Sokka Tuulikki, Kautiainen Hannu, Möttönen Timo, Hannonen Pekka
Jyväskylä Central Hospital, Jyväskylä, Finland.
J Rheumatol. 2003 Dec;30(12):2580-4.
To study whether clinically observed tenderness and/or swelling of a wrist joint over the first 3 years after diagnosis predict the development of erosions in radiographs of the same joint at 5 years in patients with early rheumatoid arthritis (RA).
A total of 58 patients with recent onset RA were enrolled in a prospective RA study at Jyväskylä Central Hospital in 1983-85. Physical examination including joint counts was performed 6 times over 3 years (at 0, 6, 12, 18, 24, and 36 mo). Radiographs of hands and feet taken at the 5-year visit were scored according to the Larsen method (0-1 = non-erosive; 2-5 = erosive). At each visit, the wrist joints were assessed for tenderness (0/1) and swelling (0/1). A frequency (ranging from 0 to 6) was calculated for 4 inflammation categories tenderness, swelling, tenderness or swelling, and tenderness and swelling over the 3 years. Percentages of wrist joints with erosions on the 5-year radiographs were calculated for the frequency groups 0, 1, 2-3, and 4-6 of each category. Two patients died, and 5 wrists were erosive at baseline. Thus the data for 107 wrist joints of 54 patients were available for analyses.
A statistically significant correlation was seen in the frequency of clinical inflammation and the development of erosions. Only one (3.3%) wrist with no tenderness in 6 examinations over the first 3 years developed erosions over 5 years, while 13 (59.1%) wrists that were tender 4-6 times in 6 examinations developed erosions. The corresponding percentages were 4.4% and 50.0% for wrists with swelling, 3.4% and 51.6% for wrists with tenderness or swelling, and 6.1% and 75.0% for wrists with tenderness and swelling.
Radiographic erosions develop rarely without preceding clinically detectable inflammation in the joints of patients with early RA.
研究在早期类风湿关节炎（RA）患者中，诊断后前3年临床上观察到的腕关节压痛和/或肿胀是否可预测同一关节在5年时X线片上侵蚀的发展。
1983 - 1985年，共有58例近期发病的RA患者纳入于约恩苏中央医院的一项前瞻性RA研究。在3年期间进行6次体格检查，包括关节计数（在0、6、12、18、24和36个月时）。在5年随访时拍摄的手和脚的X线片根据Larsen方法评分（0 - 1 = 无侵蚀；2 - 5 = 有侵蚀）。每次随访时，评估腕关节的压痛（0/1）和肿胀（0/1）。计算3年中4种炎症类别（压痛、肿胀、压痛或肿胀、压痛且肿胀）的频率（范围从0至6）。计算每类频率组0、1、2 - 3和4 - 6在5年X线片上有侵蚀的腕关节百分比。2例患者死亡，5个腕关节在基线时已有侵蚀。因此，54例患者的107个腕关节数据可用于分析。
临床炎症频率与侵蚀发展之间存在统计学显著相关性。在最初3年的6次检查中无压痛的腕关节，5年中仅有1个（3.3%）出现侵蚀，而在6次检查中压痛4 - 6次的13个腕关节（59.1%）出现侵蚀。有肿胀的腕关节相应百分比分别为4.4%和50.0%，有压痛或肿胀的腕关节为3.4%和51.6%，有压痛且肿胀的腕关节为6.1%和75.0%。
在早期RA患者关节中，若无前驱临床可检测到的炎症，很少会出现X线侵蚀。
