existing diagnosis of FM. In binary logistic regression, a co-existing diagnosis of FM was not significantly associated with US-detected inflammatory arthritis. In multiple logistic regression analysis, clinically detected synovitis was significantly associated with US-detected inflammatory arthritis (aOR, 142.35, < 0.01), and there was also a weak association with erythrocyte sedimentation rate (ESR) (aOR 1.04, = 0.05). In separate multiple logistic regression analysis, US-guided intra-articular steroid injection was the only predictor of improved joint pain at follow-up visit (aOR 18.43, < 0.001).
Musculoskeletal US can be an effective modality to detect inflammatory arthritis as well as to guide targeted intra-articular steroid injection to alleviate joint pain in SLE patients with or without FM.
系统性红斑狼疮（SLE）是一种临床表现多样的复杂自身免疫性疾病，肌肉骨骼疼痛是最常见的相关症状之一。然而，纤维肌痛（FM）是SLE患者中普遍存在的共存疾病，也可导致广泛疼痛，对于同时患有这两种疾病的患者，往往难以区分肌肉骨骼疼痛的潜在原因并提供最佳治疗。
进行了一项回顾性队列研究，纳入2012年7月1日至2022年6月30日期间在俄亥俄州立大学韦克斯纳医学中心因关节疼痛接受肌肉骨骼超声（US）检查的所有成年SLE患者。进行二元和多元逻辑回归分析，以确定超声检测到的炎症性关节炎以及肌肉骨骼疼痛改善的预测因素。
72例SLE患者中有31例（43.1%）同时诊断为FM。在二元逻辑回归中，FM的共存诊断与超声检测到的炎症性关节炎无显著相关性。在多元逻辑回归分析中，临床检测到的滑膜炎与超声检测到的炎症性关节炎显著相关（调整后比值比[aOR]为142.35，P<0.01），与红细胞沉降率（ESR）也有弱相关性（aOR为1.04，P=0.05）。在单独的多元逻辑回归分析中，超声引导下关节内注射类固醇是随访时关节疼痛改善的唯一预测因素（aOR为18.43，P<0.001）。
肌肉骨骼超声可以是检测炎症性关节炎以及指导有或无FM的SLE患者进行靶向关节内类固醇注射以减轻关节疼痛的有效方法。
