Baker Joshua F, Østergaard Mikkel, Emery Paul, Baker Daniel G, Conaghan Philip G
Philadelphia Veterans Affairs Medical Center; University of Pennsylvania, School of Medicine; and Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, USA.
Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Clin Exp Rheumatol. 2017 Jul-Aug;35(4):607-613. Epub 2017 Jan 27.
To determine thresholds for rheumatoid arthritis (RA) magnetic resonance imaging scores (RAMRIS) associated with a low risk of structural damage progression.
MRI of the dominant hand was performed and RAMRIS scores determined at weeks 0, 24, and 52. X-rays were performed and van der Heijde-Sharp scores (vdHS) determined. In a development cohort (n=297) the changes in MRI erosion score and vdHS score were determined over the 24-week to 52-week interval and progression was defined as change >0.5. We identified 24-week thresholds for synovitis and osteitis that provided >90% sensitivity for imaging progression over the 24 to 52-week interval. The performance of these cut-offs was tested in a validation cohort (n=217).
In the development cohort, synovitis or osteitis scores ≤3 by 24 weeks were associated with a low probability of progression on MRI and x-ray. The coefficient for osteitis was stronger than that of synovitis in models predicting x-ray and MRI progression. Therefore, a total inflammation score was weighted on osteitis (x2). An inflammation score ≤9 was more frequently attained than DAS28 remission (64 vs. 38) and was associated with low probability of progression regardless of attainment of clinical remission. In the validation cohort, there was a low odds of MRI progression among those with low synovitis [OR 0.27 (0.086,0.82) p=0.02], osteitis [OR 0.20 (0.085, 0.49) p<0.001] and inflammation scores [OR 0.12 (0.033, 0.41) p=0.001].
Attainment of low MRI single-hand synovitis and osteitis is not uncommon and predicts a lack of structural progression in RA, independent of clinical remission.
确定与结构损伤进展低风险相关的类风湿性关节炎（RA）磁共振成像评分（RAMRIS）阈值。
对优势手进行MRI检查，并在第0、24和52周确定RAMRIS评分。进行X线检查并确定范德海伊德-夏普评分（vdHS）。在一个开发队列（n = 297）中，确定24周龄至52周龄期间MRI侵蚀评分和vdHS评分的变化，并将进展定义为变化>0.5。我们确定了滑膜炎和骨炎的24周阈值，这些阈值在24至52周期间对成像进展的敏感性>90%。在一个验证队列（n = 217）中测试了这些临界值的性能。
在开发队列中，到24周时滑膜炎或骨炎评分≤3与MRI和X线进展的低概率相关。在预测X线和MRI进展的模型中，骨炎的系数比滑膜炎的系数更强。因此，总炎症评分以骨炎为权重（x2）。炎症评分≤9比DAS28缓解更常见（64比38），并且与进展的低概率相关，无论是否达到临床缓解。在验证队列中，滑膜炎[比值比0.27（0.086，0.82）p = 0.02]、骨炎[比值比0.20（0.085，0.49）p<0.001]和炎症评分[比值比0.12（0.033，0.41）p = 0.001]较低的患者中MRI进展的几率较低。
单手MRI滑膜炎和骨炎程度低并不罕见，且可预测RA中结构进展的缺乏，与临床缓解无关。
