Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands.
Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
Arthritis Res Ther. 2020 Nov 23;22(1):277. doi: 10.1186/s13075-020-02359-w.
The forefoot is a preferential location for joint and tendon sheath inflammation in rheumatoid arthritis (RA). It also contains bursae, of which the intermetatarsal bursae have a synovial lining. Some small imaging studies suggested that intermetatarsal bursitis (IMB) and submetatarsal bursitis (SMB) are involved in RA, but their association has not been thoroughly explored. Healthy control studies suggested that lesion size might be relevant. We studied the relation between IMB and SMB in early RA, compared to other arthritides and healthy controls, and the relevance of lesion sizes.
Six hundred and thirty-four participants were studied: 157 consecutive patients presenting with early RA, 284 other arthritides, and 193 healthy controls. All underwent unilateral contrast-enhanced MRI of the forefoot at presentation. Two readers independently scored IMB and SMB and measured transverse and dorsoplantar diameters, blinded to clinical data. Subsequently, consensus was reached. Intra-reader ICC was 0.89. Logistic regression models were used, and test characteristics were calculated.
IMB and SMB associated with RA independent of each other (P < 0.001) and independent of age, gender, BMI, RA-MRI inflammation, and anti-CCP-antibodies (P = 0.041). Sensitivity for RA of IMB was 69%, and for SMB 25%. Specificity for IMB was 70% compared to other arthritides, and 84% compared to healthy controls. For SMB, this was 94% and 97% respectively. Regarding lesion size, the groups had considerable overlap: no cut-off size for RA could be distinguished with high sensitivity and specificity.
Intermetatarsal and submetatarsal bursitis associated with early rheumatoid arthritis, contributing to the emerging evidence that inflammation of juxta-articular soft tissues is an early feature of RA.
类风湿关节炎（RA）的前足是关节和腱鞘炎症的首选部位。它还包含滑囊，其中跖间滑囊有滑膜衬里。一些小型影像学研究表明，跖间滑囊炎（IMB）和跖下滑囊炎（SMB）与 RA 有关，但它们之间的关联尚未得到彻底探讨。健康对照研究表明，病变大小可能相关。我们研究了早期 RA 中 IMB 和 SMB 之间的关系，与其他关节炎和健康对照组进行了比较，并探讨了病变大小的相关性。
研究共纳入 634 名参与者：157 名连续就诊的早期 RA 患者、284 名其他关节炎患者和 193 名健康对照者。所有参与者在就诊时均接受了单侧对比增强前足 MRI 检查。两名读者独立对 IMB 和 SMB 进行评分，并对横径和足背跖径进行测量，盲于临床数据。随后达成共识。内部读者 ICC 为 0.89。使用逻辑回归模型，计算了检验特征。
IMB 和 SMB 与 RA 相关，彼此独立（P<0.001），且与年龄、性别、BMI、RA-MRI 炎症和抗 CCP 抗体无关（P=0.041）。IMB 对 RA 的敏感性为 69%，对 SMB 的敏感性为 25%。与其他关节炎相比，IMB 的特异性为 70%，与健康对照组相比，特异性为 84%。对于 SMB，特异性分别为 94%和 97%。关于病变大小，各组之间有很大的重叠：没有可以区分高敏感性和特异性的 RA 截断值。
跖间和跖下滑囊炎与早期类风湿关节炎相关，这进一步证实了关节周围软组织炎症是 RA 的早期特征这一观点。
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