Park Eun-Jung, Jeong WooSeong, Kim Jinseok
Division of Rheumatology, Department of Medicine, National Medical Center, Seoul 04564, Korea.
Division of Rheumatology, Department of Medicine, Jeju National University School of Medicine, Jeju 63241, Korea.
J Pers Med. 2021 Mar 5;11(3):184. doi: 10.3390/jpm11030184.
(1) Background: It has long been suggested that seronegative rheumatoid arthritis (RA) represents a clinical entity quite distinct from that of seropositive. However, analytical studies of seronegative RA dedicated to clinical outcomes regarding radiographic progression and related risk factors are scarce. The aim of this study is to evaluate radiographic outcome and prognostic factors for radiographic progression in patients with seronegative rheumatoid arthritis. (2) Methods: Subjects included RA patients reported as seronegative for both rheumatoid factor and anti-citrullinated protein antibody, who were treated at Jeju National University Hospital in South Korea between 2003 and 2016, including follow-up of at least 2 years. All patients fulfilled 1987 ACA or 2010 ACR/EULAR RA criteria. Radiographic progression was measured by yearly change in the Sharp van der Heijde (SvdH) score during follow-up periods. Medical records, laboratory and radiographic data were retrospectively analyzed, and linear regression analysis was performed to evaluate prognostic factors for radiographic progression in patients with seronegative rheumatoid arthritis. (3) Results: In total, 116 patients with seronegative RA were observed and 43 (37.1%) patients demonstrated radiographic damage during follow-up period. Mean age at diagnosis was 48 years and 86 (74.1%) patients were female. Symptom duration at diagnosis was 1.3 years and mean follow-up duration was 5.2 years. Patients with radiographic damage at diagnosis were 14 (12.1%) and mean SvdH score was 6.8 at diagnosis. Radiographic damage and SvdH at diagnosis significantly correlated with radiographic progression in patients with seronegative RA after adjusting age, sex, symptom duration, number of active synovitis, and CRP at diagnosis (β 6.5 ± 1.84; = 0.001 and β- 0.12 ± 0.02; < 0.001, respectively). (4) Conclusions: This study determined that radiographic damage and SvdH at diagnosis were predictive factors in progression of radiographic damage in patients with seronegative rheumatoid arthritis. A large comparative study dedicated to this issue in seronegative RA is required.
（1）背景：长期以来，一直有人认为血清阴性类风湿关节炎（RA）代表一种与血清阳性类风湿关节炎截然不同的临床实体。然而，专门针对血清阴性RA的影像学进展及相关危险因素的临床结局的分析研究却很匮乏。本研究的目的是评估血清阴性类风湿关节炎患者的影像学结局及影像学进展的预后因素。（2）方法：研究对象包括类风湿因子和抗瓜氨酸化蛋白抗体均为血清阴性的RA患者，这些患者于2003年至2016年在韩国济州国立大学医院接受治疗，且随访时间至少为2年。所有患者均符合1987年美国风湿病学会（ACA）或2010年美国风湿病学会/欧洲抗风湿病联盟（ACR/EULAR）的RA标准。通过随访期间Sharp van der Heijde（SvdH）评分的年度变化来衡量影像学进展。对病历、实验室及影像学数据进行回顾性分析，并进行线性回归分析以评估血清阴性类风湿关节炎患者影像学进展的预后因素。（3）结果：总共观察了116例血清阴性RA患者，43例（37.1%）患者在随访期间出现了影像学损伤。诊断时的平均年龄为48岁，86例（74.1%）患者为女性。诊断时的症状持续时间为1.3年，平均随访时间为5.2年。诊断时出现影像学损伤的患者有14例（12.1%），诊断时的平均SvdH评分为6.8。在调整年龄、性别、症状持续时间、活动性滑膜炎数量及诊断时的C反应蛋白水平后，血清阴性RA患者诊断时的影像学损伤和SvdH评分与影像学进展显著相关（β分别为6.5±1.84；P = 0.001和β为 - 0.12±0.02；P < 0.001）。（4）结论：本研究确定诊断时的影像学损伤和SvdH评分是血清阴性类风湿关节炎患者影像学损伤进展的预测因素。需要针对血清阴性RA的这一问题开展大规模的对比研究。
