Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
Ann Rheum Dis. 2013 Jun;72(6):870-4. doi: 10.1136/annrheumdis-2011-201191. Epub 2012 Jun 30.
To evaluate the contribution of joint space narrowing (JSN) and erosions in general and in four different joint groups in relation to physical disability in rheumatoid arthritis (RA).
5-year follow-up data from the Behandel Strategieën (BeSt) trial were used, where 508 patients with recent onset RA were treated aiming at a disease activity score≤2.4. Joint damage was assessed annually and scored according to the Sharp-van der Heijde method. Physical disability was measured 3-monthly with the Health Assessment Questionnaire (HAQ). Generalised Estimating Equations analyses were performed to assess the relationship between the HAQ and JSN scores and erosions scores, separately and in joint groups.
Overall, damage scores were low, and neither total JSN nor erosions showed a significant effect on HAQ (β=0.001 95% CI -0.003 to 0.004 and β=0.002 95% CI -0.001 to 0.006, respectively). Of the total damage scores per joint group, damage in the wrist shows a trend for association with physical disability displaying the largest effect size (β=0.005 95% CI 0.000 to 0.011). Also in the analysis with erosions per joint group, the wrist was most strongly related with physical functioning (β=0.016 95% CI 0.003 to 0.029); in the analysis with JSN per joint group no joint group was significantly related to the HAQ. Analysis of all erosion and narrowing scores per joint group in one model reveals only erosions in the wrist to be independently associated with impaired physical functioning (β=0.017 95% CI 0.003 to 0.030).
Joint damage in the wrist, erosions more than JSN, is associated with impaired physical functioning even in patients with early RA with limited overall damage after 5 years tightly controlled treatment.
评估关节间隙狭窄（JSN）和侵蚀在类风湿关节炎（RA）中的一般作用，以及在四个不同关节群中的作用与身体残疾的关系。
使用 Behandel Strategien（BeSt）试验的 5 年随访数据，其中 508 例近期发病的 RA 患者接受治疗，目标是疾病活动评分≤2.4。每年评估关节损伤，并根据 Sharp-van der Heijde 方法进行评分。使用健康评估问卷（HAQ）每 3 个月评估一次身体残疾。使用广义估计方程分析分别评估 JSN 评分和侵蚀评分与 HAQ 之间的关系，以及在关节群中的关系。
总体而言，损伤评分较低，总 JSN 或侵蚀均未对 HAQ 产生显著影响（β=0.001，95%CI-0.003 至 0.004 和β=0.002，95%CI-0.001 至 0.006）。在每个关节群的总损伤评分中，手腕损伤与身体残疾呈趋势相关，显示出最大的效应量（β=0.005，95%CI0.000 至 0.011）。在每个关节群的侵蚀分析中，手腕与身体功能的相关性最强（β=0.016，95%CI0.003 至 0.029）；在每个关节群的 JSN 分析中，没有一个关节群与 HAQ 显著相关。在一个模型中分析所有关节群的侵蚀和狭窄评分仅显示手腕侵蚀与身体功能受损独立相关（β=0.017，95%CI0.003 至 0.030）。
即使在经过 5 年严格控制治疗后，早期 RA 患者的整体损伤有限，手腕关节的关节损伤、侵蚀甚于 JSN，与身体功能受损相关。
