| 原文 | 譯文 |
| The Impact of Ultrasonography on the Classification of Rheumatoid Arthritis with 2010 ACR/EULAR Criteria: Ultrasound-Combined Classification with Two Different Definitions of Gray-Scale Synovitis for Joint Involvement Daiki Nakagomi , Kei Ikeda, Ayako Okubo, Taro Iwamoto, Yoshie Suzuki, Hiroaki Takatori, Kotaro Suzuki, Katsuhiko Takabayashi and Hiroshi Nakajima, Chiba University Hospital, Chiba, Japan Presentation Number: 179 Background/Purpose: 2010 ACR/EULAR rheumatoid arthritis (RA) classification criteria refer to the possible use of new imaging techniques such as ultrasonography (US). However, the impact of US on the classification of RA and the optimal US definition of synovitis for this purpose have not been fully assessed with comprehensive US scanning. Therefore, the purpose of this study is to determine the impact of US assessment for synovitis on the classification of RA with 2010 ACR/EULAR criteria. Method: Ultrasonography was performed in cases with possible diagnosis of RA using either LOGIQ E9 (GE Healthcare), Aplio XG (Toshiba Medical Systems) or Avius (Hitachi Medical Corporation).All joint regions included in 2010 ACR/EULAR criteria except hip joints were assessed, and gray scale synovitis (GS) and power Doppler signals (PD) were recorded for each joint with semi-quantitative score (0-3). According to the prevalence of US findings in this cohort, US-synovitis was preliminarily defined either as GS>0 and/or PD>0 (mild-GS definition) or as GS>1 and/or PD>0 (moderate-GS definition). The numbers of cases who clinically fulfilled the ACR/EULAR criteria (CL-RA) were compared with those who fulfilled the criteria after replacing the joint involvement with US synovitis (US-RA). Result: 117 cases were enrolled. The mean age was 52.1 year-old, 25 patients (21.4%) were male, and median duration of symptom was 6 months. Rheumatoid factor and anti-CCP antibody were positive in 56 cases (47.9%) and 41 cases (35.4%), respectively. The discrepancy between clinical and US assessments was frequent in wrists and knees with both US-synovitis definitions. The numbers of cases with CL-RA (mild-GS definition) and/or US-RA were 47 (40.2%) for CL-RA (+)/ US-RA (+), 12 (10.2%) for CL-RA (+)/ US-RA (-), 11 (9.4%) for CL-RA (-)/ US-RA (+), and 47 (40.2%) for CL-RA (-)/ US-RA (-), respectively (Table 1). On the other hand, the numbers of cases with CL-RA (moderate-GS definition) and/or US-RA were 56 (47.9%) for CL-RA (+)/ US-RA (+), 21 (17.9%) for CL-RA (+)/ US-RA (-), 5 (4.3%) for CL-RA (-)/ US-RA (+), and 35 (29.9%) for CL-RA (-)/ US-RA (-), respectively (Table 2). Conclusion: The result shows that the combined use of US may alter the RA classification with ACR/EULAR criteria in 19.6-22.2% of the patients assessed, depending on the definition of US-synovitis. In order to further validate the benefit and the optimal definition of US-synovitis in the diagnosis of RA, longitudinal assessment of this cohort is in progress. | 超聲影像對2010 ACR/EULAR RA分類标準的影響: 結合兩種不同的受累關節灰階滑膜炎超聲定義的分類标準 Nakagomi D, et al. ACR 2011. Present No: 179. 背景 / 目的 : 2010 ACR/EULAR 類風濕性關節炎(RA)的分類标準指可以使用新的成像技術,如超聲（US）。然而,US對RA分類标準的影響以及以此為目的的US滑膜炎定義的優化尚未得到評價。是以,本研究的目是确定US檢測的滑膜炎對2010 ACR/EULAE RA分類标準的影響。 方法 : 使用LOGIQ E9 (GE醫療集團)、Aplio XG(東芝醫療系統)或Avius(日立醫療公司)儀器, 對疑診RA的患者進行超聲檢查。除髋關節以外，檢測2010 ACR/EULAR标準中的所有關節，灰階滑膜炎（GS）和能量多普勒信号(PD)都進行半定量評分(0 - 3)。根據本研究人群US陽性發生率,US滑膜炎初步定義為GS > 0和/或PD > 0(輕度-GS定義)或GS > 1和/或PD > 0(中度-GS定義)。比較臨床符合 ACR /EULAR标準(CL-RA)的患者數與US滑膜炎替代關節受累标準（US-RA）的患者數。 結果 : 共納入1 17例患者。平均年齡為52.1歲,25例(21.4%)為男性,平均起病時間為6個月。類風濕因子抗體和anti-CCP陽性率分别為56例(47.9%)he 41例(35.4%)。 應用兩種US-滑膜炎定義，臨床和US檢測的差别常見于腕和膝關節。CL-RA(輕度-GS定義)和/或US-RA患者例數分别為: CL-RA(+)/ US-RA (+) 47例(40.2%), CL-RA(+)/ US-RA(-) 12例(10.2%), CL-RA(-)/ US-RA(+) 11例(9.4%),CL-RA(-)/ US-RA(-)47例(40.2%),(表1)。另一方面, CL-RA(中度-GS定義)和/或US-RA患者例數分别為: CL-RA(+)/ US-RA(+) 56例(47.9%), CL-RA(+)/ US-RA(-)21例(17.9%), CL-RA(-)/ US-RA(+)5例(4.3%), CL-RA(-)/ US-RA(-) 35例(29.9%),(表2)。 結論 :結果表明, 應用不同的US滑膜炎定義，結合US 的ACR /EULARRA标準可以改變19.6 - 22.2%的患者診斷。為了進一步驗證US-滑膜炎在診斷RA中的益處和優化，本研究人群的縱向評估正在進行中。 |
轉載于:https://www.cnblogs.com/T2T4RD/archive/2011/12/09/5464233.html