Haavardsholm E A, Østergaard M, Hammer H B, Bøyesen P, Boonen A, van der Heijde D, Kvien T K
Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, N-0319 Oslo, Norway.
Ann Rheum Dis. 2009 Oct;68(10):1572-9. doi: 10.1136/ard.2008.091801. Epub 2008 Nov 19.
To evaluate the responsiveness of magnetic resonance imaging (MRI) and ultrasonography (US) compared with conventional measures of disease activity and structural damage in patients with rheumatoid arthritis (RA) during the first year of treatment with anti-tumour necrosis factor alpha (TNFalpha).
A cohort of patients with RA (N = 36, median age 53 years, disease duration 7.6 years and disease activity score (DAS28) 5.7) was evaluated by core measures of disease activity, US (one wrist), MRI (one wrist) and conventional radiography (CR, both hands and wrists) at initiation of treatment with anti-TNFalpha agents and after 3, 6 and 12 months. Responsiveness was assessed by standardised response means (SRM). Accepted thresholds were applied to classify responsiveness as trivial, low, moderate or good.
MRI synovitis (SRM between -0.79 and -0.92) and the MRI total inflammation score comprising synovitis, tenosynovitis and bone marrow oedema (SRM between -1.05 and -1.24) were highly responsive. Moderate to high responsiveness was found for MRI tenosynovitis and bone marrow oedema, all the composite indices (DAS28, simplified disease activity index (SDAI) and clinical disease activity index (CDAI)) and the 28-swollen joint count. US displayed low to moderate responsiveness. The MRI erosion score displayed low responsiveness but was more responsive than CR measures at 3 and 6 months follow-up. MRI and CR measures of annual progression rates of damage performed similarly and were highly responsive.
The most responsive measure of inflammation when evaluating anti-TNFalpha medication was a composite measure comprising MRI synovitis, tenosynovitis and bone marrow oedema, and this may be a promising outcome measure in clinical studies.
在类风湿关节炎（RA）患者接受抗肿瘤坏死因子α（TNFα）治疗的第一年，评估磁共振成像（MRI）和超声检查（US）与疾病活动和结构损伤的传统测量方法相比的反应性。
一组RA患者（N = 36，中位年龄53岁，病程7.6年，疾病活动评分（DAS28）为5.7）在开始使用抗TNFα药物治疗时以及治疗3、6和12个月后，通过疾病活动的核心测量指标、US（一侧手腕）、MRI（一侧手腕）和传统X线摄影（CR，双手和手腕）进行评估。通过标准化反应均值（SRM）评估反应性。应用公认的阈值将反应性分类为轻微、低、中度或良好。
MRI滑膜炎（SRM在-0.79至-0.92之间）以及包括滑膜炎、腱鞘炎和骨髓水肿的MRI总炎症评分（SRM在-1.05至-1.24之间）反应性很高。MRI腱鞘炎和骨髓水肿、所有综合指标（DAS28、简化疾病活动指数（SDAI）和临床疾病活动指数（CDAI））以及28个肿胀关节计数显示出中度至高反应性。US显示出低至中度反应性。MRI侵蚀评分反应性较低，但在3个月和6个月随访时比CR测量更具反应性。MRI和CR测量的损伤年进展率表现相似且反应性很高。
在评估抗TNFα药物时，最具反应性的炎症测量指标是一项综合指标，包括MRI滑膜炎、腱鞘炎和骨髓水肿，这可能是临床研究中一个有前景的结果测量指标。
