Solau-Gervais Elisabeth, Legrand Jean-Louis, Cortet Bernard, Duquesnoy Bernard, Flipo René-Marc
Department of Rheumatology, Lille University Hospital, Lille, France.
J Rheumatol. 2006 Sep;33(9):1760-5. Epub 2006 Jul 1.
To assess the practical usefulness of magnetic resonance imaging (MRI) in establishing a positive diagnosis of rheumatoid arthritis (RA) in a cohort of patients with early inflammatory polyarthralgia, in the absence of anti-cyclic citrullinated peptide (anti-CCP) antibodies.
We prospectively followed 30 outpatients with inflammatory polyarthralgia and/or synovitis of at least one joint. Patients were disease modifying antirheumatic drug-naive and received no corticosteroids. At the initial visit a clinical examination, radiographs of hands, wrists and feet, and MRI of hands were performed. Rheumatoid factor and anti-CCP antibodies were assessed. The MRI procedure was T1 fat saturation with gadolinium injection [scores were established on the basis of the axial view of the carpal and metacarpal joints, using the RA MRI scoring system (RAMRIS) defined in the OMERACT study]. In all patients, radiographs at baseline were normal and anti-CCP antibodies were negative.
At one-year followup, the final diagnosis was: 16 RA; the non-RA group was composed of 4 cases of spondyloarthropathy, 2 cases of fibromyalgia, 4 cases of undifferentiated arthritis (3 of which were self-limiting), 1 sicca syndrome, 1 hemochromatosis, 1 polymyositis, and 1 paraneoplastic syndrome. No statistical difference was found between patients with and without RA for carpal erosion, synovitis, and tenosynovitis. However, a statistical difference was observed between the RA and non-RA group where metacarpophalangeal (MCP) erosion scores were concerned (p = 0.024). This difference persisted when we compared erosions of the second and third MCP in the 2 groups (p = 0.044). ROC curve analysis revealed a positive MCP score at 15, with a specificity of 70% and a sensitivity of 64%.
In our population of 30 anti-CPP negative patients with normal radiographs, MRI of hands, showing MCP erosions, can be helpful for the diagnosis of RA.
评估在一组早期炎症性多关节痛且无抗环瓜氨酸肽（抗CCP）抗体的患者中，磁共振成像（MRI）对类风湿关节炎（RA）做出阳性诊断的实际效用。
我们前瞻性地随访了30例患有炎症性多关节痛和/或至少一个关节滑膜炎的门诊患者。患者未使用改善病情抗风湿药物，且未接受皮质类固醇治疗。在初次就诊时，进行了临床检查、手部、腕部和足部的X线片以及手部的MRI检查。评估了类风湿因子和抗CCP抗体。MRI检查采用钆增强T1脂肪抑制序列[评分基于腕关节和掌指关节的轴位视图，使用OMERACT研究中定义的RA MRI评分系统（RAMRIS）]。所有患者基线时的X线片均正常，抗CCP抗体均为阴性。
在一年的随访中，最终诊断结果为：16例RA；非RA组包括4例脊柱关节炎、2例纤维肌痛、4例未分化关节炎（其中3例为自限性）、1例干燥综合征、1例血色素沉着症、1例多发性肌炎和1例副肿瘤综合征。在腕骨侵蚀、滑膜炎和腱鞘炎方面，RA患者和非RA患者之间未发现统计学差异。然而，在掌指关节（MCP）侵蚀评分方面，RA组和非RA组之间观察到统计学差异（p = 0.024）。当我们比较两组中第二和第三掌指关节的侵蚀情况时，这种差异仍然存在（p = 0.044）。ROC曲线分析显示，MCP评分为15时为阳性，特异性为70%，敏感性为64%。
在我们这30例抗CPP阴性且X线片正常的患者中，显示MCP侵蚀的手部MRI有助于RA的诊断。
