Schleich C, Müller-Lutz A, Sewerin P, Ostendorf B, Buchbender C, Schneider M, Antoch G, Miese F
Medical Faculty, Department of Diagnostic and Interventional Radiology, University Dusseldorf, D-40225, Dusseldorf, Germany.
Skeletal Radiol. 2015 Apr;44(4):513-8. doi: 10.1007/s00256-014-2045-9. Epub 2014 Nov 1.
To intra-individually assess the association of inflammation severity and cartilage composition measured by RAMRIS synovitis sub-score and delayed gadolinium-enhanced magnetic resonance imaging of the cartilage (dGEMRIC) of metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis (RA).
Forty-three patients with RA according to ACR/EULAR classification criteria (age 52.9 ± 14.5 years, range, 18-77 years) were included in this study. All study participants received 3-T MRI scans of the metacarpophalangeal joints of the second and third finger (MCP 2 and 3). The severity of synovitis was scored according to the RAMRIS synovitis sub-score by two readers in consensus. In the cases with identical synovitis sub-scores, two radiologists decided in consensus on the joint with more severe synovitis. Cartilage composition was assessed with dGEMRIC. To test the association of inflammation severity and cartilage damage and in order to eliminate inter-patient confounders, each patient's MCP 2 and 3 were dichotomized into the joint with more severe synovitis versus the joint with less severe synovitis for a paired Wilcoxon test of dGEMRIC value.
There was a significant difference of dGEMRIC value (median of difference: 47.12, CI [16.6; 62.76]) between the dichotomized MCPs (p = 0.0001). There was a significant correlation between dGEMRIC value and RAMRIS synovitis grading of the joint with more severe synovitis (r = 0.5; p < 0.05) and the joint with less severe synovitis (r = 0.33; p < 0.05).
Our data concur with the concept that synovitis severity is associated with cartilage damage. The local inflammatory status on a joint level correlated significantly with the extent of cartilage degradation in biochemical MRI.
对类风湿关节炎（RA）患者掌指关节（MCP）通过RAMRIS滑膜炎亚评分和延迟钆增强磁共振成像（dGEMRIC）测量的炎症严重程度与软骨成分进行个体内评估。
本研究纳入43例符合美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）分类标准的RA患者（年龄52.9±14.5岁，范围18 - 77岁）。所有研究参与者均接受了第二和第三指掌指关节（MCP 2和3）的3-T磁共振成像扫描。由两位阅片者根据RAMRIS滑膜炎亚评分对滑膜炎严重程度达成共识进行评分。在滑膜炎亚评分相同的情况下，两位放射科医生共同确定滑膜炎更严重的关节。采用dGEMRIC评估软骨成分。为检验炎症严重程度与软骨损伤的相关性，并消除患者间的混杂因素，将每位患者的MCP 2和3分为滑膜炎更严重的关节与滑膜炎较轻的关节，进行dGEMRIC值的配对Wilcoxon检验。
二分法处理后的MCP之间dGEMRIC值存在显著差异（差异中位数：47.12，CI[16.6；62.76]）（p = 0.0001）。dGEMRIC值与滑膜炎更严重关节的RAMRIS滑膜炎分级（r = 0.5；p < 0.05）以及滑膜炎较轻关节的RAMRIS滑膜炎分级（r = 0.33；p < 0.05）之间存在显著相关性。
我们的数据支持滑膜炎严重程度与软骨损伤相关的概念。关节水平的局部炎症状态与生化磁共振成像中软骨降解程度显著相关。
