MRI 在缓解期类风湿关节炎患者亚临床炎症诊断中的应用价值。
The application value of MRI in the diagnosis of subclinical inflammation in patients with rheumatoid arthritis in remission.
机构信息
Department of Radiology, Huzhou Central Hospital, Huzhou, 313000, Zhejiang, People's Republic of China.
Department of Ultrasound, Huzhou Central Hospital, No. 198 Hongqi Road of Wuxing District, Huzhou, 313000, Zhejiang, People's Republic of China.
出版信息
J Orthop Surg Res. 2018 Jul 3;13(1):164. doi: 10.1186/s13018-018-0866-2.
BACKGROUND
To explore the value of MRI in the diagnosis of subclinical inflammation in patients with early rheumatoid arthritis (RA) in remission and to predict the radiographic progression.
METHODS
A total of 76 of 156 patients with early RA in remission at 1 year and with available magnetic resonance imaging (MRI) data at baseline and at 12 months were included. Complete clinical and laboratory evaluations were conducted for the patients. MRI images were assessed according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) system. Progression of bone erosions was defined as an increase of 1 or more units in annual RAMRIS score for erosions compared to baseline.
RESULTS
At 1 year, the majority of patients with RA in sustained remission showed some inflammatory activity on MRI (43.4% synovitis, 39.5% bone marrow edema (BME), and 9.2% tenosynovitis), and 25 of the 76 patients (32.9%) showed MRI progression of bone erosions. A significant difference was observed in MRI BME and bone erosion at 1 year, with higher mean score in patients with progression compared to non-progression of erosions (BME, 4.8 ± 3.6 vs 3.1 ± 2.1, P = 0.01; bone erosion, 13.5 ± 9.6 vs 4.4 ± 3.6, P < 0.001).
CONCLUSION
Persistent subclinical inflammations were shown in patients with sustained remission; BME in MRI may be a strong predictor of future radiographic progression of bone erosions in patients with persistent clinical remission.
背景
探讨磁共振成像（MRI）在诊断处于缓解期的早期类风湿关节炎（RA）患者亚临床炎症中的作用，并预测影像学进展。
方法
共纳入 156 例缓解期 1 年且基线和 12 个月时均有 MRI 数据的早期 RA 患者中的 76 例。对患者进行了完整的临床和实验室评估。MRI 图像根据类风湿关节炎 MRI 评分（RAMRIS）系统进行评估。骨侵蚀的进展定义为与基线相比，侵蚀的年度 RAMRIS 评分增加 1 个或更多单位。
结果
在 1 年时，大多数处于持续缓解期的 RA 患者的 MRI 显示有一些炎症活动（43.4%滑膜炎，39.5%骨髓水肿（BME）和 9.2%腱鞘炎），76 例患者中有 25 例（32.9%）出现 MRI 骨侵蚀进展。在 1 年时，MRI 中 BME 和骨侵蚀的差异具有统计学意义，进展患者的平均评分高于非进展患者（BME，4.8±3.6 比 3.1±2.1，P=0.01；骨侵蚀，13.5±9.6 比 4.4±3.6，P<0.001）。
结论
处于持续缓解期的患者存在持续性亚临床炎症；MRI 中的 BME 可能是预测持续临床缓解患者未来骨侵蚀影像学进展的一个有力指标。
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