Arthritis Unit, Rheumatology Department, Hospital Clínic and IDIBAPS, Barcelona, Spain.
Radiology, Musculoskeletal Section, Hospital Universitari Bellvitge, Barcelona, Spain.
Rheumatology (Oxford). 2021 Feb 1;60(2):667-674. doi: 10.1093/rheumatology/keaa258.
To identify biomarkers of treatment change and radiographic progression in patients with RA under remission.
RA patients in remission (DAS28-ESR <2.6) were selected and followed up for 5 years. An MRI of the dominant hand and an US assessment of knees/hands and serum levels of inflammation/angiogenesis biomarkers were performed at baseline and at 12th month. Synovial biopsies were obtained in patients with Power Doppler signal. Conventional radiographies of hands/feet were taken at baseline and after 5 years. Radiographic progression was defined as the change in the modified Sharp van der Heijde Score at 5 years >10.47 (small detectable change).
Sixty patients were included, 81.6% were ACPA+ and 45% were taking biological DMARDs. At baseline, 66.6% had Power Doppler signal. After 5 years, 73.3% of patients remained in remission. Change of therapy was performed in 20 patients (33.3%) and was associated with BMI [odds ratio (OR) 1.3, 95% CI: 1, 1.7], lack of biological DMARD therapy (OR 24.7, 95% CI: 2.3, 257.2), first-year progression of MRI erosions (OR 1.2, 95% CI: 1, 1.3) and calprotectin serum levels (OR 2.8, 95% CI: 1, 8.2). Radiographic progression occurred in six (10%) patients. These patients had higher first-year progression of MRI erosions (P = 0.03) and bone oedema (P = 0.04). Among 23 patients undergoing synovial biopsy, mast cell density was independently associated with clinical flares.
One-third of RA patients lost clinical remission and changed therapy throughout the 5 years of follow-up, which was independently associated with BMI, lack of biological DMARDs therapy and first-year progression of MRI erosion score and calprotectin serum levels. Significant radiographic progression was uncommon.
确定处于缓解期的类风湿关节炎（RA）患者治疗改变和影像学进展的生物标志物。
选择处于缓解期（DAS28-ESR＜2.6）的 RA 患者，并进行 5 年随访。在基线和第 12 个月时进行手部磁共振成像（MRI）和膝关节/手部超声评估，以及炎症/血管生成生物标志物的血清水平检测。在有彩色多普勒信号的患者中进行滑膜活检。在基线和 5 年后拍摄手部/足部常规 X 线片。影像学进展定义为 5 年后改良 Sharp van der Heijde 评分变化＞10.47（可检测的小变化）。
共纳入 60 例患者，81.6%为 ACPA+，45%接受生物 DMARD 治疗。基线时，66.6%有彩色多普勒信号。5 年后，73.3%的患者仍处于缓解期。20 例（33.3%）患者改变了治疗方案，与 BMI[比值比（OR）1.3，95%置信区间（CI）：1，1.7]、缺乏生物 DMARD 治疗（OR 24.7，95%CI：2.3，257.2）、第一年 MRI 侵蚀进展（OR 1.2，95%CI：1，1.3）和血清钙卫蛋白水平（OR 2.8，95%CI：1，8.2）有关。6 例（10%）患者发生影像学进展。这些患者第一年 MRI 侵蚀和骨水肿进展较快（P=0.03 和 P=0.04）。在接受滑膜活检的 23 例患者中，肥大细胞密度与临床发作独立相关。
在 5 年的随访中，三分之一的 RA 患者失去了临床缓解并改变了治疗方案，这与 BMI、缺乏生物 DMARD 治疗以及第一年 MRI 侵蚀评分和血清钙卫蛋白水平的进展独立相关。显著的影像学进展并不常见。
