Mahmoud Khaled, Md Yusof Md Yuzaiful, Teh Lee Suan, Khan Shah, Yee Chee-Seng, D'Cruz David, Isenberg David, Ciurtin Coziana, Conaghan Philip G, Emery Paul, Edwards Christopher J, Hensor Elizabeth M A, Vital Edward M
NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
Rheumatology (Oxford). 2025 Jun 1;64(6):3556-3562. doi: 10.1093/rheumatology/keae695.
To propose a new definition for SLEDAI arthritis informed by imaging.
We performed a planned secondary analysis of observational data from a multicentre study evaluating SLE patients with inflammatory joint pain (swelling not required) using various clinical instruments, laboratory tests and ultrasound. For SLEDAI arthritis, assessors (blinded to ultrasound) were asked which of the glossary terms for arthritis in any version of the SLEDAI drove their decision to score for arthritis. These definitions were tested against ultrasound and other clinical variables. ROC analysis was used to test optimal joint count thresholds.
A total of 78/133 patients had arthritis on SLEDAI-2K. In 21/78, clinician-observed swelling was not a reason for scoring (tenderness: 16/21; reported swelling between visits: 4/21; both of these: 1/21). No patient was scored for warmth or erythema alone. In total, 57 (73.1%) patients were scored for SLEDAI arthritis due to observed swelling, 90% had abnormal ultrasound (PPV = 90%, 95%CI: 79, 94). Of 21 patients with SLEDAI arthritis without observed swelling, 48% had abnormal ultrasound (PPV: 48%, 95%CI: 31, 67). Patients with SLEDAI arthritis with swelling had higher ESR, physician MSK-VAS, patient early morning stiffness (EMS)-VAS and IgG compared with other patients. Optimal sensitivity and specificity for ultrasound synovitis was 1 swollen joint using Youden's criteria.
Our data suggest that the definition of arthritis in SLEDAI be modified to: 'Inflammatory musculoskeletal pain (symmetrical small joint distribution), with one or more clinically swollen joints witnessed on examination, that is not explained by another arthropathy'.
提出一个基于影像学的系统性红斑狼疮疾病活动指数（SLEDAI）关节炎新定义。
我们对一项多中心研究的观察性数据进行了计划中的二次分析，该研究使用各种临床工具、实验室检查和超声评估患有炎性关节疼痛（无需肿胀）的SLE患者。对于SLEDAI关节炎，评估者（对超声检查结果不知情）被问及SLEDAI任何版本中关节炎的词汇术语中，哪些促使他们决定对关节炎进行评分。这些定义与超声检查及其他临床变量进行了对比测试。采用ROC分析来测试最佳关节计数阈值。
在133例患者中，共有78例根据SLEDAI - 2K标准被判定患有关节炎。在这78例患者中的21例里，临床医生观察到的肿胀并非评分的依据（压痛：16/21；就诊期间报告的肿胀：4/21；两者皆有：1/21）。没有患者仅因发热或红斑而被评分。总体而言，57例（73.1%）患者因观察到肿胀而被判定为SLEDAI关节炎，其中90%的患者超声检查异常（阳性预测值 = 90%，95%置信区间：79, 94）。在21例未观察到肿胀但被判定为SLEDAI关节炎的患者中，48%的患者超声检查异常（阳性预测值：48%，95%置信区间：31, 67）。与其他患者相比，被判定为SLEDAI关节炎且有肿胀的患者血沉（ESR）、医生肌肉骨骼视觉模拟评分（MSK - VAS）、患者晨僵（EMS）视觉模拟评分和免疫球蛋白G（IgG）更高。根据约登标准，超声滑膜炎的最佳敏感性和特异性为1个肿胀关节。
我们的数据表明，SLEDAI中关节炎的定义应修改为：“炎性肌肉骨骼疼痛（对称性小关节分布），检查时发现一个或多个临床可见的肿胀关节，且不能用其他关节病解释”。
