在一项持续进行的手部关节痛评估计划中检测系统性自身免疫性疾病。与炎症性和非炎症性关节病的比较分析。

Detection of systemic autoimmune diseases in an ongoing assessment program for hand arthralgias. A comparative analysis with inflammatory and non-inflammatory arthropathies.

机构信息

Rheumatology Unit, Hospital Italiano de La Plata - Universidad Nacional de La Plata, La Plata, Argentina.

Consultorio Reumatología Buenos Aires (CREuBA) - Ciudad Autónoma de Buenos Aires, Ciudad Autonoma de Buenos Aires, Argentina.

出版信息

Int J Rheum Dis. 2024 Aug;27(8):e15292. doi: 10.1111/1756-185X.15292.

DOI:10.1111/1756-185X.15292

PMID:39166426

Abstract

INTRODUCTION

Arthralgias are prevalent in systemic autoimmune rheumatic diseases (SARD), emphasizing the need for early recognition. This study aimed to estimate SARD frequency and compare clinical, laboratory, and imaging findings among SARD, non-inflammatory arthralgia (NIA), and RA in patients with hand arthralgias.

METHODS

A prospective evaluation program included individuals aged ≥18 with hand arthralgias. Baseline assessments covered clinical, laboratory, ultrasound, and radiography. Follow-up diagnoses categorized patients into SARD, NIA, and RA groups. Comparison between groups was performed using parametric and non-parametric tests. Two multivariate logistic regression analyzes were performed using the final diagnosis of SARD as the dependent variable (NIA and RA). ROC curves were calculated in those variables that presented an independent association in the multivariate analysis.

RESULTS

Among 1053 patients, 9.6% were SARD (SLE 47%). Comparing SARD with NIA revealed higher CRP levels, power Doppler, less rhizarthrosis in ultrasound, and more ANA positivity in SARD patients. Distinct differences were observed between SARD and RA patients in terms of pain levels, swollen joints, metacarpophalangeal involvement and morning symptoms. Diagnostic markers demonstrated specific sensitivities and specificities: ANA for SARD versus NIA (82%, 34%), US not finding rhizarthrosis for SARD versus NIA (66%, 85%), CRP (cut-off >2.5 mg/L) sensitivity 52%, specificity 60%, AUC 0.62, RA antibodies (RF, 11 IU/mL) sensitivity 76%, specificity 74%, AUC 0.8, ACPA (1.25) sensitivity 50%, specificity 98%, AUC 0.7, ANA+ sensitivity 95%, specificity 32%, AUC 0.7, and US absence of synovitis sensitivity 82%, specificity 34%, AUC 0.75.

CONCLUSION

This study highlights distinct clinical, laboratory, and imaging features differentiating SARD-related hand arthralgia from non-SARD hand arthralgia and RA.

摘要

简介

关节痛在系统性自身免疫性风湿病（SARD）中很常见，这强调了早期识别的必要性。本研究旨在评估 SARD 的频率，并比较手关节痛患者中 SARD、非炎症性关节痛（NIA）和 RA 的临床、实验室和影像学表现。

方法

一项前瞻性评估计划纳入了年龄≥18 岁且有手关节痛的个体。基线评估包括临床、实验室、超声和 X 线摄影。随访诊断将患者分为 SARD、NIA 和 RA 组。使用参数和非参数检验比较组间差异。使用 SARD 的最终诊断作为因变量（NIA 和 RA）进行了两项多元逻辑回归分析。在多元分析中具有独立相关性的变量中计算 ROC 曲线。

结果

在 1053 名患者中，9.6%为 SARD（SLE 占 47%）。与 NIA 相比，SARD 患者的 CRP 水平更高，超声显示的功率多普勒更高，手类风湿关节炎的 rhizarthrosis 较少，ANA 阳性率更高。SARD 与 RA 患者在疼痛程度、肿胀关节、掌指关节受累和晨僵症状方面存在明显差异。诊断标志物显示出特定的敏感性和特异性：ANA 对 SARD 与 NIA（82%，34%）、US 未发现 rhizarthrosis 对 SARD 与 NIA（66%，85%）、CRP（截断值>2.5mg/L）的敏感性为 52%，特异性为 60%，AUC 为 0.62，抗 RA 抗体（RF，11IU/mL）的敏感性为 76%，特异性为 74%，AUC 为 0.8，ACPA（1.25）的敏感性为 50%，特异性为 98%，AUC 为 0.7，ANA+的敏感性为 95%，特异性为 32%，AUC 为 0.7，US 未见滑膜炎的敏感性为 82%，特异性为 34%，AUC 为 0.75。