Department of Rheumatology, Copenhagen University Hospitals at Hvidovre and Glostrup, Hvidovre, Denmark.
Ann Rheum Dis. 2011 Feb;70(2):252-8. doi: 10.1136/ard.2009.123729. Epub 2010 Oct 26.
To monitor joint inflammation and destruction in rheumatoid arthritis (RA) patients receiving adalimumab/methotrexate combination therapy using MRI and ultrasonography. To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring.
Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/radiography (0/6/12 months) and clinical/biochemical assessments during adalimumab/methotrexate combination therapy.
No overall erosion progression or repair was observed at 6 or 12 months (Wilcoxon; p > 0.05), but erosion progressors and regressors were observed using the smallest detectable change cut-off. Scores of MRI synovitis, grey-scale synovitis (GSS) and power Doppler ultrasonography decreased after 6 and 12 months (p < 0.05), as did DAS28, HAQ and tender and swollen joint counts (p < 0.001). Patients with progression on CT had higher baseline MRI bone oedema scores. The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 (95% CI 1.5 to 9.3) and time-integrated MRI bone oedema, power Doppler and GSS scores were higher in bones/joints with CT progression (Mann-Whitney; p < 0.05). With CT as the reference method, sensitivities/specificities for erosion in metacarpophalangeal joints were 68%/92%, 44%/95% and 26%/98% for MRI, ultrasonography and radiography, respectively. Median intraobserver correlation coefficient was 0.95 (range 0.44-0.99).
During adalimumab/methotrexate combination therapy, no overall erosive progression or repair occurred, whereas repair of individual erosions was documented on MRI, and MRI and ultrasonography synovitis decreased. Inflammation on MRI and ultrasonography, especially MRI bone oedema, was predictive for erosive progression on CT, at bone/joint level and MRI bone oedema also at patient level.
使用 MRI 和超声检查监测接受阿达木单抗/甲氨蝶呤联合治疗的类风湿关节炎（RA）患者的关节炎症和破坏情况。评估 MRI 和超声检查对 CT 上侵蚀进展的预测价值，并比较 MRI/超声/射线照相检查在侵蚀检测/监测方面的作用。
52 例侵蚀性生物初治 RA 患者在接受阿达木单抗/甲氨蝶呤联合治疗期间接受了重复的 MRI/超声/射线照相（0/6/12 个月）和临床/生化评估。
在 6 个月或 12 个月时，未观察到总体侵蚀进展或修复（Wilcoxon；p > 0.05），但使用最小可检测变化的截止值观察到了侵蚀进展者和缓解者。6 个月和 12 个月后，MRI 滑膜炎、灰阶滑膜炎（GSS）和能量多普勒超声评分下降（p < 0.05），DAS28、HAQ 和压痛及肿胀关节计数也下降（p < 0.001）。在 CT 上有进展的患者基线时 MRI 骨水肿评分更高。基线时 MRI 骨水肿存在与不存在的患者 CT 进展的 RR 为 3.8（95%CI 1.5 至 9.3），并且在 CT 进展的骨骼/关节中，时间积分 MRI 骨水肿、能量多普勒和 GSS 评分更高（Mann-Whitney；p < 0.05）。以 CT 为参考方法，掌指关节侵蚀的 MRI、超声和射线照相的敏感性/特异性分别为 68%/92%、44%/95%和 26%/98%。观察者内相关系数的中位数为 0.95（范围 0.44 至 0.99）。
在阿达木单抗/甲氨蝶呤联合治疗期间，未发生总体侵蚀进展或修复，但 MRI 记录了个别侵蚀的修复，并且 MRI 和超声滑膜炎减少。MRI 和超声检查的炎症，尤其是 MRI 骨水肿，对 CT 上的侵蚀进展有预测作用，不仅在骨骼/关节水平，而且在 MRI 骨水肿的患者水平也有预测作用。
