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[2011] [THU0307] VALIDATION OF THE
NEW ACR/EULAR REMISSION CRITERIA IN RHEUMATOID ARTHRITIS PATIENTS
USING POWER DOPPLER ULTRASONOGRAPHY AS A GOLD
STANDARD
A. Balsa, E. de Miguel, L. Lojo, C. Castillo, D. Peiteado, C.
Plasencia, E. Martín-Mola Rheumatology Unit, Hospital Universitario
La Paz, Madrid, Spain
Background: In recent years, remission has emerged as the
treatment aim for patients with RA, however, the accuracy of the
criteria used to define remission in clinical practice is not
sufficient as joint damage may progress in patients considered to
be in clinical remission. Recently two new definitions of remission
have been proposed by American College of Rheumatology and the
European League against Rheumatism 1: When scores on the following
measures are all ≤1: tender joint count, swollen joint count, CRP
(in mg/dL) and patient global assessment (0-10 scale), or 2: when
SDAI ≤3.3.
Objectives: To investigate the accuracy and clinical utility
of these two new definitions of remission in classifying rheumatoid
arthritis (RA) patients who are in remission using the absence of
inflammatory activity detected by ultrasound (US) as the gold
standard.
Methods: This study evaluated a cohort of 100 patients with
RA classified as being in clinical remission by their attending
rheumatologist using subjective clinical judgment. Patients
underwent a complete clinical and laboratory assessment of disease
activity using standard core set measures which allow to calculate
disease activity scores. US examination of 42 joints was performed
in mode B and Power Doppler (PD) and we consider ''US remission''
as the absence of joints with PD signal, which reflects active
synovial vascularization.
Results: Synovial hypertrophy (SH) and PD were absent in 4
(4%) and 57 (57%) patients, respectively; however, if only the 28
joints of the reduced articular index had been examined, seven and
six additional patients would have been misclassified as lacking SH
or PD, respectively.
Forty three (43%) patients were in remission according to SDAI and
51 (51%) when the Boolean based definition was used, of whom 32
(74,4%) and 36 (70.6%) were un US remission respectively. In
clinical practice it is also important to know how many patients
have been incorrectly classified, 53 (53%) and 49 (49%) patients
did not fulfil the new remission criteria, however 25 (43.9%) and
21 (42.9%) respectively were in US remission status.
We calculated the sensitivity, specificity, positive and negative
Likelihood Ratio (LR) for being in remission using the two
definitions as shown in Table.
Conclusions: Our results suggest that new remission
definitions allow a correct classification of remission in many
patients, however, the accuracy is not good enough and more
sensitive image techniques will help in making clinical
decisions.
Citation: Ann Rheum Dis 2011;70(Suppl3):280
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以多普勒超声为金标准验证新版RA缓解定义
Balsa A, et al. EULAR 2011. Present
No: THU0307.
背景:
近年来，缓解已成为类风湿关节炎(RA)的治疗目标。然而在临床实践中，由于缓解标准的定义还不够精准，所谓已获临床缓解的病人仍有关节破坏进展。最近ACR与EULAR共同推荐了有关缓解的两个新定义。其一是以下四个参数值均小于或等于1：压痛关节计数，肿胀关节计数，CRP(mg/dL)和患者对病情的整体评价(0~10比例尺)。其二是SDAI≤3.3。
目的:
以超声(US)作为金标准，探讨这两个RA缓解新定义的准确性记忆临床应用价值。
方法:
本研究纳入了由风湿病医生通过临床检查而判为缓解的100例RA病人。按照标准参数组的规定，对患者进行完整的临床和实验室检查以评估疾病活动度，并计算疾病活动评分。采用B超和能量多普勒超声(PD)检查42个关节。我们将超声缓解定义为关节内无PD信号。PD信号反映了活跃的滑膜血管增生。
结果:
未见滑膜增生(SH)和PD信号阴性的病例数分别为4例(4%)和57例(57%)。然而，如果仅检查28关节，则分别有7例和6例额外的病人被误判为SH阴性和PD阴性。
获SDAI缓解的有43例(43%)患者，而基于布尔式缓解定义的有51例(51%)，他们中间分别有32例(4%)和36例(70.6%)达到超声缓解。在临床实践中同样重要的是要知道有多少病人被错分类。不符合新版缓解标准的分别有53例
(53%)和49例(49%)，然而他们中间达到超声缓解的有23例(43.9%)和21例(42.9%)。
我们估算了两种缓解定义的敏感性、特异性、阳性及阴性似然比(LR)，结果请参见相应表格。
结论:
本研究结果表明新版缓解定义能正确判别众多缓解病人，但准确度尚不足够好，临床需要更敏感的影像学技术以将帮助临床决策。
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