Prediction model for bone erosion in rheumatoid arthritis based on musculoskeletal ultrasound and clinical risk factors.

IF 2.9 3区 医学 Q2 RHEUMATOLOGY Clinical Rheumatology Pub Date : 2024-11-09 DOI:10.1007/s10067-024-07219-5
Lei Yan, Minghang Lin, Xiaojian Ye, Wenting Li, Jing Xu, Yabin Fang, Shuqiang Chen
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Abstract

Purpose: Progressive bone erosion (BE) is a prominent manifestation of structural damage in rheumatoid arthritis (RA). This study aimed to construct and validate a BE prediction model (BEPM) for RA based on musculoskeletal ultrasound and clinical risk factors.

Methods: A total of 312 RA patients without BE were consecutively collected and followed up for 2 years, who were divided into BE group and non-bone erosion group, as confirmed by two radiology experts based on at least two imaging techniques. Relevant clinical information, such as anti-cyclic citrullinated peptide (ACCP) antibody and disease duration, was collected. Musculoskeletal ultrasound examinations were performed on all patients upon admission. Univariate and binary logistic regression analyses were conducted to identify risk factors for BE and to establish the prediction model. The calibration, diagnostic efficacy, and clinical effectiveness of BEPM were evaluated by calibration curve plots, receiver-operating characteristic curve, and decision curve analysis (DCA).

Results: Binary logistic regression analysis screened four variables, including synovial hyperplasia, synovial blood flow, ACCP + , and disease duration, into the prediction model. BEPM exhibited good diagnostic performance in both the training and validation groups, with area under the curve values of 0.949 (95% CI 0.924-0.973) and 0.965 (95% CI 0.935-0.996), respectively. Using 0.376 as the optical cutoff value for BE, the sensitivity, specificity, and Youden index of the model in the training group were 86.0%, 90.4%, and 76.4%, respectively. In the DCA curves, BEPM indicated overall good population benefit.

Conclusion: BEPM demonstrates high diagnostic performance and clinical utility, and may be a useful clinical model for predicting BE in patients with RA. Key Points • Synovial hyperplasia, synovial blood flow, ACCP+ , and disease duration are independent risk factors for bone erosion in RA patients. • BEPM exhibits good diagnostic performance in both the training and validation groups. • Combining musculoskeletal ultrasound parameters with key clinical risk factors to construct a bone erosion model is feasible.

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基于肌肉骨骼超声波和临床风险因素的类风湿性关节炎骨侵蚀预测模型。
目的:进行性骨侵蚀(BE)是类风湿性关节炎(RA)结构损伤的突出表现。本研究旨在基于肌肉骨骼超声和临床风险因素,构建并验证RA的骨侵蚀预测模型(BEPM):方法:连续收集312例无骨侵蚀的RA患者,将其分为骨侵蚀组和非骨侵蚀组,由两名放射科专家根据至少两种影像学技术进行确认,并随访2年。收集相关临床信息,如抗环瓜氨酸肽(ACCP)抗体和病程。所有患者在入院时均接受了肌肉骨骼超声检查。进行了单变量和二元逻辑回归分析,以确定 BE 的风险因素并建立预测模型。通过校准曲线图、接收者工作特征曲线和决策曲线分析(DCA)评估了BEPM的校准、诊断效果和临床有效性:二元逻辑回归分析将滑膜增生、滑膜血流、ACCP + 和病程等四个变量筛选到预测模型中。BEPM 在训练组和验证组均表现出良好的诊断性能,曲线下面积值分别为 0.949(95% CI 0.924-0.973)和 0.965(95% CI 0.935-0.996)。以 0.376 作为 BE 的光学临界值,训练组模型的灵敏度、特异性和尤登指数分别为 86.0%、90.4% 和 76.4%。在 DCA 曲线中,BEPM 显示出总体良好的人群获益:结论:BEPM 具有很高的诊断性能和临床实用性,可作为预测 RA 患者 BE 的有用临床模型。要点--滑膜增生、滑膜血流、ACCP+ 和病程是 RA 患者骨侵蚀的独立风险因素。- BEPM 在训练组和验证组中都表现出良好的诊断性能。- 将肌肉骨骼超声参数与主要临床风险因素结合起来构建骨侵蚀模型是可行的。
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来源期刊
Clinical Rheumatology
Clinical Rheumatology 医学-风湿病学
CiteScore
6.90
自引率
2.90%
发文量
441
审稿时长
3 months
期刊介绍: Clinical Rheumatology is an international English-language journal devoted to publishing original clinical investigation and research in the general field of rheumatology with accent on clinical aspects at postgraduate level. The journal succeeds Acta Rheumatologica Belgica, originally founded in 1945 as the official journal of the Belgian Rheumatology Society. Clinical Rheumatology aims to cover all modern trends in clinical and experimental research as well as the management and evaluation of diagnostic and treatment procedures connected with the inflammatory, immunologic, metabolic, genetic and degenerative soft and hard connective tissue diseases.
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