Department of Rheumatology, Leids Universitair Medisch Centrum, Leiden, The Netherlands.
Department of Rheumatology, Erasmus Medical Centre, Leiden, The Netherlands.
Ann Rheum Dis. 2018 Aug;77(8):1125-1129. doi: 10.1136/annrheumdis-2018-213143. Epub 2018 Apr 20.
To assess the value of MRI-detected synovitis to determine the number of involved joints on the performance of the 2010-ACR/EULAR classification criteria for rheumatoid arthritis (RA).
277 patients with a clinical suspicion of RA consecutively included in the Leiden Early Arthritis Clinic (EAC)-cohort underwent 1.5T MRI of MCP-, wrist- and MTP-joints. Test characteristics of the 2010-criteria were calculated when the number of involved joints was determined with and without including MRI-detected synovitis. Two outcomes were studied: disease modifying anti-rheumatic drug (DMARD)-initiation and 1987-criteria fulfilment during the first year.
At baseline, 143 patients were classified as RA. When MRI-detected synovitis was considered, 14 patients additionally fulfilled the 2010-criteria. Of these, 64% (9/14) started DMARDs. When MRI-detected synovitis was also used to determine the number of involved joints the sensitivity changed from 62% to 67%, the specificity from 90% to 84% and the AUC from 0.76 to 0.75. The net reclassification index was -2.4%. When fulfilling the 1987-criteria was used as outcome, results were similar.
We found no scientific support that the use of MRI-detected synovitis is of additional benefit for the performance of the 2010 classification criteria.
评估 MRI 检测到的滑膜炎在确定类风湿关节炎（RA）2010-ACR/EULAR 分类标准所涉及关节数目的表现中的价值。
277 例临床疑似 RA 的患者连续纳入莱顿早期关节炎诊所（EAC）队列，接受 MCP、腕关节和 MTP 关节的 1.5T MRI 检查。当不包括和包括 MRI 检测到的滑膜炎来确定受累关节数时，计算 2010 标准的测试特征。研究了两个结局：第一年开始使用疾病修饰抗风湿药物（DMARD）和满足 1987 标准。
在基线时，143 例患者被分类为 RA。当考虑 MRI 检测到的滑膜炎时，另外 14 例患者符合 2010 标准。其中，64%（9/14）开始使用 DMARD。当使用 MRI 检测到的滑膜炎来确定受累关节数时，敏感性从 62%变为 67%，特异性从 90%变为 84%，AUC 从 0.76 变为 0.75。净重新分类指数为-2.4%。当以满足 1987 标准为结局时，结果相似。
我们没有发现科学证据表明使用 MRI 检测到的滑膜炎对 2010 分类标准的表现有额外的益处。
