早期未治疗类风湿关节炎中滑膜炎与骨质改变的关系：一项对照磁共振成像研究。

The relationship between synovitis and bone changes in early untreated rheumatoid arthritis: a controlled magnetic resonance imaging study.

作者信息

McGonagle D, Conaghan P G, O'Connor P, Gibbon W, Green M, Wakefield R, Ridgway J, Emery P

机构信息

University of Leeds, UK.

出版信息

Arthritis Rheum. 1999 Aug;42(8):1706-11. doi: 10.1002/1529-0131(199908)42:8<1706::AID-ANR20>3.0.CO;2-Z.

DOI:10.1002/1529-0131(199908)42:8<1706::AID-ANR20>3.0.CO;2-Z

PMID:10446871

Abstract

OBJECTIVE

The interrelationship between synovitis and bone damage in rheumatoid arthritis (RA) is a subject of controversy. Using magnetic resonance imaging (MRI), this study followed the bone changes in early RA and determined their relationship to synovitis.

METHODS

Thirty-one patients with early RA who had swelling of the metacarpophalangeal (MCP) joints and 31 healthy control subjects with no clinical evidence of arthritis underwent MRI of the second through fifth MCP joints of the dominant hand by use of a 1.5T scanner. Coronal T1-weighted and T2-fat suppressed (FS) sequences were performed to evaluate bone edema, and gadolinium-diethylenetriaminepentaacetic acid (Gd-DTPA) pulse sequences were obtained to evaluate synovitis. Bony abnormalities were described as bone edema (low signal on T1-weighted sequences and intermediate/high signal on T2 FS sequences adjacent to the bone cortex) or as bone cysts (circular juxtacortical abnormalities with low signal on T1-weighted images and with very high signal on T2 FS sequences). Contrast and noncontrast MRI films were scored in a blinded manner, and Fisher's exact probability test was used to determine differences between groups.

RESULTS

Twenty-one of the 31 RA patients (68%) had bone edema, which was seen in 43 of 124 joints (35% of joints) and 3 of the 31 control subjects had bone edema seen in 3 of 124 joints (2% of joints) (P < 0.0001). Thirty RA patients (97%) had Gd-DTPA-confirmed MCP joint synovitis, and bone edema was seen in 40 of the 75 joints with Gd-DTPA-proven synovitis (53%), but in only 3 of 49 without (6%) (P < 0.0001).

CONCLUSION

MCP joint bone edema is present in the majority of patients with RA at presentation, but is seen only occasionally in normal control subjects. The fact that bone edema occurred rarely in the absence of synovitis in patients with RA suggests that bony changes in RA are secondary to synovitis.

摘要

目的

类风湿关节炎（RA）中滑膜炎与骨损害之间的相互关系存在争议。本研究利用磁共振成像（MRI）追踪早期RA的骨改变，并确定其与滑膜炎的关系。

方法

31例有掌指（MCP）关节肿胀的早期RA患者和31例无关节炎临床证据的健康对照者，使用1.5T扫描仪对优势手的第二至第五MCP关节进行MRI检查。采用冠状面T1加权和T2脂肪抑制（FS）序列评估骨水肿，采用钆喷酸葡胺（Gd-DTPA）脉冲序列评估滑膜炎。骨异常表现为骨水肿（T1加权序列上低信号，与骨皮质相邻的T2 FS序列上为中等/高信号）或骨囊肿（皮质旁圆形异常，T1加权图像上低信号，T2 FS序列上极高信号）。以盲法对增强和非增强MRI片进行评分，采用Fisher精确概率检验确定组间差异。

结果

31例RA患者中有21例（68%）出现骨水肿，在124个关节中的43个（占关节的35%）观察到骨水肿；31例对照者中有3例在124个关节中的3个（占关节的2%）出现骨水肿（P<0.0001）。30例RA患者（97%）经Gd-DTPA证实有MCP关节滑膜炎，在75个经Gd-DTPA证实有滑膜炎的关节中有40个（53%）观察到骨水肿，而在49个无滑膜炎的关节中仅有3个（6%）观察到骨水肿（P<0.0001）。