关键词: 类风湿关节炎, 滑膜炎, 肿瘤坏死因子抑制剂, 临床应答

Abstract: Background　Exploring the factors influencing the efficacy of tumor necrosis factor （TNF） inhibitors in the treatment of rheumatoid arthritis （RA） can help to develop individualized treatment strategies and improve the efficiency of RA treatment.Synovitis status detected by ultrasound，a low-cost and easy-to-operate imaging method，may evaluate the joint damage from RA.Objective　This study aimed to evaluate the value of ultrasound-detected improvement in synovitis in predicting the clinical response to TNF inhibitor therapy in RA patients.Methods　80 active RA patients from the First Affiliated Hospital of University of South China were consecutively enrolled from January 2015 to June 2017，and received TNF inhibitor therapy （etanercept 25 mg administered twice a week by subcutaneous injection） for 24 weeks.28 joints （bilateral shoulder joints，wrist joints，elbow joints，knee joints，1-5 metacarpophalangeal joints and 1-5 proximal interphalangeal joints） of RA patients were examined by ultrasound at baseline，4，12，and 24 weeks after treatment，and the number of synovitis joints measured at each time was recorded.The clinical response was assessed at different time points after initiation of treatment by DAS28-ESR score.Results　The number of ultrasound-detected synovitis joints was positively correlated with TJC （r=0.452，P<0.001），SJC （r=0.454，P<0.001），and DAS28-ESR score （r=0.451，P<0.001）at baseline.At the end of the 4th，12th，and 24th weeks of treatment，the number of ultrasound-detected synovitis joints was positively correlated with the DAS28-ESR score （r=0.451，P<0.001；r=0.369，P=0.001；r=0.534，P<0.001）.The number of ultrasound-detected synovitis joints differed significantly across the measurement time points （P<0.05）.To be specific，it showed a successive decrease over the 4 measurements （P<0.05）.The cases with response to TNF inhibitor therapy at the end of 4th，12th and 24th weeks of treatment numbered 23（28.8%），41（51.2%），and 54（67.5%），respectively.During the 24-week treatment，the number of ultrasound-detected synovitis joints measured at the 4 time points showed no significant differences between those with responses and those without （P>0.05）.The overall clinical response rate at the end of treatment was higher in those with ultrasound-detected improvement in synovitis at the end of 4 weeks of treatment than that of those without （P<0.05）.But the overall clinical response rate was not associated with ultrasound-detected improvement in synovitis after 12 and 24 weeks of treatment （P>0.05）.Conclusion　Ultrasound-detected synovitis status is positively correlated with RA activity.And improvement in synovitis in short-term （4-week） treatment detected by ultrasound may have an impact clinical response in RA patients treated with TNF inhibitor.

Key words: Rheumatoid arthritis, Synovitis, Tumor necrosis factor inhibitor, Clinical response