Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, , Erlangen, Germany.
Ann Rheum Dis. 2014 Jun;73(6):1101-6. doi: 10.1136/annrheumdis-2012-202850. Epub 2013 Apr 26.
To investigate the relation between anatomic changes of the synovium, the bone, the bone marrow and the cartilage to biochemical properties of the cartilage in patients with rheumatoid arthritis (RA).
33 patients with RA received 3-T MRI scans of the metacarpophalangeal joints. Two independent methods, (A) the delayed gadolinium enhanced MRI of the cartilage (dGEMRIC, T2-mapping), which was used to assess the biochemical properties of the cartilage; (B) synovitis, osteitis and bone erosions were quantified according to the RA MRI scoring (RAMRIS) method and cartilage thickness (CT), interbone joint space (IBJS, distance between proximal and distal bone surface) and intercartilage joint space (ICJS, distance between proximal and distal cartilage surface) were measured.
Biochemical changes of the cartilage, corresponding to low dGEMRIC and high T2 values, were more likely to be seen in joints with decreased IBJS and ICJS as well as decreased CT. For instance, dGEMRIC was directly correlated to the IBJS (p=0.001) and ICJS (p=0.001), whereas T2 mapping was inversely correlated to IBJS and ICJS (both p=0.017). Moreover, the degree of osteitis, and to some extent synovitis, was correlated to biochemical cartilage changes as measured by dGEMRIC (p=0.003) or the T2 mapping (p=0.013). By contrast, bone erosions did not correlate to the degree of biochemical cartilage changes.
These data support the concept that synovitis and osteitis may be two main triggers for cartilage damage. Thus, the actual inflammatory state of a joint, but not so much the degree of bone erosion, appears to influence cartilage properties in RA.
探讨类风湿关节炎（RA）患者滑膜、骨、骨髓和软骨的解剖学变化与软骨生化特性之间的关系。
33 例 RA 患者接受了掌指关节 3-T MRI 扫描。采用两种独立的方法，（A）延迟钆增强 MRI 软骨成像（dGEMRIC，T2 映射），用于评估软骨的生化特性；（B）根据 RA MRI 评分（RAMRIS）方法和软骨厚度（CT）、骨间关节间隙（IBJS，近端和远端骨表面之间的距离）和软骨间关节间隙（ICJS，近端和远端软骨表面之间的距离）来量化滑膜炎、骨炎和骨侵蚀。
生化变化的软骨，对应于低 dGEMRIC 和高 T2 值，更可能发生在 IBJS 和 ICJS 减少以及 CT 减少的关节中。例如，dGEMRIC 与 IBJS 直接相关（p=0.001）和 ICJS（p=0.001），而 T2 映射与 IBJS 和 ICJS 呈负相关（均 p=0.017）。此外，骨炎的程度，在一定程度上滑膜炎，与 dGEMRIC（p=0.003）或 T2 映射（p=0.013）测量的软骨生化变化相关。相比之下，骨侵蚀与生化软骨变化的程度无关。
这些数据支持滑膜炎和骨炎可能是软骨损伤的两个主要触发因素的概念。因此，关节的实际炎症状态，而不是骨侵蚀的程度，似乎会影响 RA 中的软骨特性。
