Department of Rheumatology, Leiden University Medical Center, 2300 RC Leiden, the Netherlands.
Ann Rheum Dis. 2013 Mar;72(3):345-9. doi: 10.1136/annrheumdis-2012-201391. Epub 2012 May 12.
Radiological damage is an important outcome measure in rheumatoid arthritis (RA), both for research and clinical purposes. Depending on the setting, both hands and feet are radiographed, or only a part of these. It is unknown whether radiographing part of the four extremities gives comparable information to radiographing both hands and feet. This study therefore aimed to compare the radiological information obtained both when evaluating single time point radiographs and progression over time, in early and advanced RA.
6261 sets of hands and feet x-rays of 2193 RA patients from Leiden, Groningen (both from The Netherlands) and North America were studied. Correlations between joint damage at different regions were compared (unilateral vs bilateral and hands vs feet). Analyses were done at single time points (cross-sectional) and for progression over time (longitudinal), both for continuous severity measures (Sharp/van der Heijde score; SHS) and binomial measures of erosiveness.
When studying single time points, the severity of joint damage (SHS) is highly correlated between left and right, but weakly correlated between hands and feet. Correlation coefficients were higher in advanced than early RA. These findings were comparable in the three datasets. When evaluating erosiveness using only unilateral x-rays or hands without feet, 19.3% and 24.0-40.4% are incorrectly classified as non-erosiveness. Similarly, when evaluating disease progression by imaging only unilateral x-rays or only hand x-rays, progression would have been missed in 11.6-16.2% and 21.2-31.0% of patients.
Performing x-rays of both hands and feet yields additive information compared with imaging only a part of these.
放射学损伤是类风湿关节炎（RA）的一个重要结局指标，无论是在研究还是临床方面。根据具体情况，可能会拍摄双手和双脚的 X 光片，或者只拍摄其中一部分。目前尚不清楚拍摄四肢的一部分与拍摄双手和双脚相比，是否能提供具有可比性的信息。因此，本研究旨在比较在早期和晚期 RA 中评估单一时间点 X 光片和随时间进展的放射学信息时，分别拍摄双手和双脚 X 光片所获得的放射学信息。
研究了来自荷兰莱顿和格罗宁根（均来自荷兰）以及北美的 2193 例 RA 患者的 6261 组手部和足部 X 光片。比较了不同部位关节损伤之间的相关性（单侧与双侧、手部与足部）。分析在单一时间点（横断面）和随时间进展（纵向）进行，分别使用连续严重程度测量（Sharp/van der Heijde 评分；SHS）和侵蚀性的二项式测量。
在研究单一时间点时，关节损伤的严重程度（SHS）在左右两侧之间高度相关，但在手和脚之间相关性较弱。在晚期 RA 中，相关系数较高。这一发现在三个数据集之间是可比的。仅使用单侧 X 光片或不包括足部的手部 X 光片评估侵蚀性时，19.3%和 24.0-40.4%会被错误地归类为非侵蚀性。同样，仅使用单侧 X 光片或仅手部 X 光片评估影像学疾病进展时，11.6-16.2%和 21.2-31.0%的患者可能会漏诊疾病进展。
与仅拍摄这些部位的一部分相比，同时拍摄双手和双脚的 X 光片可提供附加信息。
