Department of Rheumatology, Pitié Salpêtriere Hospital, APHP, Université Paris 6-UPMC, Paris, France.
J Rheumatol. 2011 Sep;38(9):2039-44. doi: 10.3899/jrheum.110421.
In rheumatoid arthritis (RA), radiographic progression may occur despite clinical remission. This may be explained by subclinical inflammation. Magnetic resonance imaging (MRI) provides a greater sensitivity than clinical examination and radiography for assessing disease activity. Our objective was to determine the MRI characteristics of RA patients in clinical remission or low disease activity (LDA) state.
Databases from 6 cohorts were collected from 5 international centers. RA patients in clinical remission according to Disease Activity Score28-C-reactive protein (DAS28-CRP < 2.6; n = 213) or LDA-state (2.6 ≤ DAS28-CRP < 3.2; n = 81) with available MRI data were included. MRI were assessed according to the OMERACT RA MRI scoring system (RAMRIS).
70% women, median age 55 (interquartile range, IQR 43-63) years, disease duration 2.3 (IQR 0.7-5.1) years, DAS28-CRP 2.2 (IQR 1.8-2.6), Simplified Disease Activity Index, SDAI, 3.9 (IQR 1.9-6.5), Clinical Disease Activity Index, CDAI, 3.1 (IQR 1.5- 5.8), rheumatoid factor/anti-cyclic citrullinated peptide positivity 57%/54%, presence of radiographic erosions: 66%. Wrist and metacarpophalangeal MRI (MCP-MRI) data were available for 287 and 241 patients, respectively. MRI inflammatory activity in wrist and/or MCP joints was observed in the majority [synovitis: 95%, bone edema (osteitis): 35%] of patients. The median (IQR) RAMRIS score was 6 (3-9) for synovitis and 0 (0-2) for osteitis. Synovitis and osteitis were not less frequent in DAS28 clinical remission (synovitis/osteitis 96%/35%) than LDA (91/36). A trend towards lower frequencies of osteitis in patients in SDAI and CDAI remission was observed.
Subclinical inflammation was identified by MRI in the majority of RA patients in clinical remission or LDA state. This may explain structural progression in such patients. Further work is required to understand the place of modern imaging in future remission criteria.
在类风湿关节炎（RA）中，尽管临床缓解，但仍可能发生放射学进展。这可能是由亚临床炎症引起的。磁共振成像（MRI）在评估疾病活动方面比临床检查和放射照相具有更高的敏感性。我们的目的是确定处于临床缓解或低疾病活动（LDA）状态的 RA 患者的 MRI 特征。
从 5 个国际中心的 6 个队列的数据库中收集数据。纳入了根据疾病活动评分 28- C 反应蛋白（DAS28-CRP<2.6；n=213）或 LDA 状态（2.6≤DAS28-CRP<3.2；n=81）的临床缓解或 LDA 状态且有可用 MRI 数据的 RA 患者。根据 OMERACT RA MRI 评分系统（RAMRIS）评估 MRI。
70%为女性，中位年龄 55 岁（四分位距，IQR 43-63），疾病病程 2.3 年（IQR 0.7-5.1），DAS28-CRP 2.2（IQR 1.8-2.6），简化疾病活动指数（SDAI）为 3.9（IQR 1.9-6.5），临床疾病活动指数（CDAI）为 3.1（IQR 1.5-5.8），类风湿因子/抗环瓜氨酸肽阳性率分别为 57%/54%，存在放射学侵蚀：66%。手腕和掌指关节 MRI（MCP-MRI）数据分别可用于 287 例和 241 例患者。大多数患者的手腕和/或 MCP 关节存在 MRI 炎症活动[滑膜炎：95%，骨水肿（骨炎）：35%]。滑膜炎的中位数（IQR）RAMRIS 评分为 6（3-9），骨炎为 0（0-2）。与 LDA（91%/36%）相比，DAS28 临床缓解时滑膜炎/骨炎的频率更高（滑膜炎/骨炎 96%/35%）。在 SDAI 和 CDAI 缓解的患者中，骨炎的频率呈下降趋势。
在处于临床缓解或 LDA 状态的大多数 RA 患者中，MRI 显示存在亚临床炎症。这可能解释了此类患者的结构进展。需要进一步研究以了解现代影像学在未来缓解标准中的地位。
