Boesen Mikael, Boesen Lars, Jensen Karl Erik, Cimmino Marco Amedeo, Torp-Pedersen Søren, Terslev Lene, Koenig Merete, Danneskiold-Samsøe Bente, Røgind Henrik, Bliddal Henning
The Parker Institute Frederiksberg Hospital, Copenhagen, Denmark;
J Rheumatol. 2008 Apr;35(4):584-91. Epub 2008 Mar 1.
To assess the magnetic resonance imaging (MRI) and ultrasound (US) changes in the wrist of patients with rheumatoid arthritis (RA) 4 weeks after an US guided intraarticular (IA) injection.
Contrast enhanced MRI and US-Doppler were performed at baseline and 4 weeks after IA injection of either 40 mg methylprednisolone (n = 12) or 25 mg etanercept (n = 13) in 25 patients with RA taking disease modifying antirheumatic drugs with a therapy-resistant wrist joint. All injections were US guided.
There was an improvement in swollen target joint score (p < 0.001), tender target joint score (p < 0.002), and physician visual analog scale score (p < 0.001) after 4 weeks. Baseline MRI synovitis score was mean 5.08 (range 3-9) and was unchanged at followup in the whole group (p = 0.52) and between treatment groups (p = 0.43). MRI edema score (mean 4.46, range 0-29) in the total group was unchanged after 4 weeks (p = 0.13), whereas MRI erosion score increased in the total group from baseline, 17.88 (range 7-40), to 4 weeks, 18.25 (range 7-40) (p < 0.001). Neither US-Doppler color fraction (0.07) nor Resistive Index (RI) (p = 0.36) changed from baseline to 4 week followup.
In contrast to the clinical evaluation, imaging measures of relevance for the estimation of inflammation, US-Doppler, US RI, MRI synovitis, and bone-marrow edema did not change 4 weeks after a single IA injection of either methylprednisolone or etanercept in the wrist. Within the same period, erosive progression in some patients suggested that joints with active disease may deteriorate within as little as 1 month, and that this development is not arrested by 1 injection. Given the small sample size of our study further studies are required to confirm our results.
评估类风湿关节炎（RA）患者在超声引导下进行关节内（IA）注射4周后手腕部的磁共振成像（MRI）和超声（US）变化。
对25例服用改善病情抗风湿药物但腕关节治疗抵抗的RA患者，在基线期以及注射40mg甲泼尼龙（n = 12）或25mg依那西普（n = 13）后4周进行对比增强MRI和超声多普勒检查。所有注射均在超声引导下进行。
4周后，肿胀靶关节评分（p < 0.001）、压痛靶关节评分（p < 0.002）和医生视觉模拟量表评分（p < 0.001）均有改善。基线期MRI滑膜炎评分为5.08（范围3 - 9），在整个组的随访中未改变（p = 0.52），治疗组间也未改变（p = 0.43）。4周后，整个组的MRI水肿评分（平均4.46，范围0 - 29）未改变（p = 0.13），而整个组的MRI侵蚀评分从基线期的17.88（范围7 - 40）增加到4周时的18.25（范围7 - 40）（p < 0.001）。从基线期到4周随访，超声多普勒彩色分数（0.07）和阻力指数（RI）（p = 0.36）均未改变。
与临床评估不同，在手腕部单次IA注射甲泼尼龙或依那西普4周后，用于评估炎症的相关影像学指标，即超声多普勒、超声RI、MRI滑膜炎和骨髓水肿均未改变。在同一时期，部分患者的侵蚀进展提示，患有活动性疾病的关节可能在短短1个月内恶化，且1次注射并不能阻止这种进展。鉴于本研究样本量较小，需要进一步研究以证实我们的结果。
