Forslind K, Svensson B
a Department of Clinical Sciences, Section of Rheumatology , Lund University , Helsingborg , Sweden.
b Department of Medicine, Section of Rheumatology , Helsingborgs Lasarett , Helsingborg , Sweden.
Scand J Rheumatol. 2016;45(2):99-102. doi: 10.3109/03009742.2015.1070902. Epub 2015 Aug 31.
To determine the value of magnetic resonance imaging (MRI) of bones and joints in patients with recent-onset rheumatoid arthritis (RA) treated for 2 years from diagnosis with disease-modifying anti-rheumatic drugs (DMARDs) and glucocorticoids.
Thirteen patients with early RA were treated according to clinical practice and followed with MRI, radiographs, and Disease Activity Score calculated on 28 joints (DAS28) at inclusion (baseline) and after 1, 4, 7, 13, and 25 months. MRI of the dominant wrist and metacarpophalangeal (MCP) joints were assessed for synovitis, bone oedema, and erosions using the RA MRI Score (RAMRIS) and for tenosynovitis by an MRI tenosynovitis scoring method. Radiographs were assessed by the van der Heijde modified Sharp score (SHS). Clinical remission was defined by a DAS28 < 2.6.
MRI at baseline detected inflammation in joints and tendons in all patients as well as erosions in 10 out of 13 patients. Over time, the erosion score increased while the synovitis and tenosynovitis scores remained almost unchanged. Bone oedema strongly correlated with synovitis. Synovitis and tenosynovitis correlated well with the erosion score at baseline but not thereafter. The MRI changes showed that joint damage started early and continued in the presence of persistent synovial and tenosynovial inflammation.
The observations made in this small study suggest that the treatment goal of 'clinical remission' should be supplemented by a 'joint remission' goal. To this end, MRI is an appropriate tool. Further studies are needed to evaluate the optimal use of MRI in early RA.
确定接受改善病情抗风湿药物（DMARDs）和糖皮质激素治疗2年的近期发病类风湿关节炎（RA）患者的骨关节磁共振成像（MRI）价值。
13例早期RA患者按照临床实践进行治疗，并在纳入研究时（基线）以及1、4、7、13和25个月后进行MRI、X线片检查，并计算28个关节的疾病活动评分（DAS28）。使用类风湿关节炎MRI评分（RAMRIS）评估优势腕关节和掌指（MCP）关节的滑膜炎、骨水肿和侵蚀情况，并通过MRI腱鞘炎评分方法评估腱鞘炎。通过范德海伊德改良夏普评分（SHS）评估X线片。临床缓解定义为DAS28<2.6。
基线时MRI检测到所有患者关节和肌腱存在炎症，13例患者中有10例存在侵蚀。随着时间推移，侵蚀评分增加，而滑膜炎和腱鞘炎评分几乎保持不变。骨水肿与滑膜炎密切相关。滑膜炎和腱鞘炎在基线时与侵蚀评分相关性良好，但之后则不然。MRI变化表明关节损伤早期就已开始，并在持续性滑膜和腱鞘炎存在的情况下持续发展。
这项小型研究的观察结果表明，“临床缓解”的治疗目标应辅以“关节缓解”目标。为此，MRI是一种合适的工具。需要进一步研究以评估MRI在早期RA中的最佳应用。
