Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
Ann Rheum Dis. 2010 Apr;69(4):727-9. doi: 10.1136/ard.2009.108332. Epub 2009 May 18.
Joint destruction in rheumatoid arthritis (RA) was until recently seen as an irreversible state. Lately, it was found that repair of bone erosions occurs; however, little is known about its prevalence.
To investigate the frequency of repair and patients' characteristics associated with repair in an inception cohort.
250 patients with RA, included in the Leiden Early Arthritis Clinic between 1993 and 2000 and treated with conventional disease-modifying antirheumatic drugs, were studied (mean follow-up 10.1 years). Radiographs obtained annually were scored using the Sharp-van der Heijde method, initially aware of the chronology. Patients with a negative change in erosion scores on subsequent radiographs were selected and their series of radiographs were re-scored with concealed time sequence by three readers. Repair was defined as agreement between two readers of a negative change in erosion scores that persisted for at least 2 years.
Repair was identified in 32 joints in 18 patients (7.2%). Patients with repair had a greater prevalence of autoantibodies (rheumatoid arthritis, anti-citrullinated protein antibody) and a higher level of joint destruction. In the joints with repair, arthritis was absent in the 2 years preceding repair.
Repair occurred in 7.2% of the patients with RA, particularly in clinically inactive joints in patients with severe destructive disease.
类风湿关节炎（RA）中的关节破坏在过去被认为是一种不可逆转的状态。最近发现骨侵蚀有修复的现象，但是对于其发生率知之甚少。
在一个起始队列中调查修复的频率以及与修复相关的患者特征。
1993 年至 2000 年间在莱顿早期关节炎诊所纳入的 250 例 RA 患者（平均随访 10.1 年）接受了常规疾病修饰抗风湿药物治疗。每年获得的 X 线片采用 Sharp-van der Heijde 评分法进行评分，最初了解其时间顺序。选择随后 X 线片侵蚀评分无变化的患者，并由三位读者对其 X 线片系列进行隐蔽时间序列重新评分。修复定义为两位读者对侵蚀评分无变化的一致判断，且该判断至少持续 2 年。
18 例患者的 32 个关节中发现了修复（7.2%）。有修复的患者自身抗体（类风湿关节炎、抗瓜氨酸蛋白抗体）的患病率更高，关节破坏程度更严重。在有修复的关节中，关节炎在修复前的 2 年内不存在。
RA 患者中有 7.2%出现了修复，尤其是在严重破坏性疾病患者的临床无活动性关节中。
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