Sewerin Philipp, Buchbender Christian, Vordenbäumen Stefan, Scherer Axel, Miese Falk, Brinks Ralph, Wittsack Hans-Joerg, Klein Sabine, Schneider Matthias, Antoch Gerald, Ostendorf Benedikt
Department of Rheumatology, Univ Duesseldorf, Medical Faculty, Moorenstrasse 5, Duesseldorf D-40225, Germany.
BMC Musculoskelet Disord. 2014 Mar 26;15:104. doi: 10.1186/1471-2474-15-104.
To evaluate a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and foot (HaF-score) in rheumatoid arthritis (RA).
Magnetic resonance imaging (MRI, 0.2 Tesla) of the dominant hand and foot of 26 ACPA positive RA patients before and 6 months after initiation of methotrexate was obtained. RAMRIS of the hand was complemented by corresponding scoring of the foot (MTP I-V; HaF-score). Disease Activity Score 28 (DAS28) and a tender and swollen joint count (JC) of the joints scored in MRI were recorded. Changes in these scores (Δ) were assessed.
ΔHaF-score correlated significantly with ΔDAS28 (r = 0.820, 95%-CI 0.633-0.916). Correlations to ΔDAS28 were best for changes in the synovitis subscore (0.648) and bone marrow edema (0.703). Correlations to ΔDAS28 were significantly better for of the ΔHaF-score than ΔRAMRIS (0.499, 0.139-0.743, p = 0.0368).All patients with at least moderate response (EULAR criteria, n = 11) had continuing disease activity on MRI, including five cases with new erosions, three of them at the feet. Improvements of the hand JC or foot JC were seen in 16 and 15 cases, respectively. However, MRI of the hand or feet improved in only 10 and 9 cases, respectively. No patient fulfilled SDAI remission criteria.
The HaF-score identifies patients with continuing disease activity despite clinical response that would have been missed by consideration of the traditional RAMRIS or the DAS28 alone. Response as opposed to remission may be an insufficient goal in RA as all patients showed continuing disease activity, especially at the feet.
评估类风湿关节炎（RA）患者手足联合类风湿关节炎磁共振成像评分（RAMRIS）（HaF评分）。
对26例抗环瓜氨酸肽（ACPA）阳性的RA患者在开始使用甲氨蝶呤前及用药6个月后进行优势手和足的磁共振成像（MRI，0.2特斯拉）检查。手部的RAMRIS通过足部相应评分（跖趾关节I-V；HaF评分）进行补充。记录疾病活动评分28（DAS28）以及MRI评分关节的压痛和肿胀关节计数（JC）。评估这些评分的变化（Δ）。
ΔHaF评分与ΔDAS28显著相关（r = 0.820，95%置信区间0.633 - 0.916）。与ΔDAS28的相关性在滑膜炎亚评分变化（0.648）和骨髓水肿（0.703）方面最佳。与ΔDAS28的相关性，ΔHaF评分显著优于ΔRAMRIS（0.499，0.139 - 0.743，p = 0.0368）。所有至少有中度反应（依欧洲抗风湿病联盟标准，n = 11）的患者在MRI上仍有疾病活动，包括5例有新骨侵蚀的患者，其中3例在足部。手部JC改善的有16例，足部JC改善的有15例。然而，手部或足部MRI改善的分别仅10例和9例。没有患者达到简化疾病活动指数（SDAI）缓解标准。
HaF评分可识别出尽管有临床反应但仍有持续疾病活动的患者，而仅考虑传统的RAMRIS或DAS28会遗漏这些情况。在RA中，与缓解相反的反应可能是一个不充分的目标，因为所有患者都显示有持续疾病活动，尤其是在足部。
