Correlation of ultrasonography synovitis with disease activity and clinical response to etanercept treatment in juvenile idiopathic arthritis patients

This study aimed to investigate the correlation of ultrasonography (US) of synovitis with disease activity and clinical response to etanercept (ETN) in juvenile idiopathic arthritis (JIA) patients. Eighty-two JIA patients who underwent ETN treatment for 24 weeks were consecutively enrolled. US evaluations of 28 joints (shoulder, elbow, wrist, metacarpophalangeal, and proximal interphalangeal of hands and knee) at baseline were performed using grey-scale US and power doppler (PD) US, and US synovitis was defined as grey-scale abnormalities or PD abnormalities. Clinical response was assessed according to the ACRpedi 50 response criteria. In total, 2296 joints were scanned and 608 (26.5%) joints presented US synovitis, which was numerically higher than clinical synovitis (513 (22.3%)). The mean number of joints showing synovitis on US was 7.42±3.35, which was also numerically higher than that of clinical synovitis (6.26±2.70). The number of joints showing synovitis on US was positively correlated with C-reactive protein, erythrocyte sedimentation rate, number of joints with active disease, number of joints with limited range of motion, physician's global assessment of disease activity, parent/patient global assessment of overall well-being, and childhood health assessment questionnaire score. Most interestingly, the baseline number of joints showing synovitis on US was increased in ACRpedi 50 response JIA patients compared to non-response JIA patients, and it serves as an independent predictive factor for higher clinical response to ETN treatment. In conclusion, US is a more sensitive test to evaluate subclinical synovitis and disease activity in JIA patients, and US synovitis might serve as a marker for predicting increased clinical response rate to ETN treatment.

本研究旨在探讨幼年特发性关节炎（juvenile idiopathic arthritis, JIA）患者的滑膜炎超声检查（ultrasonography, US）结果与疾病活动度及依那西普（etanercept, ETN）治疗应答的相关性。本研究连续纳入82例接受依那西普治疗24周的幼年特发性关节炎患者。于基线时采用灰阶超声（grey-scale US）与能量多普勒超声（power doppler, PD US）对28个关节（手部肩、肘、腕、掌指关节及近端指间关节，以及膝关节）进行超声评估；超声滑膜炎定义为灰阶超声异常或能量多普勒超声异常。临床应答依据儿科ACR50（ACRpedi 50）应答标准进行评估。本研究共扫描2296个关节，其中608个（26.5%）存在超声滑膜炎，该比例高于临床滑膜炎的检出比例（513个，22.3%）。超声检出的滑膜炎关节平均数量为7.42±3.35，同样高于临床滑膜炎的关节平均数量（6.26±2.70）。超声检出的滑膜炎关节数量与C反应蛋白（C-reactive protein）、红细胞沉降率（erythrocyte sedimentation rate）、活动性病变关节数、关节活动受限关节数、医师疾病活动度整体评估评分、家长/患者整体健康状况评估评分及儿童健康评估问卷得分呈正相关。最值得关注的是，与无应答患者相比，达到儿科ACR50应答的幼年特发性关节炎患者基线超声滑膜炎关节数量更多，且该指标可作为依那西普治疗更高临床应答率的独立预测因子。综上，超声检查在评估幼年特发性关节炎患者亚临床滑膜炎及疾病活动度方面具有更高的敏感性，且超声滑膜炎或可作为预测依那西普治疗临床应答率升高的标志物。