Spire Sciences, LLC, San Francisco, CA, USA.
J Rheumatol. 2011 Sep;38(9):2023-30. doi: 10.3899/jrheum.110418.
The current validated magnetic resonance imaging (MRI) scoring method for rheumatoid arthritis (RA) in clinical trials, RA MRI Score (RAMRIS), incorporates all metacarpophalangeal (MCP) and wrist joints except MCP-1. The experience with radiographic scoring, however, was that excluding certain bones in the wrist improved the discriminative power for changes over time. In this study, we pool MRI data from randomized controlled clinical trails (RCT) to determine which combination of MCP and wrist joints are most sensitive and discriminative for structural changes over time.
MR images from 4 multicenter RCT, including 522 RA patients, were read by 2 radiologists, using the RAMRIS scoring system for erosion, osteitis, and synovitis. In one RCT, joint-space narrowing (JSN) was assessed cross-sectionally by one radiologist using a previously validated method. Baseline frequencies of erosion, JSN, osteitis, and synovitis of different bones and joints in the hand and wrist were compared. Intraclass correlation coefficients between readers were determined for each location. Finally, 7 different combinations of bone/joint locations were compared for their ability to discriminate subjects showing increases or decreases from baseline greater than or equal to smallest detectable changes (SDC) at Weeks 12 or 24.
Frequency of involvement and reliability for assessing change varied by location. As in earlier analyses, excluding certain wrist bones increased the percentage of subjects showing changes greater than or equal to SDC.
These findings suggest that excluding wrist bones that do not frequently or reliably demonstrate structural changes improves the discriminative power of the RAMRIS scoring system.
目前临床试验中用于评估类风湿关节炎（RA）的经验证的磁共振成像（MRI）评分方法——RA MRI 评分（RAMRIS），纳入了除第 1 掌指关节（MCP-1）以外的所有掌指关节（MCP）和腕关节。然而，基于放射学评分的经验表明，排除腕关节中的某些骨头可以提高对随时间变化的区分能力。在这项研究中，我们汇集了来自随机对照临床试验（RCT）的 MRI 数据，以确定哪些 MCP 和腕关节的组合对于随时间的结构变化最敏感和最具区分性。
我们对来自 4 项多中心 RCT 的 MRI 图像进行了分析，这些 RCT 共纳入了 522 例 RA 患者，由 2 位放射科医生使用 RAMRIS 评分系统评估侵蚀、骨炎和滑膜炎。在一项 RCT 中，一位放射科医生使用之前验证过的方法进行了横断面评估关节间隙狭窄（JSN）。比较了手部和腕部不同骨骼和关节的基线侵蚀、JSN、骨炎和滑膜炎的发生率。确定了每位读者在每个部位的组内相关系数。最后，比较了 7 种不同的骨骼/关节位置组合，以评估它们在区分基线时显示大于或等于最小可检测变化（SDC）的患者在第 12 或 24 周时的增加或减少的能力。
受累的频率和评估变化的可靠性因位置而异。与之前的分析一样，排除某些腕骨可以增加显示大于或等于 SDC 的变化的患者比例。
这些发现表明，排除通常不会或不能可靠地显示结构变化的腕骨可以提高 RAMRIS 评分系统的区分能力。
