Department of Rheumatology, Leiden University Medical Centre, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Radiology, Leiden University Medical Centre, Leiden, The Netherlands.
Arthritis Res Ther. 2019 Feb 14;21(1):56. doi: 10.1186/s13075-019-1845-7.
MRI-detected subclinical joint inflammation in the hand joints of patients with undifferentiated arthritis (UA) predicts progression to rheumatoid arthritis (RA). It is unknown if adding MRI of the foot increases predictive accuracy compared to the hand alone.
1.5-T contrast-enhanced MRI of the unilateral foot (MTP-1-5) and hand (MCP-2-5 and wrist) was performed in 123 patients presenting with UA (not fulfilling the 2010 RA criteria) and scored for bone marrow edema (BME), synovitis and tenosynovitis. Symptom-free controls (n = 193) served as a reference for defining an abnormal MRI. Patients were followed for RA development ≤ 1 year, defined as fulfilling the classification criteria or initiation of disease-modifying antirheumatic drugs because of the expert opinion of RA. The added predictive value of foot MRI to hand MRI was evaluated.
Fifty-two percent developed RA. Foot tenosynovitis was predictive (OR 2.55, 95% CI 1.01-6.43), independent of BME and synovitis (OR 3.29, 95% CI 1.03-10.53), but not independent of CRP and number of swollen joints (OR 2.14, 95% CI 0.77-5.95). Hand tenosynovitis was also predictive independent of BME and synovitis (OR 3.99, 95% CI 1.64-9.69) and independent of CRP and swollen joints (OR 2.36, 95% CI 1.04-5.38). Adding foot tenosynovitis to hand tenosynovitis changed the sensitivity from 72 to 73%, specificity from 59 to 54% and AUC from 0.66 to 0.64; the net reclassification index was - 3.5.
MRI-detected tenosynovitis of the foot predicts progression to RA. However, adding MRI of the foot does not improve the predictive accuracy compared to MRI of the hand alone. In view of cost reduction, the performance of foot MRI for prognostic purposes in UA can be omitted.
在未分化关节炎（UA）患者的手部关节中，MRI 检测到的亚临床关节炎症可预测发展为类风湿关节炎（RA）。目前尚不清楚与单独手部 MRI 相比，增加足部 MRI 是否会提高预测准确性。
对 123 例出现 UA（不符合 2010 年 RA 标准）的患者进行单侧足部（MTP-1-5）和手部（MCP-2-5 和腕部）1.5-T 对比增强 MRI 检查，并对骨髓水肿（BME）、滑膜炎和腱鞘炎进行评分。无症状对照者（n=193）作为定义异常 MRI 的参考。患者在≤1 年内接受 RA 治疗，定义为符合分类标准或因专家意见认为 RA 而开始使用疾病修正抗风湿药物。评估了足部 MRI 对手部 MRI 的附加预测价值。
52%的患者发展为 RA。足部腱鞘炎具有预测性（OR 2.55，95%CI 1.01-6.43），与 BME 和滑膜炎无关（OR 3.29，95%CI 1.03-10.53），但与 CRP 和肿胀关节数无关（OR 2.14，95%CI 0.77-5.95）。手部腱鞘炎也具有预测性，与 BME 和滑膜炎无关（OR 3.99，95%CI 1.64-9.69），与 CRP 和肿胀关节数无关（OR 2.36，95%CI 1.04-5.38）。将足部腱鞘炎添加到手部腱鞘炎中，可将敏感性从 72%提高到 73%，特异性从 59%提高到 54%，AUC 从 0.66 提高到 0.64；净重新分类指数为-3.5。
MRI 检测到的足部腱鞘炎可预测 RA 的发展。然而，与单独手部 MRI 相比，增加足部 MRI 并不能提高预测准确性。考虑到成本降低，UA 患者的足部 MRI 可用于预后目的，也可省略。
