类风湿关节炎合并纤维肌痛简易分类标准的临床验证

doi:10.19723/j.issn.1671-167X.2022.02.013

摘要/Abstract

摘要：

目的: 验证类风湿关节炎(rheumatoid arthritis,RA)纤维肌痛(fibromyalgia,FM)简易分类标准(Pollard标准)在中国RA合并FM患者中诊断的敏感度和特异度,评估RA合并FM的临床特点。方法: 选择2018年12月—2019年6月在北京大学人民医院风湿免疫科门诊就诊的RA患者的病例资料进行回顾性分析,共入选病例202例,按照1990年美国风湿病学会(American College of Rheumatolgy, ACR)的FM分类标准诊断为FM的42例,将入组患者分为RA合并FM组(RA-FM组)42例和单纯RA组(RA组)160例。结果: 两组患者在一般人口学方面差异无统计学意义(P>0.05)。Pollard标准的敏感度为95.2%,特异度为52.6%。伴有FM的RA患者(RA-FM组)DAS28评分(5.95 vs. 4.38, P=0.011)较不伴FM的患者高,疼痛关节数(tender joint counts,TJC)(16.5 vs. 4.5, P<0.01)更多。RA-FM组患者功能状态HAQ评分(1.24 vs. 0.66, P<0.001)及生活质量SF36评分(28.63 vs. 58.22,P<0.001)更差,疲劳症状较RA组常见(88.1% vs. 50.6%, P<0.001),焦虑(10 vs. 4, P<0.01)及抑郁评分(12 vs. 6, P<0.001)更高。两组ESR、CRP、晨僵时间、肿胀关节数差异无统计学意义(P>0.05)。结论: Pollard标准在临床应用时敏感度较高,对于特异度还需要结合多方面因素综合考虑;RA-FM组患者功能状态更差,该组患者的DAS28评分可能会被高估;长时间未缓解的RA疾病活动应考虑合并FM的可能。

关键词: 类风湿关节炎, 纤维肌痛, 分类标准

Abstract:

Objective: To evaluate the sensitivity and specificity of Pollard’s classification criteria(2010) for the diagnosis of rheumatoid arthritis (RA) patients withfibromyalgia (FM) in Chinese patients, and to assess the clinical features and psychological status of RA-FM patients in a real-world observational setting. Methods: Two hundred and two patients with rheumatoid arthritis were enrolled from the outpatients in Rheumatology and Immunology Department in Peking University People’s Hospital. All the patients were evaluated whether incorporating fibromyalgia translation occured using the 1990 American College of Rheumatolgy (ACR)-FM classification criteria. Forty two RA patients were concomitant with FM, while the other one hundred and sixty RA patients without FM were set as the control group. Results: There was no significant difference in general demography between the two groups (P>0.05). In this study, the Pollard’s classification criteria (2010) for RA-FM in Chinese patients had a high sensitivity of 95.2% and relatively low specificity of 52.6%. Compared with those patients without FM, RA patients with FM (RA-FM patients) had higher Disease Activity Scale in 28 joints (DAS-28) score (5.95 vs. 4.38, P=0.011) and much more 28-tender joint counts (TJC) (16.5 vs.4.5, P<0.001).RA-FM patients had worse Health Assessment Questionnaire (HAQ) score (1.24 vs. 0.66, P<0.001) and lower SF-36 (28.63 vs. 58.22, P<0.001). Fatigue was more common in RA-FM patients (88.1% vs. 50.6%,P<0.001) and the degree of fatigue was significantly increased in RA-FM patients (fatigue VAS 5.55 vs. 3.55, P<0.001). RA-FM patients also had higher anxiety (10 vs.4, P<0.001) and depression scores (12 vs.6, P<0.001). erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), morning stiffness time and 28-swollen joint counts (SJC) showed no difference between these two groups. Conclusion: The Pollard’s classification criteria (2010) for RA-FM are feasible in Chinese rheumatoid arthritis patients. The Pollard’s classification criteria is highly sensitive in clinical application, while the relativelylow specificity indicates that various factors need to be considered in combination. RA patients with FM result in higher disease activity,worse function aland psychological status. RA patients with FM also have poorer quality of life. DAS-28 scores may be overestimated in RA patients with FM. In a RA patient thatdoes not reach remission, the possibility of fibromyalgia should be con-sidered.

