风湿病学家在临床怀疑关节痛的患者中估计患有风湿性关节炎的风险方面的专业知识:它的价值是什么?
Stijn Claassen1, Hanna W van Steenbergen2, Annette H M van der Helm-Van Mil2,3
1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands s.claassen@lumc.nl.
RMD open
|February 20, 2026
概括
风湿病学家高估了临床怀疑关节痛 (CSA) 患者的类风湿性关节炎 (RA) 风险. 欧洲风湿病学协会联盟/美国风湿病学学院 (EULAR/ACR) 的标准对于RA风险分层更为准确.
科学领域:
- 类风湿病学 类风湿病学
- 临床决策 - 临床决策
- 流行病学 流行病学
背景情况:
- 临床专业知识对于诊断关节痛 (关节疼痛) 和将其与其他肌肉骨疾病区分开来至关重要.
- 在预测临床疑似关节痛 (CSA) 患者的类风湿性关节炎 (RA) 进展方面,类风湿学专业知识的可靠性尚未得到充分证实.
- 已确立的风险分层标准存在,但可能比临床专业知识的时间效率要低.
研究的目的:
- 评估风湿病学家在估计CSA患者的RA风险方面的临床专业知识的准确性.
- 为了比较风湿病学家专业知识的表现与欧洲风湿病学协会联盟/美国风湿病学学院 (EULAR/ACR) 风险分层标准的风险分层标准.
主要方法:
- 分析了来自莱登CSA队列和TREAT EARLIER试验的501名CSA患者.
- 风湿病学家根据病史,体检和实验室结果使用0-10数值评分表估计了RA风险.
- 一年内RA的发展是主要结果,与基于专业知识的估计和EULAR/ACR标准 (没有成像) 之间的区别进行比较.
主要成果:
- 风湿病学家的专业知识显示,对RA发展存在中等程度的歧视 (AUC=0.64),普遍高估了风险.
- 根据EULAR/ACR风险分层标准,预测RA发展的准确性显著提高 (AUC=0.91).
- 基于专业知识的风险估计平均为5 (SD 1.6) 在0-10级,表明过度估计的倾向.
结论:
- 风湿病学家的临床专业知识不足以准确评估CSA患者的RA进展风险.
- 已建立的EULAR/ACR风险分层标准优于临床专业知识,用于对此群体的RA风险评估.
- 当准确的风险信息对于临床或治疗决策至关重要时,建议使用既定的标准.
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