临床荟萃

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肌骨超声检查对临床缓解类风湿关节炎患者疾病复发的预测价值

  

  1. 1.北京市顺义区医院 风湿免疫科,北京 101300;2.北京大学第一医院 风湿免疫科,北京 100034
  • 出版日期:2019-09-20 发布日期:2019-11-19
  • 通讯作者: 赵学刚, Email:zhaoxg101300@163.com
  • 基金资助:
    北京市顺义区临床重点专科建设项目支持——类风湿关节炎临床诊治相关研究(2015QJZ07)

Predictive value of musculoskeletal ultrasonography in clinical remission of  disease recurrence in patients with rheumatoid arthritis

  1. 1.Department of Rheumatology and Immunology, Shunyi District Hospital, Beijing 101300, China;
    2.Department of Rheumatology and Immunology, First Hospital of Peking University, Beijing 100034, China
  • Online:2019-09-20 Published:2019-11-19
  • Contact: Corresponding author: Zhao Xuegang, Email:zhaoxg101300@163.com

摘要: 目的  探讨类风湿关节炎(RA)复发的相关因素及肌骨超声表现与疾病复发的相关性。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。记录患者的临床资料及28个关节肌骨超声影像结果。保持原有治疗不变的基础上,观察患者后3个月的病情变化情况,将疾病复发(DAS28ESR>2.6)的患者定义为疾病复发组,将疾病持续缓解的患者(DAS28ESR≤2.6)定义为持续缓解组,比较两组各临床指标及超声影像的差异, 应用多因素logistic回归进行相关因素分析。结果  共63例患者纳入研究并行28个关节肌骨超声检查。3个月内疾病复发26例(41.3%),持续缓解37例(58.7%)。疾病复发组在亚临床滑膜炎检出率方面明显高于持续缓解组,在深度缓解率(DAS28ESR<1.6)方面低于持续缓解组。亚临床滑膜炎是RA复发独立危险因素,而深度缓解是RA复发的保护因素。结论  RA复发与高疾病活动度及亚临床滑膜炎有关。

关键词: 关节炎, 类风湿, 复发, 肌骨超声, 临床缓解

Abstract: Objective  To investigate the relapses of rheumatoid arthritis(RA) and the correlation with musculoskeletal ultrasound.Methods  A total of 63 RA patients whose erythrocyte sedimentation rate(DAS28ESR) were continuously ≤2.6  were followed up strictly for at least 3 months. The clinical data and ultrasound results of 28 articular musculoskeletal specimens were recorded.With the persistence of the original treatment, patients' 3month clinical information were collected.Patients with disease recurrence (DAS28ESR) were divided into the disease recurrence group, patients with disease continuous remission (DAS28ESR≤2.6)  were divided into the continuous remission group. The differences of clinical indexes and ultrasonography images between disease recurrence group and continuous remission group were compared  by logistic regression analysis. Results  A total of 26 cases with  disease  recurrence (41.3%)  and 37 cases with  continuous remission(58.7%) were observed within 3 months. Detection rate of subclinical synovitis of   disease recurrence group was obviously higher than that of  continuous  remission group,while it  was lower in depth remission rate(DAS28ESR<1.6). Subclinical synovitis was an independent risk factor for the recurrence of RA, while  the deep remission was a protective factor for the recurrence of RA. Conclusion  The recurrence of RA was related to high disease activity and subclinical synovitis.

Key words: arthritis, , rheumatoid, recurrence, musculoskeletal ultrasonography, clinical remission