巨细胞动脉炎(GCA)超声评分(OGUS)在诊断和初始治疗后预测未来复发的GCA患者:一项多中心前瞻性研究的结果。

IF 20.3 1区 医学 Q1 RHEUMATOLOGY
Annals of the Rheumatic Diseases Pub Date : 2025-05-01 Epub Date: 2025-02-06 DOI:10.1016/j.ard.2025.01.018
Sara Monti, Cristina Ponte, Valentin S Schäfer, Davide Rozza, Carlo Scirè, Giulia Franchi, Alessandra Milanesi, Nikita Khmelinskii, Simon M Petzinna, Greta Carrara, Cristina Di Nicola, João Eurico Fonseca, Carlomaurizio Montecucco, Wolfgang A Schmidt, Christian Dejaco, Raashid A Luqmani
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引用次数: 0

摘要

目的:探讨超声在巨细胞动脉炎(GCA)诊断中的预后作用,以及在随访最初几周内超声异常的变化,以预测复发、血管并发症或开始使用改善疾病的抗风湿药物(DMARDs)。方法:前瞻性、多中心研究,在固定时间点对新发GCA患者进行连续超声评估。风湿病预后指标(OMERACT) GCA超声评分(OGUS)用于量化血管壁异常。复发定义为gca相关症状复发或需要治疗的炎症标志物升高。采用具有稳健方差估计的多变量泊松模型,包括年龄、性别、大血管GCA、糖皮质激素累积剂量和基线OGUS作为协变量。结果:在849次访问中评估了97例患者。35例(36.1%)患者共66次复发,中位复发时间为210天(IQR, 94.5-323.5)。诊断时较高的OGUS与12个月内复发的风险增加相关(OGUS每增加1点的发病率比[IRR]: 1.85;95% ci, 1.05-3.32)。结论:超声检查在GCA中具有预后作用,可提示危险分层。诊断时较高的OGUS与复发有关,而在第一周内较高程度和快速的改善与较低的复发率有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The giant cell arteritis (GCA) ultrasound score (OGUS) at diagnosis and after initial treatment predicts future relapses in GCA patients: results of a multicentre prospective study.

Objectives: To test the prognostic role of ultrasonography at diagnosis of giant cell arteritis (GCA) and the change of ultrasound abnormalities during the initial weeks of follow-up for the prediction of relapse, vascular complications, or initiation of disease-modifying antirheumatic drugs (DMARDs).

Methods: Prospective, multicentre study of patients with new onset GCA undergoing serial ultrasound assessment at fixed time points. The Outcome Measures in Rheumatology (OMERACT) GCA ultrasonography score (OGUS) was used to quantify vessel wall abnormalities. Relapse was defined as recurrence of GCA-related symptoms or rise of inflammatory markers requiring treatment. A multivariable Poisson model with robust variance estimator was applied, including age, sex, large vessel GCA, glucocorticoid cumulative dose, and baseline OGUS as covariates.

Results: Ninety-seven patients were assessed in 849 visits. Thirty-five (36.1%) patients experienced a total of 66 relapses, with median time to relapse of 210 days (IQR, 94.5-323.5). Higher OGUS at diagnosis was associated with an increased risk of relapse within 12 months (incidence rate ratio [IRR] for each 1 point increase in OGUS: 1.85; 95% CI, 1.05-3.32). At multivariable analysis, OGUS normalisation (score <1) over the first 3 weeks was negatively associated with subsequent relapses (IRR, 0.44; 95% CI, 0.22-0.88) and predicted time to first relapse. OGUS reduction over the first 12 weeks was inversely associated with initiation of DMARDs. Ischaemic/aortic complications were rare.

Conclusions: Ultrasonography has a prognostic role in GCA and can inform risk stratification. Higher OGUS at diagnosis is associated with relapse, while a higher degree and rapidity of improvement in the first weeks are linked with lower relapse rate.

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来源期刊
Annals of the Rheumatic Diseases
Annals of the Rheumatic Diseases 医学-风湿病学
CiteScore
35.00
自引率
9.90%
发文量
3728
审稿时长
1.4 months
期刊介绍: Annals of the Rheumatic Diseases (ARD) is an international peer-reviewed journal covering all aspects of rheumatology, which includes the full spectrum of musculoskeletal conditions, arthritic disease, and connective tissue disorders. ARD publishes basic, clinical, and translational scientific research, including the most important recommendations for the management of various conditions.
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