| Objective:To analyze the correlation between osteoporosis and 7-joint ultrasound score in patients with rheumatoid arthritis,establish a prediction model of osteoporosis in rheumatoid arthritis,and verify the model internally and externally.Methods:A total of 300 patients with rheumatoid arthritis who underwent bone mineral density measurement at our hospital from June 2019 to October 2020 were enrolled in the study.The patients were divided into two groups according to their entry time: a training set containing the first 2/3 of the patients(n=200)and a validation set containing the remaining 1/3 of the patients(n=100).Binary logistic regression analysis was used to establish the regression models,and the concordance index(C-index),calibration plot and decision curve analysis were used to evaluate the prediction model.Results:1.There was no significant difference between the training set and the verification set in terms of the demographic characteristics,laboratory values or ultrasonography(P>0.05),indicating that the demographic characteristics,laboratory tests and ultrasonic performance of the training group and the verification group were consistent.2.In the training set patients with RA,DAS28(r=0.639,P<0.001),7-joint ultrasonic bone erosion(r=0.647,P<0.001),the total US7 score(r=0.644,P<0.001)and tenosynovitis score on GSUS(r=0.613,P<0.001)were positively correlated with osteoporosis in RA patients.Age(r=0.443,P<0.001),ESR(r=0.500,P<0.001),CCP(r=0.424,P<0.001),CRP(r=0.505,P<0.001),synovitis score on GSUS(r=0.542,P<0.001),synovitis score on PDUS(r=0.597,P<0.001),and tenosynovitis score on PDUS(r=0.516,P<0.001)were moderately correlated with osteoporosis in RA patients.Disease duration(r=0.356,P<0.001),RF(r=0.369,P<0.001),treatment duration(r=0.328,P<0.001)were weakly positively correlated with the severity of osteoporosis in RA patients.3.six variables,including age(OR:1.149;95%CI:1.081～1.222;P<0.001),disease duration(OR:1.011;95%CI:1.002～1.020;P=0.022),the disease activity score using 28 joint counts(DAS28)(OR:1.715;95%CI:1.105～2.661;P=0.016),anti-cyclic citrullinated peptide antibody(CCP)(OR:1.001;95%CI:1.000～1.002;P=0.015),tenosynovitis score on GSUS(OR:2.281;95%CI:1.351～3.849;P=0.002)and 7-joint ultrasonic bone erosion(OR:1.623;95%CI:1.140～2.312;P=0.007),were selected to enter the model.The prediction model is: Logit Y=-12.668+0.139*age(X1)+0.011*disease duration(X2)+0.539*DAS28(X4)+0.001*CCP(X7)+0.824*tenosynovitis score on GSUS(X12)+0.484*7-joint ultrasonic bone erosion(X14).The model had good differentiation;the C-index in the internal verification was 0.958(95% CI is 0.946-0.982)and the C-index in the external verification was 0.973(95% CI is 0.960-0.999).The calibration polt of the model showed excellent consistency between the prediction probability and actual probability.4.When that risk probability value of nomogram is 0.376 as the diagnostic cut-off value of osteoporosis,the sensitivity,specificity,positive likelihood ratio,negative likelihood ratio and Jordan index of the model were 92.22%,88.18%,7.80,0.088 and 80.40%,respectively.5.In the decision curve,the model curve in the training set is notably better than the two extreme lines,suggesting that the overall net benefit in the population is good;the verification set also performed well.Conclusions:1.There was a correlation between osteoporosis in rheumatoid arthritis and7-joint scoring method,and there was a strong positive correlation between 7-joint ultrasonic bone erosion,US7 total score and tenosynovitis score on GSUS.2.Age,course of disease,DAS28,CCP,tenosynovitis score on GSUS,and7-joint ultrasound bone erosion are risk factors for osteoporosis in rheumatoid arthritis.3.A newly generated predictive model has been suggested to have good differentiation,calibration and clinical validity and may be a useful clinical model for predicting osteoporosis in patients with rheumatoid arthritis. |
PDF Full Text Request