目的:我们的目的是建立低剂量全身性糖皮质激素治疗试验在评估新的临床怀疑的炎性关节炎患者中的实用性。
方法:我们回顾性地确定了墨尔本一家私人风湿病诊所的患者,澳大利亚1月1日之间,2019年12月31日,2021年,他出现了临床怀疑的炎性关节炎,随后接受了低剂量泼尼松龙的试验(每天15mg断奶,超过三周,以5mg的增量)。我们排除了已知自身免疫性/炎症性疾病或出现时并发免疫抑制的患者。我们收集了参与者的基本人口统计细节和临床细节,糖皮质激素反应,调查,和治疗。
结果:我们招募了177名参与者,中位年龄为52岁,69.5%为女性。中位症状出现时间为12个月。63.3%和85%患有双侧疾病,手是受影响最严重的关节。在参与者中,29.4%的患者在临床检查中有滑膜炎,75.7%的患者在初始评估中有影像学检查。在介绍时,CRP中位数为11,ESR中位数为16.79.7%的队列从低剂量糖皮质激素获得了关节炎症状的显着改善,83.6%的队列需要长期免疫抑制来治疗潜在的炎症。在那些对糖皮质激素有反应的人中,92.1%被诊断患有炎症。28%的类风湿关节炎是最常见的总体诊断。
结论:低剂量糖皮质激素在未分化关节炎患者中的初步试验有助于预测炎性关节炎的诊断。它也是进一步长期保留类固醇治疗的预测因子。
OBJECTIVE: We aim to establish the utility of a trial of low-dose systemic glucocorticoid therapy in the assessment of new clinically suspected inflammatory arthritis patients.
METHODS: We retrospectively identified patients from a private rheumatology practice in Melbourne, Australia between January 1st, 2019, and December 31st, 2021, who presented with clinically suspected inflammatory arthritis and subsequently underwent a trial of low-dose prednisolone (15 mg daily weaned over three weeks in 5 mg increments). We excluded patients with known autoimmune/ inflammatory disorders or concurrent immunosuppression at presentation. We collected basic participant demographic details and clinical details of their presentation, glucocorticoid response, investigations, and treatment.
RESULTS: We recruited 177 participants with a median age of 52, and 69.5% were female gender. The median symptom time to presentation was 12 months. Hands were the most affected joint in 63.3% and 85% had bilateral disease. Among the participants, 29.4% had synovitis on clinical review and 75.7% had imaging performed as part of the initial assessment. At presentation, the median CRP was 11 and the median ESR was 16. 79.7% of the cohort experienced significant improvement in their arthritis symptoms from low-dose glucocorticoids and 83.6% of the cohort required long-term immunosuppression for an underlying inflammatory condition. Of those who responded to glucocorticoids, 92.1% were diagnosed with an inflammatory condition. Rheumatoid arthritis was the most common overall diagnosis in 28%.
CONCLUSIONS: An initial trial of low-dose glucocorticoids in undifferentiated arthritis patients is useful in predicting the diagnosis of inflammatory arthritis. It is also a predictor of further long-term steroid-sparing therapy.