Kirwan J, Byron M, Watt I
Rheumatology Unit, University of Bristol Division of Medicine, Bristol, UK.
Rheumatology (Oxford). 2001 Mar;40(3):297-301. doi: 10.1093/rheumatology/40.3.297.
To test the hypotheses that the progression of joint space narrowing behaves differently from the progression of erosions and that clinically and radiologically assessed soft tissue swelling relates more to diffuse cartilage loss than to erosive damage.
Radiographs and clinical data were obtained from 28 patients in a prospective, multicentre, randomized, placebo-controlled trial of prednisolone 7.5 mg daily over 2 yr. Radiographic scoring included the Larsen score, joint space narrowing and soft tissue swelling. Clinical joint inflammation in the hands was assessed every 3 months and cumulative synovitis score over the period of study was then calculated for each joint. The placebo-treated patients and the prednisolone-treated patients were analysed separately. The Larsen scores were compared after log transformation [transformed score=log(10) (original score+1)]. Changes in Larsen scores and joint space narrowing scores were compared with the cumulative presence of clinical synovitis and radiological soft tissue swelling using the correlation coefficient.
There was a difference in the rate of progression in the Larsen score between placebo- and prednisolone-treated patients, but there was no significant difference in the rate of joint space loss. In placebo-treated patients, measures of synovitis correlated more strongly with progression of joint space narrowing than with changes in the Larsen score. In prednisolone-treated patients there was no correlation between clinical synovitis and change in Larsen score (r=0.029) and only a slight and non-significant correlation with joint space narrowing (r=0.127). Radiographic evidence of soft tissue swelling remained correlated with joint space narrowing (r=0.279, P:<0.001) but was not correlated with change in Larsen score (r=-0.113, P:<0.001 for difference between correlations). The correlation between Larsen score progression and joint space narrowing seen in the non-treated patients was completely abolished in the glucocorticoid-treated group (r=-0.003).
The progression of joint space narrowing behaves differently from the progression of erosions. Prednisolone slows (or even stops) the progression of erosions (as assessed by the Larsen score) while making no difference to the progression of cartilage loss (as assessed by joint space narrowing). The results also suggest that synovitis, whether measured clinically or radiologically, is more closely related to diffuse cartilage loss than to erosion progression. Any link between synovitis and erosions is abolished by glucocorticoid therapy while the link between synovitis and cartilage loss is not, pointing to at least two different mechanisms for these observed radiological features.
验证以下假设，即关节间隙狭窄的进展与糜烂的进展表现不同，且临床和放射学评估的软组织肿胀与弥漫性软骨丢失的关系比与糜烂性损伤的关系更为密切。
在一项前瞻性、多中心、随机、安慰剂对照试验中，获取了28例患者的X线片和临床数据，该试验为期2年，患者每日服用7.5毫克泼尼松龙。放射学评分包括Larsen评分、关节间隙狭窄和软组织肿胀。每3个月评估一次手部的临床关节炎症，然后计算每个关节在研究期间的累积滑膜炎评分。分别对安慰剂治疗组和泼尼松龙治疗组的患者进行分析。对Larsen评分进行对数转换后进行比较[转换后的分数=log(10)(原始分数+1)]。使用相关系数比较Larsen评分和关节间隙狭窄评分的变化与临床滑膜炎和放射学软组织肿胀的累积情况。
安慰剂治疗组和泼尼松龙治疗组患者的Larsen评分进展率存在差异，但关节间隙丢失率无显著差异。在安慰剂治疗组患者中，滑膜炎指标与关节间隙狭窄进展的相关性比与Larsen评分变化的相关性更强。在泼尼松龙治疗组患者中，临床滑膜炎与Larsen评分变化之间无相关性(r = 0.029)，与关节间隙狭窄仅有轻微且无统计学意义的相关性(r = 0.127)。软组织肿胀的放射学证据与关节间隙狭窄仍具有相关性(r = 0.279，P < 0.001)，但与Larsen评分变化无相关性(r = -0.113，相关性差异P < 0.001)。在未治疗患者中观察到的Larsen评分进展与关节间隙狭窄之间的相关性在糖皮质激素治疗组中完全消失(r = -0.003)。
关节间隙狭窄的进展与糜烂的进展表现不同。泼尼松龙减缓（甚至停止）了糜烂的进展（通过Larsen评分评估），而对软骨丢失的进展（通过关节间隙狭窄评估）没有影响。结果还表明，滑膜炎，无论是通过临床还是放射学测量，与弥漫性软骨丢失的关系比与糜烂进展的关系更为密切。糖皮质激素治疗消除了滑膜炎与糜烂之间的任何联系，而滑膜炎与软骨丢失之间的联系并未消除，这表明这些观察到的放射学特征至少存在两种不同的机制。
