在类风湿关节炎的靶向治疗升级中，临床疾病活动的变化与 MRI 炎症的变化相关性很弱。
Changes in clinical disease activity are weakly linked to changes in MRI inflammation on treat-to-target escalation of therapy in rheumatoid arthritis.
机构信息
Department of Molecular Medicine and Pathology, Faculty of Medical and Health Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand.
Department of Rheumatology, Greenlane Clinical Centre, Auckland District Health Board, 214 Green Lane West, Epsom, Auckland, 1051, New Zealand.
出版信息
Arthritis Res Ther. 2017 Oct 24;19(1):241. doi: 10.1186/s13075-017-1433-7.
BACKGROUND
Rheumatoid arthritis (RA) treat-to-target (T2T) regimens often use the disease activity score (28 joints) incorporating C-reactive protein (DAS28) as an outcome measure. We compared changes in the DAS28 with changes in magnetic resonance imaging (MRI) inflammation on treatment escalation.
METHODS
Eighty seropositive RA patients with active disease were enrolled. Group A (N = 57) escalated to another conventional disease-modifying therapy (cDMARD) combination, and Group B (N = 23) to anti-TNF therapy/cDMARDs. Contrast-enhanced 3T-MRI wrist scans were obtained before and 4 months after regimen change. Scan pairs were scored for inflammation (MRI(i)) and damage. Disease activity was assessed using the DAS28.
RESULTS
Eighty patients were enrolled and 66 MRI scan pairs were available for analysis. Intra-reader reliability was high: intraclass correlation coefficient (average) 0.89 (0.56-0.97). ΔDAS28 did not differ between groups: Group A, -0.94 (-3.30, 1.61); Group B, -1.53 (-3.59, 0.56) (p = 0.45). ΔMRI(i) also did not differ: Group A, 0 (-25, 10); Group B, -1 (-15, 28) (p = 0.12). Combining groups, ΔMRI(i) correlated weakly with ΔDAS28 (Spearman's 0.36, p = 0.003). Using multiple linear regression analysis adjusting for confounders, ΔDAS28 was associated with ΔMRI(i) (p = 0.056). Of the individual MRI measures, only Δtenosynovitis correlated with ΔDAS28 (Spearman's 0.33, p = 0.007). ΔMRI(i) was negatively associated with the MRI erosion score at entry (p = 0.0052).
CONCLUSIONS
We report the first study investigating the link between changes in clinical and imaging inflammation in a real-world RA cohort escalating to conventional and biologic DMARDs. The association was significant but relatively weak, suggesting that MRI targets cannot yet be advocated as outcomes for T2T escalation.
TRIAL REGISTRATION
ANZCTR 12614000895684 . Registered 22 August 2014.
背景
类风湿关节炎（RA）的达标治疗（T2T）方案通常使用包含 C 反应蛋白的 28 个关节疾病活动评分（DAS28）作为疗效评估指标。我们比较了治疗升级时 DAS28 的变化与磁共振成像（MRI）炎症的变化。
方法
纳入 80 例血清阳性、活动期 RA 患者。A 组（n=57）升级为另一种传统的疾病修饰治疗（cDMARD）联合治疗，B 组（n=23）升级为抗 TNF 治疗/cDMARDs。在治疗方案改变前和 4 个月后，分别对患者进行 3T 磁共振腕关节增强扫描。对扫描对进行炎症（MRI(i))和损伤评分。采用 DAS28 评估疾病活动度。
结果
共纳入 80 例患者，66 对 MRI 扫描可供分析。内部观察者的可靠性很高：组内相关系数（平均值）为 0.89（0.56-0.97）。两组间 DAS28 的变化无差异：A 组为-0.94（-3.30，1.61）；B 组为-1.53（-3.59，0.56）（p=0.45）。MRI(i)的变化也无差异：A 组为 0（-25，10）；B 组为-1（-15，28）（p=0.12）。两组合并后，MRI(i)的变化与 DAS28 的变化呈弱相关（Spearman's 0.36，p=0.003）。采用多元线性回归分析校正混杂因素后，DAS28 与 MRI(i)的变化相关（p=0.056）。在各个 MRI 指标中，只有肌腱滑膜炎的变化与 DAS28 的变化相关（Spearman's 0.33，p=0.007）。MRI(i)的变化与入组时的 MRI 侵蚀评分呈负相关（p=0.0052）。
结论
我们报告了第一项研究，该研究调查了在现实世界的 RA 患者队列中，从常规和生物 DMARD 升级时临床和影像学炎症变化之间的关联。这种关联虽然显著，但相对较弱，这表明 MRI 指标尚不能作为 T2T 升级的疗效评估指标。
试验注册
ANZCTR 12614000895684。2014 年 8 月 22 日注册。
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