关节痛患者的关节痛是否提示亚临床炎症导致类风湿关节炎进展？一项横断面 MRI 研究。
Is joint pain in patients with arthralgia suspicious for progression to rheumatoid arthritis explained by subclinical inflammation? A cross-sectional MRI study.
机构信息
Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands.
出版信息
Rheumatology (Oxford). 2019 Jan 1;58(1):86-93. doi: 10.1093/rheumatology/key220.
OBJECTIVES
The development of RA includes a phase of arthralgia preceding clinical arthritis. The aetiology of symptoms of arthralgia is unclear. Since subclinical joint inflammation is expected to be causally related to pain, we aimed to study associations between subclinical MRI-detected inflammation and pain in patients with arthralgia suspicious for progression to RA.
METHODS
Unilateral MRIs of the wrist, MCP (2-5) and MTP (1-5) joints of 325 patients who fulfilled the EULAR definition of arthralgia suspicious for progression to RA were scored by two readers on subclinical inflammation (synovitis, bone marrow oedema and tenosynovitis). Associations between MRI-detected inflammation and overall pain severity at patient level (measured using the visual analogue scale), as well as with local joint tenderness, were studied. Analyses were stratified for ACPA.
RESULTS
At patient level, synovitis (β = 0.10, P = 0.048) and tenosynovitis (β = 0.11, P = 0.026) associated with the visual analogue scale pain. Of the 1620 imaged joints, 447 (28%) were tender. MRI-detected synovitis associated independently with joint tenderness in all patients (odds ratio 1.74, P < 0.001), and in the ACPA-negative stratum (odds ratio 1.96, P < 0.001). In the ACPA-positive stratum only bone marrow oedema (osteitis) was independently associated with tenderness (odds ratio 2.39, P = 0.005). Sensitivity analyses in patients who developed inflammatory arthritis during follow-up (n = 61) revealed similar associations. Subclinical inflammation was present in 51% of tender joints and 39% of non-tender joints.
CONCLUSION
In patients with arthralgia suspicious for progression to RA, MRI-detected subclinical inflammation is associated with overall pain and local joint tenderness. However, the association is partial, indicating that subclinical inflammation is not the sole explanation of the arthralgia.
目的
类风湿关节炎（RA）的发病过程包括一个出现临床关节炎之前的关节痛阶段。关节痛症状的病因尚不清楚。由于预计亚临床关节炎症与疼痛有因果关系，我们旨在研究亚临床 MRI 检测到的炎症与怀疑进展为 RA 的关节炎患者疼痛之间的关联。
方法
对符合 EULAR 定义的怀疑进展为 RA 的关节炎患者的 325 例单侧腕、掌指（2-5 个）和跖趾（1-5 个）关节进行 MRI 检查，由两位读者对亚临床炎症（滑膜炎、骨髓水肿和腱鞘炎）进行评分。研究 MRI 检测到的炎症与患者水平的总体疼痛严重程度（使用视觉模拟量表测量）以及与局部关节压痛之间的关系。分析按 ACPA 进行分层。
结果
在患者水平上，滑膜炎（β=0.10，P=0.048）和腱鞘炎（β=0.11，P=0.026）与视觉模拟量表疼痛相关。在成像的 1620 个关节中，447 个（28%）有压痛。MRI 检测到的滑膜炎在所有患者（优势比 1.74，P<0.001）和 ACPA 阴性分层（优势比 1.96，P<0.001）中与关节压痛独立相关。在 ACPA 阳性分层中，仅骨髓水肿（骨炎）与压痛独立相关（优势比 2.39，P=0.005）。在随访期间发生炎症性关节炎的患者（n=61）的敏感性分析显示出类似的关联。在有压痛的关节中，51%存在亚临床炎症，在无压痛的关节中，39%存在亚临床炎症。
结论
在怀疑进展为 RA 的关节炎患者中，MRI 检测到的亚临床炎症与整体疼痛和局部关节压痛相关。然而，这种关联是部分的，表明亚临床炎症不是关节痛的唯一解释。
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