Rhumatologie, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France
University of Montpellier, Montpellier, Occitanie, France.
RMD Open. 2024 Sep 17;10(3):e004269. doi: 10.1136/rmdopen-2024-004269.
(1) To assess the progression of ultrasonography-detected synovitis in a cohort of patients with rheumatoid arthritis (RA) in remission during 1 year of follow-up (2) to evaluate the ability of consecutive examinations of ultrasonography to predict relapse (R) or radiographic progression (RP) at 1 year.
Patients with RA (2010 American College of Rheumatology-European Alliance of Associations for Rheumatology criteria) in clinical remission (Disease Activity Score in 28 joints (DAS28)<2.6 without clinically active synovitis) were included. An independent investigator performed ultrasonography every 3 months for 1 year. Ultrasonography-detected synovitis was defined as power Doppler-positive ultrasonography synovitis (PDUS) grade ≥1 in at least one joint. PDUS at ≥2 consecutive visits during the follow-up defined persistent PDUS. An increase of ≥1 point in the modified total Sharp score defined RP. An increase in DAS28-C-reactive protein (CRP)>0.6 or DAS28-CRP>3.2 and any modification of disease-modifying anti-rheumatic drugs or glucocorticoids defined relapse. Univariate and multivariate Cox regression analyses were used to evaluate factors associated with R/RP at 1 year.
PDUS was detected in 75 (65.2%), 66, 60, 46 and 29 of the 115 patients with RA at baseline and at months 3, 6, 9 and 12, respectively. 58 (50.4%) patients exhibited persistent PDUS. After 1 year, 22/85 (25.9%) experienced relapse and 12 (14.1%) showed RP. On multivariate analysis, factors predicting R/RP at 1 year were persistent PDUS (HR=2.98, p=0.014) and an increase in DAS28-CRP level at the visit before relapse (HR=4.36, p=0.004).
Persistent PDUS during follow-up, rather than at baseline, predicted worse outcome at 1 year and requires careful monitoring.
(1) 在 1 年的随访中，评估处于缓解期的类风湿关节炎（RA）患者的超声检查到的滑膜炎进展情况；(2) 评估连续超声检查预测 1 年内复发（R）或放射学进展（RP）的能力。
纳入符合 2010 年美国风湿病学会-欧洲抗风湿病联盟（ACR/EULAR）标准的处于临床缓解期（28 关节疾病活动度评分（DAS28）<2.6 且无临床活动性滑膜炎）的 RA 患者。由一位独立的研究者在 1 年内每 3 个月进行一次超声检查。超声检查到的滑膜炎定义为至少 1 个关节的能量多普勒阳性超声滑膜炎（PDUS）分级≥1。在随访期间至少 2 次连续就诊时 PDUS 持续存在定义为持续性 PDUS。改良总Sharp 评分增加≥1 定义为 RP。DAS28-C 反应蛋白（CRP）增加≥0.6 或 DAS28-CRP 增加≥3.2 且改变疾病修饰抗风湿药物或糖皮质激素的定义为复发。采用单变量和多变量 Cox 回归分析来评估与 1 年内 R/RP 相关的因素。
115 例 RA 患者中有 75 例（65.2%）、66 例、60 例、46 例和 29 例分别在基线和就诊后 3、6、9 和 12 个月时检测到 PDUS。58 例（50.4%）患者出现持续性 PDUS。1 年后，22/85（25.9%）例患者复发，12 例（14.1%）患者出现 RP。多变量分析显示，预测 1 年内 R/RP 的因素为持续性 PDUS（HR=2.98，p=0.014）和复发前就诊时 DAS28-CRP 水平的升高（HR=4.36，p=0.004）。
随访期间而非基线时的持续性 PDUS 预测 1 年内预后更差，需要密切监测。
