McQueen Fiona M, McHaffie Alexandra, Clarke Andrew, Lee Arier C, Reeves Quentin, Curteis Barbara, Dalbeth Nicola
Arthritis Res Ther. 2014 Jan 30;16(1):R33. doi: 10.1186/ar4462.
Cartilage damage impacts on patient disability in rheumatoid arthritis (RA). The aims of this magnetic resonance imaging (MRI) study were to investigate cartilage damage over three years and determine predictive factors.
A total of 38 RA patients and 22 controls were enrolled at t = 0 (2009). After 3 years, clinical and MRI data were available in 28 patients and 15 controls. 3T MRI scans were scored for cartilage damage, bone erosion, synovitis and osteitis. A model was developed to predict cartilage damage from baseline parameters.
Inter-reader reliability for the Auckland MRI cartilage score (AMRICS) was high for status scores; intraclass correlation coefficient (ICC), 0.90 (0.81 to 0.95) and moderate for change scores (ICC 0.58 (0.24 to 0.77)). AMRICS scores correlated with the Outcome MEasures in Rheumatoid Arthritis Clinical Trials (OMERACT) MRI joint space narrowing (jsn) and X-Ray (XR) jsn scores (r =0.96, P < 0.0001 and 0.80, P < 0.0001, respectively). AMRICS change scores were greater for RA patients than controls (P = 0.06 and P = 0.04 for the two readers). Using linear regression, baseline MRI cartilage, synovitis and osteitis scores predicted the three-year AMRICS (R² = 0.67, 0.37 and 0.39, respectively). A multiple linear regression model predicted the three-year AMRICS (R² = 0.78). Baseline radial osteitis predicted increased cartilage scores at the radiolunate and radioscaphoid joints, P = 0.0001 and 0.0012, respectively and synovitis at radioulnar, radiocarpal and intercarpal-carpometacarpal joints also influenced three-year cartilage scores (P-values of 0.001, 0.04 and 0.01, respectively).
MRI cartilage damage progression is preceded by osteitis and synovitis but is most influenced by pre-existing cartilage damage suggesting primacy of the cartilage damage pathway in certain patients.
软骨损伤会影响类风湿关节炎（RA）患者的残疾状况。本磁共振成像（MRI）研究旨在调查三年内的软骨损伤情况并确定预测因素。
于t = 0（2009年）共纳入38例RA患者和22例对照。3年后，28例患者和15例对照有临床和MRI数据。对3T MRI扫描的软骨损伤、骨侵蚀、滑膜炎和骨炎进行评分。建立了一个模型，根据基线参数预测软骨损伤情况。
奥克兰MRI软骨评分（AMRICS）的阅片者间状态评分可靠性高；组内相关系数（ICC）为0.90（0.81至0.95），变化评分的可靠性中等（ICC 0.58（0.24至0.77））。AMRICS评分与类风湿关节炎临床试验（OMERACT）MRI关节间隙狭窄（jsn）和X线（XR）jsn评分相关（r分别为0.96，P < 0.0001和0.80，P < 0.0001）。RA患者的AMRICS变化评分高于对照（两位阅片者的P值分别为0.06和0.04）。使用线性回归分析，基线MRI软骨、滑膜炎和骨炎评分可预测三年后的AMRICS（R²分别为0.67、0.37和0.39）。多元线性回归模型可预测三年后的AMRICS（R² = 0.78）。基线桡侧骨炎可预测桡月关节和桡舟关节软骨评分增加，P值分别为0.0001和0.0012，桡尺关节、桡腕关节和腕骨间 - 腕掌关节的滑膜炎也会影响三年后的软骨评分（P值分别为0.001、0.04和0.01）。
MRI显示软骨损伤进展之前存在骨炎和滑膜炎，但最主要受既往软骨损伤影响，提示在某些患者中软骨损伤途径占主导地位。
