MRI 检测到的侵蚀是否特异性地针对 RA？一项大型探索性横断面研究。
Are MRI-detected erosions specific for RA? A large explorative cross-sectional study.
机构信息
Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
出版信息
Ann Rheum Dis. 2018 Jun;77(6):861-868. doi: 10.1136/annrheumdis-2017-212252. Epub 2018 Feb 28.
OBJECTIVES
MRI is recommended in the diagnostic process of rheumatoid arthritis (RA) to detect joint damage early. MRI-detected erosions are also present in symptom-free controls, especially at older age. It is unclear if RA-specific MRI-detected erosions can be distinguished from 'physiological' erosions in symptom-free individuals. This study compared MRI-detected erosions of patients with RA with healthy controls and with other arthritides.
METHODS
589 newly presenting patients with early arthritis (238 RA, 351 other arthritides) and 193 symptom-free controls underwent contrast-enhanced 1.5T MRI of unilateral metacarpophalangeal and metatarsophalangeal (MTP) joints. Total erosion score (according to the Rheumatoid Arthritis MRI Scoring System), number, severity, location of erosions and simultaneous presence of MRI-detected inflammation (synovitis and/or bone marrow oedema) were compared; participants were categorised in three age groups (<40, 40-59, ≥60).
RESULTS
Patients with RA had statistically significant higher total erosion scores than controls but scores of individual persons largely overlapped. Grade ≥2 erosions and MTP5 erosions were specific for RA (specificity 98%-100% and 90%-98% for different age groups). MTP1 erosions were only specific if aged <40 (specificity 98%) and erosions with inflammation if aged <60 (specificity 91%-100%). ≥1 of the mentioned erosion characteristics were present in 29% of patients with RA. Comparing patients with RA with other arthritides revealed that grade ≥2 erosions and MTP5 erosions remained specific for RA (specificity ≥89%) as well as MTP1 erosions if aged <40 (specificity 93%), in contrast to erosions combined with inflammation (specificity 49%-85%).
CONCLUSIONS
Total erosion scores of individual persons were largely overlapping. Erosion characteristics specific for RA were identified, but were infrequently present. Caution is needed not to overestimate the value of MRI erosions in the diagnostic process.
目的
MRI 被推荐用于类风湿关节炎（RA）的诊断过程中，以早期发现关节损伤。无症状对照者也存在 MRI 检测到的侵蚀，尤其是年龄较大者。目前尚不清楚 RA 特异性 MRI 检测到的侵蚀是否可以与无症状个体的“生理性”侵蚀区分开来。本研究比较了 RA 患者、健康对照者和其他关节炎患者的 MRI 检测到的侵蚀。
方法
589 例新出现的早期关节炎患者（238 例 RA，351 例其他关节炎）和 193 例无症状对照者接受了单侧掌指和跖趾（MTP）关节的对比增强 1.5T MRI 检查。比较了总侵蚀评分（根据类风湿关节炎 MRI 评分系统）、侵蚀数量、严重程度、位置以及同时存在的 MRI 检测到的炎症（滑膜炎和/或骨髓水肿）；参与者被分为 3 个年龄组（<40 岁、40-59 岁、≥60 岁）。
结果
RA 患者的总侵蚀评分明显高于对照组，但个体评分大多重叠。≥2 级侵蚀和 MTP5 侵蚀是 RA 的特异性表现（不同年龄组的特异性为 98%-100%和 90%-98%）。仅在年龄<40 岁时 MTP1 侵蚀具有特异性（特异性 98%），而在年龄<60 岁时，伴有炎症的侵蚀具有特异性（特异性 91%-100%）。RA 患者中，有 29%存在上述侵蚀特征中的≥1 种。将 RA 患者与其他关节炎患者进行比较发现，≥2 级侵蚀和 MTP5 侵蚀仍然是 RA 的特异性表现（特异性≥89%），如果年龄<40 岁，MTP1 侵蚀也具有特异性（特异性 93%），而与炎症相关的侵蚀则特异性较低（49%-85%）。
结论
个体的侵蚀总评分大多重叠。确定了 RA 的侵蚀特征，但很少出现。在诊断过程中，需要谨慎不要高估 MRI 侵蚀的价值。
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