采用磁共振成像和抗瓜氨酸化蛋白抗体、抗 RA33 和 RF 自身抗体状态研究狼疮关节炎的侵蚀表型。
A study of erosive phenotypes in lupus arthritis using magnetic resonance imaging and anti-citrullinated protein antibody, anti-RA33 and RF autoantibody status.
机构信息
Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK. Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
出版信息
Rheumatology (Oxford). 2014 Oct;53(10):1835-43. doi: 10.1093/rheumatology/keu215. Epub 2014 May 20.
OBJECTIVES
The aims of this study were to investigate the extent of MRI-determined joint disease (erosion and synovitis) in SLE and to link this to autoantibody profiles known to be relevant to SLE, including ACPA, RF and anti-RA33 antibodies.
METHODS
Contrast-enhanced MRI of the hand and wrist was performed in 34 symptomatic SLE patients and in 15 RA patients with similar disease duration. Images were scored by two observers using the OMERACT rheumatoid arthritis MRI scoring (RAMRIS) system. Findings were correlated with clinical examination and autoantibody status.
RESULTS
Erosions were present at the wrist in 93% of SLE patients and at the MCP joints in 61% of SLE patients. Despite the high prevalence of MRI-determined erosion, only 8.8% of SLE patients were ACPA positive, although these patients had a higher burden of erosive disease. There was no positive correlation with anti-RA33 titres and erosion scores in the SLE patients, but there was a negative correlation with anti-RA33 titres and total bone oedema scores in the SLE patients. Ninety-three per cent of SLE patients had at least grade 1 synovitis at one or more MCP joints, and wrist joint synovitis was present in all the SLE patients.
CONCLUSION
An MRI-determined joint erosive phenotype is common in SLE, even in ACPA-negative cases. The conventional radiographic observation that anti-RA33 is not positively associated with erosion in patients with RA was also found to be the case in SLE patients.
目的
本研究旨在探讨系统性红斑狼疮（SLE）患者磁共振成像（MRI）确定的关节疾病（侵蚀和滑膜炎）的程度，并将其与已知与 SLE 相关的自身抗体谱相关联，包括 ACPA、RF 和抗-RA33 抗体。
方法
对 34 例有症状的 SLE 患者和 15 例病程相似的 RA 患者进行了手部和腕部对比增强 MRI。两名观察者使用 OMERACT 类风湿关节炎 MRI 评分（RAMRIS）系统对图像进行评分。将结果与临床检查和自身抗体状况相关联。
结果
93%的 SLE 患者腕关节存在侵蚀，61%的 SLE 患者掌指关节存在侵蚀。尽管 MRI 确定的侵蚀患病率很高，但只有 8.8%的 SLE 患者为 ACPA 阳性，尽管这些患者的侵蚀性疾病负担更高。在 SLE 患者中，与抗-RA33 滴度和侵蚀评分无正相关，但与 SLE 患者的总骨水肿评分有负相关。93%的 SLE 患者在一个或多个掌指关节存在至少 1 级滑膜炎，所有 SLE 患者的腕关节均存在滑膜炎。
结论
即使在 ACPA 阴性的情况下，SLE 患者也常出现 MRI 确定的关节侵蚀表型。在 RA 患者中，抗-RA33 与侵蚀无正相关的传统影像学观察结果也适用于 SLE 患者。
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