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类风湿关节炎临床缓解与超声影像学缓解的比较研究

A comparison between traditional and modified composite remission scores and ultrasound imaging assessments in remission patients with rheumatoid arthritis

摘要:

目的 比较类风湿关节炎(RA)临床缓解与超声影像学缓解的差异,探讨超声影像学在评估RA病情活动和在目标治疗中的价值.方法 选择严格随访且28个关节疾病活动评分-红细胞沉降率(DAS28-ESR)≤2.6持续至少3个月的RA患者,按不同的缓解标准划分成缓解和未缓解组,比较各自的缓解率.对所有患者行超声检查,评价临床缓解患者的超声影像学滑膜炎活动情况;同时,对患者的疾病活动度进行回顾性分析.采用Mann-Whitney U检验、x2检验及重复测量的多因素方差分析.结果 共48例患者纳入研究并行超声检查,达到美国风湿病学会(ACR)缓解标准的37例(77%),达到2010年ACR/欧洲抗风湿联盟(EULAR)缓解标准中的简化疾病活动指数(SDAI)缓解29例(60%),布尔定义缓解标准32例(67%).比较SDAI缓解组与未缓解组的超声表现,缓解组超声病情活动与未达缓解组相比并没有明显改善[灰度等级评分(GS),P=0.38;多普勒评分(PD),P=0.32].SDAI缓解组仍有23例(79%)患者存在GS和(或)PD活动,其影像学缓解率与未达SDAI缓解组相比差异无统计学意义(P=0.29).将影像学数据纳入达标治疗的参考依据时,即在患者达到临床缓解而未达到影像学缓解时继续强化治疗尽可能地减少影像学活动,患者获得的临床持续缓解时间更持久(P<0.01).结论 使用更严格的临床缓解标准可以减少残留的炎症活动,但超声病情活动并没有明显减少.综合临床体格检查及包含超声在内的影像学指标,对疾病活动状态进行综合评估并指导治疗,有助于实现真正的严格控制,减缓疾病进程.

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abstracts:

Objective This study is aimed to assess the accuracy of clinical measurement of remission and investigate the association between clinical remission and the ultrasound imaging assessment of synovitis and infla'mation and to explore the value of ultrasound imaging in the evaluation of disease activity in the tight control of rheumatoid arthritis (RA).Methods RA patients with a disease activity score in 28 joints (DAS28-ESR) ≤2.6 for at least 3 months were stratified-using a standard and more stringent DAS28 and simplified disease activity index (SDAI) remission thresholds and the corresponding clinical and ultrasound imaging measures of synovitis were recorded.In addition,a retrospective analysis of disease activity in patients was carried out.Mann-Whitney U test,x2 test and multi-factor analysis of variance of repeated measurements were used for statistical analysis.Results A total of 48 cases were recruited.Thirty-seven cases (77%) met the ACR remission criteria,29 cases (60%) fulfilled the SDAI remission criteria,and 32 (67%) cases reached 2010 ACR/EULAR Boolean-based definition of remission criteria.There was no significant differences on imaging disease activity between SDAI remission patients and those who were not in remission (GS score,P=0.38; PD score,P=0.32).Seventy-nine percent patients in SDAI remission had GS and/or PD activity,but the difference was not statistically different when compared with patients who did not reach SDAI remission (P=0.29).Sustainable remission obtained in patients who also had achieved image remission could have longer remission time (P<0.01) Conclusion Using more stringent clinical remission criteria could help in reducing residual inflammatory activity of,but ultrasound PD activities may not be significantly reduced.Integrated clinical indicators such as physical examination and imaging tools such as ultrasound can provide more accurate assessment of disease activity and could be used to guide treatment to achieve "true"remission.

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