Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
Ann Rheum Dis. 2015 Jun;74(6):1225-32. doi: 10.1136/annrheumdis-2014-205522. Epub 2014 Apr 9.
The phase of arthralgia is the earliest moment to clinically recognize patients who may develop Rheumatoid Arthritis (RA). Previous imaging studies in the arthralgia phase have shown that inflammation precedes RA development. It is unknown which symptoms/characteristics relate to subclinical joint inflammation as measured by MRI. Among all patients with arthralgia, those with clinically suspect arthralgia (CSA) are suspected to progress to arthritis according to the clinical judgement of their rheumatologists. We determined the symptoms/characteristics of patients with CSA who had inflammation on MRI.
102 patients with CSA and without clinical arthritis were included. They completed questionnaires, underwent joint counts and unilateral 1.5 T MRI of MCP joints 2-4, wrist and MTP joints 1-5. Synovitis, bone marrow oedema (BME) and tenosynovitis were scored according to the OMERACT rheumatoid arthritis MRI scoring system. Symptoms and signs were related to MRI inflammation (based on MRI scores in symptom-free controls; a sum of synovitis, BME and tenosynovitis scores ≥3 was considered positive). Whether certain clinical characteristics frequently occurred together with MRI inflammation was studied by partial least squares analysis.
MRI was performed in 93 patients with CSA, 44% of whom had subclinical MRI inflammation. Synovitis was the most prevalent inflammatory feature on MRI (20%). Patients with MRI inflammation were older and were more frequently positive for anti-citrullinated peptide antibodies than patients without MRI inflammation (p<0.001 and 0.049). In PLS analysis, including 16 clinical and serological characteristics as independent variables and MRI inflammation as dependent variable, no clear clusters of patients with and without MRI inflammation were identified.
Subclinical inflammation as measured by MRI is present in 44% of patients with CSA. A combination of symptoms/characteristics incompletely differentiated patients with and without MRI inflammation.
关节痛阶段是临床上最早识别可能发展为类风湿关节炎（RA）的患者的时刻。先前在关节痛阶段的影像学研究表明，炎症先于 RA 发展。尚不清楚哪些症状/特征与 MRI 测量的亚临床关节炎症有关。在所有关节痛患者中，根据风湿病医生的临床判断，具有临床可疑关节痛（CSA）的患者被怀疑进展为关节炎。我们确定了 MRI 有炎症的 CSA 患者的症状/特征。
纳入了 102 例 CSA 且无临床关节炎的患者。他们完成了问卷调查，接受了关节计数和单侧 1.5T MCP 关节 2-4、腕关节和 MTP 关节 1-5 的 MRI 检查。滑膜炎、骨髓水肿（BME）和腱鞘炎根据 OMERACT 类风湿关节炎 MRI 评分系统进行评分。根据无症状对照者的 MRI 评分（滑膜炎、BME 和腱鞘炎评分总和≥3 被认为阳性），将症状和体征与 MRI 炎症相关联。通过偏最小二乘分析研究某些临床特征是否经常与 MRI 炎症同时发生。
93 例 CSA 患者进行了 MRI 检查，其中 44%存在亚临床 MRI 炎症。MRI 上最常见的炎症特征是滑膜炎（20%）。与无 MRI 炎症的患者相比，MRI 炎症患者年龄更大，抗瓜氨酸肽抗体阳性率更高（p<0.001 和 0.049）。在包括 16 个临床和血清学特征作为自变量和 MRI 炎症作为因变量的 PLS 分析中，未发现 MRI 炎症患者和无 MRI 炎症患者有明显的聚类。
MRI 测量的亚临床炎症在 44%的 CSA 患者中存在。症状/特征的组合不能完全区分 MRI 炎症患者和无 MRI 炎症患者。
