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| 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. | 超声影像对2010 ACR/EULAR RA分类标准的影响: 结合两种不同的受累关节灰阶滑膜炎超声定义的分类标准 Nakagomi D, et al. ACR 2011. Present No: 179. 背景 / 目的 : 2010 ACR/EULAR 类风湿性关节炎(RA)的分类标准指可以使用新的成像技术,如超声（US）。然而,US对RA分类标准的影响以及以此为目的的US滑膜炎定义的优化尚未得到评价。因此,本研究的目是确定US检测的滑膜炎对2010 ACR/EULAE RA分类标准的影响。 方法 : 使用LOGIQ E9 (GE医疗集团)、Aplio XG(东芝医疗系统)或Avius(日立医疗公司)仪器, 对疑诊RA的患者进行超声检查。除髋关节以外，检测2010 ACR/EULAR标准中的所有关节，灰阶滑膜炎（GS）和能量多普勒信号(PD)都进行半定量评分(0 - 3)。根据本研究人群US阳性发生率,US滑膜炎初步定义为GS > 0和/或PD > 0(轻度-GS定义)或GS > 1和/或PD > 0(中度-GS定义)。比较临床符合 ACR /EULAR标准(CL-RA)的患者数与US滑膜炎替代关节受累标准（US-RA）的患者数。 结果 : 共纳入1 17例患者。平均年龄为52.1岁,25例(21.4%)为男性,平均起病时间为6个月。类风湿因子抗体和anti-CCP阳性率分别为56例(47.9%)he 41例(35.4%)。 应用两种US-滑膜炎定义，临床和US检测的差别常见于腕和膝关节。CL-RA(轻度-GS定义)和/或US-RA患者例数分别为: 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定义)和/或US-RA患者例数分别为: 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)。 结论 :结果表明, 应用不同的US滑膜炎定义，结合US 的ACR /EULARRA标准可以改变19.6 - 22.2%的患者诊断。为了进一步验证US-滑膜炎在诊断RA中的益处和优化，本研究人群的纵向评估正在进行中。 |
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