Rydell Emil, Forslind Kristina, Nilsson Jan-Åke, Karlsson Magnus, Åkesson Kristina E, Jacobsson Lennart T H, Turesson Carl
Rheumatology, Department of Clinical Sciences Malmö, Lund University, Jan Waldenströms gata 1B, SE-205 02, Malmö, Sweden.
Department of Rheumatology, Skåne University Hospital, Malmö, Sweden.
Arthritis Res Ther. 2021 Jan 14;23(1):27. doi: 10.1186/s13075-020-02413-7.
Radiographic damage in rheumatoid arthritis (RA) includes erosions and joint space narrowing (JSN). Different mechanisms may underlie their development. The objective of this study was to evaluate predictors of these entities separately.
Consecutive early RA patients (symptom duration ≤12 months) from a defined area (Malmö, Sweden) recruited during 1995-2005 were investigated. Radiographs of hands and feet were scored by a trained reader according to the modified Sharp-van der Heijde score. Fat mass and lean mass distribution were measured at baseline using dual energy x-ray absorptiometry. Potential predictors of erosion and JSN progression from inclusion to the 5-year follow-up were evaluated.
Two hundred and thirty-three patients were included. Radiographs at baseline and 5 years were available for 162 patients. The median (interquartile) progression of erosion and JSN scores were 4 (0-8) and 8 (1-16), respectively. Rheumatoid factor (RF) was a robust significant predictor of both erosion and JSN score progression. In adjusted analyses, anti-CCP antibodies predicted erosions while the erythrocyte sedimentation rate was predictive of both outcomes. Smoking and high baseline disease activity (DAS28 > 5.1) predicted progression of erosions. Baseline erosion score was associated with progression of both erosion and JSN progression, while baseline JSN score was predictive only of the progression of JSN. Overweight/obesity (BMI ≥ 25 kg/m) was a significant negative predictor of JSN score progression (β = - 0.14, p = 0.018, adjusted for RF, age, baseline JSN score) also when additionally adjusting for ever smoking (p = 0.041). Among female patients, this effect was observed in those of estimated post-menopausal age (> 51 years), but not in younger women. The truncal to peripheral fat ratio was associated with less JSN score progression in women, but not in men.
Overweight RA patients had less JSN progression, independent of smoking status. This effect was seen in particular among older women (mainly post-menopausal), but not younger. Truncal fat was associated with less JSN progression in female patients. Smoking predicted erosion progression, and erosions may precede JSN. BMI and fat distribution may influence cartilage damage in early RA and might be related to hormonal factors.
类风湿关节炎（RA）的影像学损害包括骨侵蚀和关节间隙狭窄（JSN）。它们的发展可能有不同的机制。本研究的目的是分别评估这些病变的预测因素。
对1995年至2005年期间从瑞典马尔默特定区域招募的连续早期RA患者（症状持续时间≤12个月）进行调查。由一名经过培训的阅片者根据改良的Sharp-van der Heijde评分对手和脚的X线片进行评分。在基线时使用双能X线吸收法测量脂肪量和瘦体量分布。评估从纳入研究到5年随访期间骨侵蚀和JSN进展的潜在预测因素。
共纳入233例患者。162例患者有基线和5年时的X线片。骨侵蚀和JSN评分的中位数（四分位间距）进展分别为4（0 - 8）和8（1 - 16）。类风湿因子（RF）是骨侵蚀和JSN评分进展的有力显著预测因素。在多因素分析中，抗环瓜氨酸肽（CCP）抗体可预测骨侵蚀，而红细胞沉降率可预测两种结局。吸烟和高基线疾病活动度（疾病活动评分28（DAS28）>5.1）可预测骨侵蚀进展。基线骨侵蚀评分与骨侵蚀和JSN进展均相关，而基线JSN评分仅可预测JSN进展。超重/肥胖（体重指数（BMI）≥25 kg/m²）是JSN评分进展的显著负性预测因素（β = -0.14，p = 0.018，校正RF、年龄、基线JSN评分），在进一步校正既往吸烟情况后（p = 0.041）仍成立。在女性患者中，这种效应在估计绝经后年龄（>51岁）的患者中观察到，而在年轻女性中未观察到。躯干与外周脂肪比与女性较少的JSN评分进展相关，而与男性无关。
超重的RA患者JSN进展较少，与吸烟状态无关。这种效应尤其在老年女性（主要是绝经后）中可见，而在年轻女性中未见。躯干脂肪与女性患者较少的JSN进展相关。吸烟可预测骨侵蚀进展，且骨侵蚀可能先于JSN出现。BMI和脂肪分布可能影响早期RA中的软骨损伤，且可能与激素因素有关。
