Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Italy.
Department of Rheumatology and Clinical Immunology, Freiburg University Medical Center, Medical Faculty, Albert Ludwigs University, Freiburg, Germany.
Clin Exp Rheumatol. 2020 May-Jun;38(3):536-542. Epub 2019 Jul 25.
There is growing evidence that the development of rheumatoid arthritis (RA) is a multistep process. The European League Against Rheumatism (EULAR) identified different phases before the onset of RA, from the presence of genetic and environmental risk factors for RA, towards clinically suspected arthralgia and undifferentiated arthritis. Currently, a new definition of "window of opportunity" is emerging; this states that the window could even lie in preclinical phase of RA, preceding diagnosis or fulfillment of classification criteria for RA. In this scenario, the detection of subclinical inflammation by imaging tools could be useful together with autoantibodies and joint symptoms to better stratify people at high risk for developing RA and to plan prevention trials in high-risk cohorts. This review will give an overview on the use of computed tomography, magnetic resonance imaging and ultrasonography in the preclinical phases of RA.
越来越多的证据表明，类风湿关节炎 (RA) 的发展是一个多步骤的过程。欧洲抗风湿病联盟 (EULAR) 在 RA 发病前确定了不同的阶段，从存在 RA 的遗传和环境风险因素，到临床上疑似关节痛和未分化关节炎。目前，“机会之窗”的新定义正在出现；这表明该窗口甚至可能存在于 RA 的临床前阶段，即在 RA 的诊断或分类标准得到满足之前。在这种情况下，通过影像学工具检测亚临床炎症，结合自身抗体和关节症状，可能有助于更好地区分处于 RA 高风险的人群，并在高危人群中计划预防试验。这篇综述将概述计算机断层扫描、磁共振成像和超声在 RA 临床前阶段的应用。
