Department of Clinical Imaging and Radiology, Medical School, University of Ioannina, Greece.
Scand J Rheumatol. 2012 Oct;41(5):339-44. doi: 10.3109/03009742.2012.666263. Epub 2012 May 31.
To evaluate the magnetic resonance imaging (MRI) findings of hand involvement before and 1 year after treatment in patients with early rheumatoid arthritis (RA).
MRI of the dominant hand was performed in 22 patients fulfilling the new criteria for early RA. The patients were divided into three groups. Nine had very early RA (VERA; disease duration < 3 months), seven had early RA (ERA; disease duration < 6 months), and six had established RA (ESTRA; disease duration > 12 months). The MRI protocol consisted of fat-suppressed T2, and plain and contrast-enhanced T1-weighted sequences. Assessment of bone marrow oedema, synovitis, and bone erosions was performed by the OMERACT RA MRI scoring system. Patients were treated with methotrexate (MTX) 0.2 mg/kg/body weight/week and prednisone 7.5 mg/day. Clinical assessment was evaluated using the Disease Activity Score for 28 joint indices (DAS28).
After treatment, a significant decrease was observed: (a) in DAS28 of VERA (6.2 ± 0.9 vs. 2.4 ± 1.2), ERA (5.3 ± 0.8 vs. 2.8 ± 1.0), and ESTRA patients (5.7 ± 8.0 vs. 2.7 ± 0.7; p < 0.05); (b) in bone oedema (16.77 ± 13.78 vs. 5.88 ± 6.31) and synovitis (12.44 ± 6.44 vs. 2.88 ± 3.25) of VERA patients; and (c) in synovitis (7.57 ± 6.32 vs. 1.42 ± 1.81) of ERA patients (p < 0.05). No significant difference was found in erosions in any group.
Bone marrow oedema and synovitis decrease significantly when RA is diagnosed and treated early. MRI is useful in the early detection of these changes. MTX treatment resulted in a significant decrease in DAS28 score and significant improvement in bone oedema and synovitis.
评估早期类风湿关节炎（RA）患者治疗前后手部磁共振成像（MRI）的表现。
对符合早期 RA 新标准的 22 例患者进行了手部 MRI 检查。将患者分为三组：9 例为极早期 RA（VERA；病程<3 个月），7 例为早期 RA（ERA；病程<6 个月），6 例为已确诊 RA（ESTRA；病程>12 个月）。MRI 方案包括脂肪抑制 T2、平扫和对比增强 T1 加权序列。采用 OMERACT RA MRI 评分系统评估骨髓水肿、滑膜炎和骨侵蚀情况。患者接受甲氨蝶呤（MTX）0.2mg/kg/体重/周和泼尼松 7.5mg/天治疗。采用 28 关节疾病活动评分（DAS28）评估临床评估。
治疗后，VERA（6.2±0.9 与 2.4±1.2）、ERA（5.3±0.8 与 2.8±1.0）和 ESTRA 患者（5.7±8.0 与 2.7±0.7）的 DAS28 显著降低（p<0.05）；VERA 患者的骨髓水肿（16.77±13.78 与 5.88±6.31）和滑膜炎（12.44±6.44 与 2.88±3.25）显著降低（p<0.05）；ERA 患者的滑膜炎（7.57±6.32 与 1.42±1.81）显著降低（p<0.05）。任何一组的侵蚀均无显著差异。
RA 早期诊断和治疗时，骨髓水肿和滑膜炎明显减少。MRI 有助于早期发现这些变化。MTX 治疗可显著降低 DAS28 评分，并显著改善骨髓水肿和滑膜炎。
