Division of Rheumatology, University of Pavia School of Medicine, IRCCS Policlinico San Matteo Fondation, Piazzale Golgi 2, 27100 Pavia, Italy.
Ther Adv Musculoskelet Dis. 2012 Aug;4(4):235-44. doi: 10.1177/1759720X12453092.
Although rheumatoid arthritis (RA) is traditionally considered as the prototype of destructive arthritis, the course of the disease varies considerably, with some patients experiencing more rapid progression of joint damage and disability than others. Given the increasing availability of treatment targets and options, timely recognition of individual's outcomes could allow therapeutic allocation according to personalized benefit-risk profiles. Research efforts are thus increasingly focused at discovering predictive markers that could identify patients with aggressive, rapidly progressive disease and poor prognosis. As joint destruction in RA is the result of the cumulative burden of inflammation, variables reflecting the severity of synovitis and its persistence over time might refine our ability to build early prognostic algorithms. The goal of this article is to review the clinical implications of the assessment of synovitis in relation to radiographic outcomes. Traditional and novel assessment tools will be discussed, including clinical measures, imaging techniques and tissue biomarkers. Achievements in the field of synovial tissue analysis and peripheral blood biomarkers of synovitis represent only the first steps of ongoing progress, which still need to be integrated into the phenotypic heterogeneity of RA.
虽然类风湿关节炎 (RA) 通常被认为是破坏性关节炎的典型范例，但疾病的病程差异很大，一些患者的关节损伤和残疾进展速度比其他患者更快。鉴于治疗靶点和选择的日益增加，及时识别个体的结局可以根据个性化的获益-风险状况进行治疗分配。因此，研究工作越来越集中在发现预测标志物上，这些标志物可以识别出具有侵袭性、快速进展和预后不良的疾病患者。由于 RA 中的关节破坏是炎症累积负担的结果，因此反映滑膜炎严重程度及其随时间持续存在的变量可能会提高我们构建早期预后算法的能力。本文的目的是回顾滑膜炎评估与影像学结果之间的临床意义。将讨论传统和新型评估工具，包括临床指标、影像学技术和组织生物标志物。滑膜组织分析领域的成就和滑膜炎的外周血生物标志物仅代表正在进行的进展的第一步，仍需要整合到 RA 的表型异质性中。
