Rau R, Wassenberg S, Herborn G, Perschel W T, Freitag G
Department of Rheumatology, Evangelisches Fachkrankenhaus Ratingen, Germany.
J Rheumatol. 2001 Dec;28(12):2608-15.
Conventional radiographic scoring methods in rheumatoid arthritis (RA) are designed to quantify progression and disregard any improvement. Reparative changes observed during longterm followup of RA have rarely been described as healing phenomena. Healing may become increasingly important with the availability of more potent antirheumatic drugs. We investigated whether radiologic healing phenomena can be identified by different observers in a blinded fashion.
Healing phenomena were defined as (1) reappearance (and sclerosis) of the cortical plate, (2) partial or complete filling in of an erosion, or (3) subchondral bone sclerosis with osteophyte formation (secondary osteoarthritis). Pairs of radiographs of hands, wrists, and forefeet [taken 2 to 8 (mean 4.8) yrs apart] of 34 patients were selected from longterm studies: 24 sets with healing phenomena and 10 with progressive disease without healing. The radiographs were blinded and read in pairs in random order by 3 observers unaware of the patients selected for the study. One observer read the set a second time after 8 weeks, resulting in a total of 4 observations. Thirty-eight joints were rated 0 to 5 depending on the amount of surface destruction. In addition an attempt was made to identify joints with healing phenomena. The data were analyzed with help of descriptive statistics such as means, standard deviations, and frequency tables.
Out of 1292 joints scored at the second time point, 74 had healing phenomena. These joints were identified in a mean of 89% (95/89/88/82%, respectively) in the 4 observations performed by the 3 readers. Patients without healing phenomena were correctly identified by all observers. In 54 joints less typical healing phenomena were seen in all observations. Sixty-two joints with healing in addition to the 74 joints were seen in 3 observations, 76 in 2, and 127 in one observation. All observers agreed that 1090 joints had no healing phenomenon. The 24 patients with healing had a slight reduction in the Ratingen score, while the 10 patients without healing showed a moderate progression. In the group with healing an increase and decrease in the score occurred in the same patients at different joints.
In patients with RA followed for several years healing or reparative changes of erosions can be observed. These phenomena can be identified by different observers with high sensitivity even when the observers are blinded to chronological sequence of the films.
类风湿关节炎（RA）的传统放射学评分方法旨在量化疾病进展，而忽略任何改善情况。在RA的长期随访中观察到的修复性改变很少被描述为愈合现象。随着更有效的抗风湿药物的出现，愈合可能变得越来越重要。我们研究了不同观察者能否以盲法识别放射学愈合现象。
愈合现象定义为：（1）皮质板重新出现（并硬化）；（2）侵蚀部分或完全填充；或（3）伴有骨赘形成的软骨下骨硬化（继发性骨关节炎）。从长期研究中选取34例患者的手、腕和前足的成对X线片（间隔2至8年，平均4.8年）：24组有愈合现象，10组为无愈合的进行性疾病。X线片进行盲法处理，并由3名不了解入选该研究患者情况的观察者按随机顺序成对阅读。一名观察者在8周后再次阅读该组片子，共进行4次观察。根据表面破坏程度，对38个关节进行0至5分的评分。此外，尝试识别有愈合现象的关节。借助描述性统计方法，如均值、标准差和频率表对数据进行分析。
在第二次评分的1292个关节中，74个有关节愈合现象。在3名观察者进行的4次观察中，这些关节的识别率平均为89%（分别为95%/89%/88%/82%）。所有观察者均正确识别出无愈合现象的患者。在54个关节中，在所有观察中均可见不太典型的愈合现象。除了这74个关节外，62个关节在3次观察中出现愈合，76个在2次观察中出现愈合，127个在1次观察中出现愈合。所有观察者均认为1090个关节无愈合现象。24例有愈合的患者的勒廷根评分略有降低，而10例无愈合的患者则显示中度进展。在有愈合的组中，同一患者不同关节的评分有升有降。
在随访数年的RA患者中，可以观察到侵蚀的愈合或修复性改变。即使观察者对片子的时间顺序不知情，这些现象也能被不同观察者以高灵敏度识别出来。
