Academic Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK.
Rheumatology (Oxford). 2012 Jun;51(6):1099-106. doi: 10.1093/rheumatology/ker420. Epub 2012 Feb 10.
Bone marrow oedema (BMO) and HLA-B27 are poor prognostic factors in axial SpA, and psoriasis is a poor prognostic factor in small-joint polyarthropathy. The aim of this study was to investigate the influence of HLA-B27, MRI BMO and psoriasis on long-term outcomes in early SpA-related knee joint oligoarthritis.
Patients with SpA-related oligoarthritis with knee involvement were recruited. Baseline assessment included ESSG criteria, RF, HLA-B27 and MRI. The degree of MRI BMO was determined on fat-suppression sequences and scored using the whole-organ magnetic resonance imaging score (WORMS) (range 0-45). Patients were treated at the discretion of their rheumatologist and followed up for 10 years. Outcome assessments included joint counts, functional and symptomatic questionnaire, CRP and radiographic assessment for OA.
Forty-four patients were recruited [mean age 32 years (range 15-59 years), 70% male] with a mean disease duration at baseline of 9.75 months (1-48 months). Twenty-six (59%) patients (mean age 43 years, 65% male) returned for follow-up after a mean of 10 years (range 8.4-12.6 years). Ten (38%) patients had persistent clinical synovitis and 31% of knees had secondary radiographic OA. Global outcome was poor/very poor in 69% of cases. The only factor predicting outcome at 10 years was psoriasis, but neither HLA-B27 nor BMO. PsA patients had significantly worse global outcome compared with ReA (P = 0.036), and significantly worse symptomatic (P = 0.001) and functional (P = 0.001) outcome compared with other subtypes.
SpA-related knee joint oligoarthritis has significant long-term clinical and radiological morbidity despite standard treatments. HLA-B27 and MRI BMO were not predictors of poor outcome as they are in axial SpA; however, the presence of psoriasis predicted significantly worse outcome.
骨髓水肿（BMO）和 HLA-B27 是中轴型脊柱关节炎的预后不良因素，而银屑病是小关节多关节炎的预后不良因素。本研究旨在探讨 HLA-B27、MRI BMO 和银屑病对早期脊柱关节炎相关膝关节寡关节炎长期结局的影响。
招募了患有脊柱关节炎相关寡关节炎伴膝关节受累的患者。基线评估包括 ESSG 标准、RF、HLA-B27 和 MRI。通过脂肪抑制序列确定 MRI BMO 的程度，并使用全器官磁共振成像评分（WORMS）（范围 0-45）进行评分。患者的治疗由风湿病医生决定，并进行了 10 年的随访。结局评估包括关节计数、功能和症状问卷、CRP 和放射学评估 OA。
共招募了 44 例患者[平均年龄 32 岁（范围 15-59 岁），70%为男性]，基线时平均病程为 9.75 个月（1-48 个月）。26 例（59%）患者（平均年龄 43 岁，65%为男性）在平均 10 年后（范围 8.4-12.6 年）进行了随访。10 例（38%）患者持续存在临床滑膜炎，31%的膝关节发生继发性放射学 OA。69%的病例总体结局较差/极差。10 年时唯一预测结局的因素是银屑病，但 HLA-B27 和 BMO 不是。与反应性关节炎相比，银屑病关节炎患者的总体结局明显更差（P=0.036），且症状（P=0.001）和功能（P=0.001）结局明显更差。
尽管采用了标准治疗，但脊柱关节炎相关膝关节寡关节炎仍存在显著的长期临床和放射学发病率。HLA-B27 和 MRI BMO 不是中轴型脊柱关节炎的不良预后因素；然而，银屑病的存在预测了明显更差的结局。
