预测高危人群中的炎性关节炎：风险分层评分的制定

Predicting Inflammatory Arthritis in At-Risk Persons: Development of Scores for Risk Stratification.

作者信息

Duquenne Laurence, Hensor Elizabeth M, Wilson Michelle, Garcia-Montoya Leticia, Nam Jacqueline L, Wu Jianhua, Harnden Kate, Anioke Innocent Chidi, Di Matteo Andrea, Chowdhury Rahaymin, Sidhu Navkiran, Ponchel Frederique, Mankia Kulveer, Emery Paul

机构信息

Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, Leeds, United Kingdom (L.D., E.M.H., M.W., L.G., J.L.N., K.H., A.D.M., R.C., N.S., K.M., P.E.).

Leeds Institute for Data Analytics, University of Leeds, Leeds, and Wolfson Institute of Population Health, Queen Mary University of London, London, United Kingdom (J.W.).

出版信息

Ann Intern Med. 2023 Aug;176(8):1027-1036. doi: 10.7326/M23-0272. Epub 2023 Aug 1.

DOI:10.7326/M23-0272

PMID:37523695

Abstract

BACKGROUND

Inflammatory arthritis (IA) is an immune-related condition defined by the presence of clinical synovitis. Its most common form is rheumatoid arthritis.

OBJECTIVE

To develop scores for predicting IA in at-risk persons using multidimensional biomarkers.

DESIGN

Prospective observational cohort study.

SETTING

Single-center, Leeds, United Kingdom.

PARTICIPANTS

Persons with new musculoskeletal symptoms, a positive test result for anticitrullinated protein antibodies, and no clinical synovitis and followed for 48 weeks or more or until IA occurred.

MEASUREMENTS

A simple score was developed using logistic regression, and a comprehensive score was developed using the least absolute shrinkage and selection operator Cox proportional hazards regression. Internal validation with bootstrapping was estimated, and a decision curve analysis was done.

RESULTS

Of 455 participants, 32.5% (148 of 455) developed IA, and 15.4% (70 of 455) developed it within 1 year. The simple score identified 249 low-risk participants with a false negative rate of 5% (and 206 high-risk participants with a false-positive rate of 72%). The comprehensive score identified 119 high-risk participants with a false-positive rate of 29% (and 336 low-risk participants with a false-negative rate of 19%); 40% of high-risk participants developed IA within 1 year and 71% within 5 years.

LIMITATIONS

External validation is required. Recruitment occurred over 13 years, with lower rates of IA in later years. There was geographic variation in laboratory testing and recruitment availability.

CONCLUSION

The simple score identified persons at low risk for IA who were less likely to need secondary care. The comprehensive score identified high-risk persons who could benefit from risk stratification and preventive measures. Both scores may be useful in clinical care and should also be useful in clinical trials.

PRIMARY FUNDING SOURCE

National Institute for Health and Care Research Leeds Biomedical Research Centre.

摘要

背景

炎症性关节炎（IA）是一种由临床滑膜炎定义的免疫相关疾病。其最常见的形式是类风湿关节炎。

目的

使用多维生物标志物制定预测高危人群患IA的评分。

设计

前瞻性观察队列研究。

地点

英国利兹的单中心。

参与者

有新的肌肉骨骼症状、抗瓜氨酸化蛋白抗体检测结果呈阳性且无临床滑膜炎，并随访48周或更长时间或直至发生IA的人群。

测量

使用逻辑回归制定简单评分，使用最小绝对收缩和选择算子Cox比例风险回归制定综合评分。估计了自展法的内部验证，并进行了决策曲线分析。

结果

455名参与者中，32.5%（455名中的148名）发生了IA，15.4%（455名中的70名）在1年内发生了IA。简单评分识别出249名低风险参与者，假阴性率为5%（以及206名高风险参与者，假阳性率为72%）。综合评分识别出119名高风险参与者，假阳性率为29%（以及336名低风险参与者，假阴性率为19%）；40%的高风险参与者在1年内发生了IA，71%在5年内发生了IA。