能量多普勒超声监测TNF拮抗剂治疗RA的疗效

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Arthritis Rheum. 2008 Aug;58(8):2248-56.

Power Doppler ultrasonographic monitoring of response to anti-tumor necrosis factor therapy in patients with rheumatoid arthritis.

Naredo E, Möller I, Cruz A, Carmona L, Garrido J.

Source

Hospital Severo Ochoa, Madrid, Spain. enaredo@ser.es <enaredo@ser.es>

Abstract

OBJECTIVE:

To evaluate the validity, responsiveness, and predictive value of power Doppler ultrasonography (PDUS) monitoring of response to tumor necrosis factor (TNF) blocking agents in rheumatoid arthritis (RA).

METHODS:

Three hundred sixty-seven RA patients were prospectively recruited at 25 Spanish centers; complete clinical, laboratory, and PDUS data were obtained on 278 patients. The patients underwent clinical, laboratory, and PDUS assessment at baseline and after 1, 3, 6, and 12 months of anti-TNF treatment, and radiographic assessment of the hands and feet at baseline and 12 months. The Disease Activity Score in 28 joints (DAS28) was recorded at each visit. PDUS examination included 86 intraarticular and periarticular sites in 28 joints. US synovial fluid (SF), synovial hypertrophy (SH), and PD signal were scored in all synovial sites. US count and index for SF, SH, and PD signal were obtained. Sensitivity to change of the PDUS variables was assessed by estimating the smallest detectable difference (SDD) from the intraobserver variability.

RESULTS:

A significant parallel improvement in DAS28 and PDUS parameters was found at followup assessment (P < 0.0005 for within-subject between-visit changes). The SDD for PDUS parameters was lower than the mean changes throughout followup. Time-integrated values of US joint count for PD signal and rheumatoid factor (RF) showed predictive value in relation to progression of radiographic erosion (R = 0.64), and time-integrated values of US joint count for PD signal, RF, and erythrocyte sedimentation rate were predictors of progression of the total radiographic score (R = 0.59).

CONCLUSION:

These findings indicate that PDUS is a valid method for monitoring response to anti-TNF therapy in RA; results obtained by PDUS are reproducible and sensitive to change. PDUS findings may have predictive value in relation to radiologic outcome.

PMID: 18668537

能量多普勒超声监测TNF拮抗剂治疗RA的疗效

Naredo E, et al. Arthritis Rheum. 2008 ;58:2248-56. (PMID: 18668537)

目的：评估能量多普勒超声(PDUS)监测TNF拮抗剂疗效的有效性、灵敏度和预测价值。

方法：为进行此项前瞻性研究，25个西班牙医学中心共纳入367例RA患者，其中有完整临床、实验室和PDUS数据的共计278例。临床、实验室和PDUS评估在基线和抗TNF治疗1、3、6和12个月时进行，手足放射学摄片评估是在基线和治疗12个月时进行。每次随访时均记录DAS28。PDUS检查针对28个关节的86个关节内和关节周围部位。超声检查每一个患者，并记录滑膜液(SF)、滑膜增厚(SH)以及PD信号。通过评估同一观察者内部最小可分辨差异(SDD)的不同，从而评判PDUS参数对于变化的敏感性。

结果：随访结果发现DAS28改善与PDUS改善之间有显著平行性(同一受试者两次随访之间的变化, P<0.0005)。PDUS参数的SDD低于随访过程中的均值。PD信号(US关节计数的时间整合值)和RF对于骨侵蚀放射学进展有预测作用(R = 0.64)，而PD信号(US关节计数的时间整合值) 、RF以及ESR对于放射学总评分进展而言有预测价值(R = 0.59)。