Key words: Rheumatoid arthritis, Fibromyalgia, Classification

中图分类号:

R593.22

高超,陈立红,王莉,姚鸿,黄晓玮,贾语博,刘田. 类风湿关节炎合并纤维肌痛简易分类标准的临床验证[J]. 北京大学学报（医学版）, 2022, 54(2): 278-282.

GAO Chao,CHEN Li-hong,WANG Li,YAO Hong,HUANG Xiao-wei,JIA Yu-bo,LIU Tian. Validation of the Pollard’s classification criteria (2010) for rheumatoid arthritis patients with fibromyalgia[J]. Journal of Peking University (Health Sciences), 2022, 54(2): 278-282.

图/表 4

表1

表2

两组患者临床和免疫特征比较"

Feature	RA (n=160)	RA-FM (n=42)	P
DAS28, $x -$ ±s	4.38±1.37	5.95±1.21	0.011
TJC, M(P₂₅, P₂₅)	4.5 (1, 8)	16.5 (10, 24)	<0.001
SJC, M(P₂₅, P₂₅)	1 (0, 3.75)	2 (0.75, 4)	0.470
Morning stiffness/min, M(P₂₅, P₂₅)	15 (0, 60)	25 (3.75, 99)	0.062
CRP/(mg/dL), M(P₂₅, P₂₅)	14.89 (4.10, 36.14)	27.86 (2.95, 54.68)	0.152
ESR/(mm/h), M(P₂₅, P₂₅)	43.50 (17.00, 70.75)	50.50 (16.75, 76.50)	0.518

表2

表3

表4

参考文献 18

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Feature	RA (n=160)	RA-FM (n=42)	P
Age/years, M(P₂₅,P₇₅)	64 (56, 71)	62.5 (56, 71.5)	0.779
Disease duration/years, M(P₂₅,P₇₅)	9 (4, 17.8)	11.5 (2, 21)	0.617
Gender, n(%)			0.567
Male	33 (20.6)	7 (16.7)
Female	127 (79.4)	35 (83.3)
Smoking, n(%)	144/160 (90.0)	37/42 (88.1)	0.939
Education, n(%)			0.584
Primary	26 (16.3)	9 (21.4)
Junior	47 (29.4)	11 (26.2)
Senior	41 (25.6)	14 (33.3)
Higher education	46 (28.8)	8 (19.0)
Race, n(%)			0.755
Han	152 (95.0)	41 (97.6)
Others	8 (5.0)	1 (2.4)
Marital status, n(%)			0.536
Married	155 (96.9)	42 (100.0)
Unmarried	5 (3.1)	0 (0)
Occupation, n(%)			0.792
Employed	16 (10.0)	2 (4.8)
Retired	113 (70.6)	30 (71.4)
Other	31 (19.4)	10 (23.8)

Feature	RA (n=160)	RA-FM (n=42)	P
HAQ, M(P₂₅, P₂₅)	0.66 (0.20, 0.90)	1.24 (0.26, 1.50)	<0.001
VAS/cm, M(P₂₅, P₂₅)	3 (2, 5)	5 (3, 7)	0.01
SF36, M(P₂₅, P₂₅)	58.22 (47.26, 73.17)	28.63 (19.80, 39.97)	<0.001

Feature	RA (n=160)	RA-FM (n=42)	P-value
Anxiety	4 (1, 7)	10 (8, 12)	<0.001
Depressed	6 (3, 8)	12 (10, 15)	<0.001
Fatigue	81/160	37/42	<0.001
Fatigue VAS	3.55 (1.00, 4.73)	5.55 (4.61, 5.91)	<0.001