Ultrasound in anti-CCP+ at-risk individuals without clinical synovitis: development of a novel 6-joint protocol for feasible risk prediction.

Autor:	Di Matteo A; Rheumatology Department, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK., De Lorenzis E; Rheumatology Department, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.; Division of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino-Gemelli IRCSS, Rome, Italy., Duquenne L; Rheumatology Department, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Nam JL; Rheumatology Department, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Garcia-Montoya L; Rheumatology Department, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Harnden K; Rheumatology Department, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Chowdhury R; Rheumatology Department, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Wakefield RJ; Rheumatology Department, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Emery P; Rheumatology Department, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK., Mankia K; Rheumatology Department, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.; National Institute for Health Research, Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK.
Jazyk:	angličtina
Zdroj:	Rheumatology (Oxford, England) [Rheumatology (Oxford)] 2024 Aug 01; Vol. 63 (8), pp. 2213-2221.
DOI:	10.1093/rheumatology/kead570
Abstrakt:	Objectives: To investigate, in anti-CCP antibody-positive individuals with musculoskeletal symptoms but no clinical synovitis (CCP+ at-risk), the additional value of US for the prediction of inflammatory arthritis. Furthermore, to define a concise US protocol for feasible risk prediction. Methods: Demographic and clinical data were collected in 417 CCP+ at-risk (Leeds CCP cohort) with a baseline US scan assessing synovitis and bone erosions in 36 joints, and a follow-up duration ≥24 months. Multivariable binary regression models for inflammatory arthritis development at 24 months evaluated routine clinical variables associated with inflammatory arthritis alone ('clinical' model) and combined with a 36-joint US scanning protocol ('clinical-US extended' model). A 'clinical-US short' model was also developed. Results: At 24 months, 92/417 (22.1%) CCP+ at-risk developed inflammatory arthritis (median time 7 months, interquartile range 3-12). The 'clinical-US extended' model performed better than the 'clinical' model [area under the curve (AUC) 0.788 vs AUC 0.731, respectively, P < 0.001] with an odds ratio for inflammatory arthritis development of 3.18 (95% CI 1.80-5.63) for US synovitis and 2.54 (95% CI 1.21-5.37) for bone erosions. The 'clinical-US short' model, which retained the wrists, knees and MTP5 joints, performed better (AUC 0.782) than the 'clinical' model (P < 0.001) and similarly (difference in Akaike information criteria <2) to the 'clinical-US extended' model. Conclusions: US provides valuable information for predicting progression to inflammatory arthritis in CCP+ individuals both alone and in addition to clinical variables. US synovitis was associated with a 3-fold increase risk of inflammatory arthritis development. A concise US protocol of six joints provides clinically feasible risk prediction in CCP+ at-risk. (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Society for Rheumatology.)
Databáze:	MEDLINE
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