RA超声骨侵蚀的特异性

Zayat AS, et al. Ann Rheum Dis. 2015May;74(5):897-903.

原文

The specificity of ultrasound-detected bone erosions for rheumatoid arthritis.

Background: Bone erosion is one of thehallmarks of rheumatoid arthritis (RA), but also seen in other rheumaticdiseases. The objective of this study was to determine the specificity ofultrasound (US)-detected bone erosions (including their size) in the classical‘target’ joints for RA.

Methods: Patients fulfilling thediagnostic criteria for RA, psoriatic arthritis, osteoarthritis or gout inaddition to healthy volunteers were included. The following areas were examinedby US: distal radius and ulna, 2nd, 3rd and 5th metacarpophalangeal(MCP), 2nd and 3rd proximal interphalangeal (PIP) and 1st and 5thmetatarsophalangeal (MTP) joints. All joints were scanned in four quadrantsusing both semiquantitative(0–3) and quantitative (erosion diameter) scoring systems.

Results: 310 subjects were recruited. Theinter-reader and intrareaderagreements were good to excellent. US-detected bone erosions were more frequentbut not specific for RA (specificity 32.9% and sensitivity 91.4%). The presenceof erosions with semiquantitativescore ≥2 in four target joints (2nd, 5rd MCP, 5th MTP joints and distal ulna)was highly specific for RA (specificity 97.9% and sensitivity 41.4%). Size oferosion was found to be associated with RA. Erosions of any size in the 5th MTPjoint were both specific and sensitive for RA (specificity 85.4% andsensitivity 68.6%).

Conclusions: The presence of US-detectederosions is not specific for RA. However, larger erosions in selected joints,especially 2nd and 5rd MCP, 5th MTP joints and distal ulna, were highlyspecific for and predictive of RA.

译文

背景: 骨侵蚀是RA的标志之一, 同时也见于在其他风湿性疾病中。本研究的目的是确定超声检测在RA的经典“目标” 关节中特异性（含大小）。

方法: 入组患者为符合诊断标准的RA、PsA、OA和痛风患者,此外还有健康的志愿者。超声检查以下关节: 尺桡骨远端, 第2、第3和第5掌指关节（MCP）, 第2和第3近端指间关节（PIP）, 以及第1和第5跖趾关节（MTP）。所有关节均采用四象限超声扫描, 使用半定量（0-3）和定量（侵蚀直径） 评分系统。

结果:共纳入310名病例。阅片者自身和不同阅片者之间的评判一致性为良好至极好。超声比X线发现更多RA骨侵蚀但不具特异性（敏感性91.4％, 特异性32.9％）。四个目标关节（第2、第5 MCP、第5 MTP和尺骨远端）存在骨侵蚀（ 半定量评分≥2）对于诊断RA具有较高特异性（敏感性41.4 ％, 特异性97.9％）。本研究发现骨侵蚀的大小与RA具有相关性。第5跖趾关节出现骨侵蚀(不论大小如何)对于RA诊断有较好的敏感性和特异性(敏感性68.6％, 特异性85.4％)。

讨论: 超声发现骨侵蚀对于RA诊断并不具有特异性。然而, 对于特定关节出现较大的骨侵蚀, 尤其是第2和第5 MCP、第5 MTP关节和尺骨远端, 对于RA诊断则具有较高的敏感性和特异性。