Richi P, Balsa A, Muñoz-Fernández S, Villaverde V, Fernández-Prada M, Vicario J L, Martín-Mola E
Rheumatology Unit, La Paz Hospital, Madrid, Spain Transfusions Centre Comunidad Autónoma de Madrid, Spain.
Ann Rheum Dis. 2002 Mar;61(3):270-2. doi: 10.1136/ard.61.3.270.
To determine whether the presence of radiographic erosions at disease onset in patients with early rheumatoid arthritis (RA) is associated with clinical, serological, or genetic factors of poor outcome and whether patients with erosions only in the feet have a different pattern of presentation.
Sixty one patients with early RA (<6 months of evolution) were studied. Clinical evaluation and serological, radiological, and genetic studies were performed at disease onset and after one year.
Forty one (67%) patients showed erosions in their hands or in their feet, or in both. Subjects with erosive RA had a higher number of swollen joints (SJN; 9 (SD 6) v. 6 (3), p=0.008), and rheumatoid factor (RF) positivity was more common (80% v. 50%, p<0.02) than those without erosions. Seven (17%) of the 41 patients in the group with erosions had erosions only in their feet. This group had a longer duration of morning stiffness (120 (60) v. 72 (52) min, p<0.005), better patient's global assessment of general health (34 (22) v. 57 (25), p< 0.05), and lower erythrocyte sedimentation rate (32 (22) v. 60 (30) mm/1st h, p <0.05) than the rest of the subjects with erosions, and none of them was in remission after one year. Remission after one year was related to a lack of cortical damage at onset and RF negativity.
Radiological damage at disease onset is associated with a worse clinical presentation and RF positivity, which are markers of poor outcome. There is a subgroup of patients, with erosions only in their feet, whose clinical presentation is less aggressive. To identify these cases of early erosive RA, radiographs of the feet should be obtained routinely.
确定早期类风湿关节炎（RA）患者疾病发作时影像学侵蚀的存在是否与预后不良的临床、血清学或遗传因素相关，以及仅足部有侵蚀的患者是否有不同的表现模式。
研究了61例早期RA（病程<6个月）患者。在疾病发作时和一年后进行了临床评估以及血清学、放射学和遗传学研究。
41例（67%）患者手部或足部或两者均出现侵蚀。侵蚀性RA患者的肿胀关节数更多（分别为9（标准差6）和6（3），p = 0.008），类风湿因子（RF）阳性比无侵蚀患者更常见（分别为80%和50%，p<0.02）。侵蚀组41例患者中有7例（17%）仅足部有侵蚀。该组晨僵持续时间更长（分别为120（60）和72（52）分钟，p<0.005），患者对总体健康的整体评估更好（分别为34（22）和57（25），p <0.05），红细胞沉降率更低（分别为32（22）和60（30）mm/第1小时，p <0.05），且一年后无一例缓解。一年后缓解与发作时无皮质损伤和RF阴性有关。
疾病发作时的放射学损伤与更差的临床表现和RF阳性相关，而RF阳性是预后不良的标志。有一个亚组患者仅足部有侵蚀，其临床表现不那么严重。为了识别这些早期侵蚀性RA病例，应常规拍摄足部X线片。
