Haavisto Matti, Saraste Antti, Pirilä Laura, Hannukainen Jarna C, Kalliokoski Kari K, Kirjavainen Anna, Kemppainen Jukka, Möttönen Timo, Knuuti Juhani, Yli-Kerttula Timo, Roivainen Anne
Turku PET Centre, University of Turku Turku PET Centre, Turku University Hospital.
Turku PET Centre, University of Turku Turku PET Centre, Turku University Hospital Heart Center.
Rheumatology (Oxford). 2016 Oct;55(10):1777-85. doi: 10.1093/rheumatology/kew240. Epub 2016 Jun 21.
Increased atherosclerosis in RA is not fully explained by the ordinary risk factors, but it may be related to vascular inflammation. The aim of this study was to investigate the degree of carotid artery inflammation in drug-naive patients with early RA before and after DMARD triple therapy.
Fifteen non-diabetic patients with recently diagnosed RA [age 51 (16) years, 6 males] were examined before and at 2 and 4 weeks after the initiation of combination therapy with MTX, SSZ, HCQ and ⩽10 mg/day oral prednisolone. Eight healthy males aged 49 (6) years were examined once as controls. Inflammation in the carotid artery was quantified, using [(18)F]fluorodeoxyglucose ((18)F-FDG)-PET/CT, as the maximum standardized uptake value (SUVmax) and the maximum target-to-background ratio (TBRmax).
Before the treatment, patients with RA had significantly higher carotid artery (18)F-FDG uptake, as compared with healthy controls [TBRmax 1.78 (0.07) vs 1.51 (0.08), P = 0.03]. The 4-week DMARD therapy reduced the TBRmax to the level of healthy controls [1.53 (0.05), P = 0.84]. Compared with the baseline, the TBRmax decreased by 12.4 (16.8)% (P = 0.01) during 4-week DMARD therapy. At baseline, the SUVmax correlated with ESR (r = 0.52, P = 0.02) and CRP (r = 0.65, P = 0.01). Change in SUVmax correlated with changes in ESR and CRP after 4 weeks of treatment, as did the changes in TBRmax and SUVmax with DAS at 12 weeks of treatment.
(18)F-FDG-PET/CT revealed that drug-naive patients with early RA show carotid artery inflammation that can be efficiently reduced by 1-month DMARD triple therapy.
类风湿关节炎（RA）中动脉粥样硬化增加不能完全由常见危险因素解释，但其可能与血管炎症有关。本研究旨在调查初治的早期RA患者在接受改善病情抗风湿药（DMARD）三联疗法前后颈动脉炎症程度。
15例新诊断的非糖尿病RA患者[年龄51（16）岁，男性6例]在开始使用甲氨蝶呤（MTX）、柳氮磺吡啶（SSZ）、羟氯喹（HCQ）及≤10mg/日口服泼尼松龙联合治疗前、治疗2周和4周时接受检查。8例年龄49（6）岁的健康男性作为对照仅接受一次检查。使用[18F]氟脱氧葡萄糖（18F-FDG）-正电子发射断层显像/计算机断层扫描（PET/CT）对颈动脉炎症进行量化，以最大标准化摄取值（SUVmax）和最大靶本比（TBRmax）表示。
治疗前，RA患者的颈动脉18F-FDG摄取显著高于健康对照[TBRmax 1.78（0.07）对1.51（0.08），P = 0.03]。4周的DMARD治疗使TBRmax降至健康对照水平[1.53（0.05），P = 0.84]。与基线相比，4周DMARD治疗期间TBRmax下降了12.4（16.8）%（P = 0.01）。基线时，SUVmax与红细胞沉降率（ESR）相关（r = 0.52，P = 0.02），与C反应蛋白（CRP）相关（r = 0.65，P = 0.01）。治疗4周后SUVmax的变化与ESR和CRP的变化相关，治疗12周时TBRmax和SUVmax的变化与疾病活动度评分（DAS）的变化也相关。
18F-FDG-PET/CT显示初治的早期RA患者存在颈动脉炎症，1个月的DMARD三联疗法可有效减轻这种炎症。
