Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
Rheumatology (Oxford). 2022 May 5;61(5):2113-2118. doi: 10.1093/rheumatology/keab651.
Morning stiffness (MS) is characteristic of RA and associates with markers of systemic and local inflammation in RA patients. In patients with arthralgia, MS is a cardinal symptom to recognize arthralgia at-risk for RA development [i.e. clinically suspect arthralgia (CSA)]. In CSA, MS is also assumed to reflect inflammation, but this has never been studied. Therefore we aimed to study whether MS in CSA patients is associated with systemic and subclinical joint inflammation.
A total of 575 patients presenting with CSA underwent laboratory investigations and contrast-enhanced 1.5 T MRI of the hand and forefoot (scored according to the Rheumatoid Arthritis MRI Score method). Associations of MS (duration ≥60 min) with the presence of subclinical joint inflammation (synovitis, tenosynovitis and osteitis) and increased CRP (≥5 mg/l) were determined with logistic regression. Additionally, the effect of MS duration (≥30, ≥60 and ≥120 min) was studied.
A total of 195 (34%) CSA patients experienced MS. These patients more often had subclinical synovitis [34% vs 21%; odds ratio (OR) 1.95 (95% CI 1.32, 2.87)], subclinical tenosynovitis [36% vs 26%; OR 1.59 (95% CI 1.10, 2.31)] and increased CRP [31% vs 19%; OR 1.93 (95% CI 1.30, 2.88)] than patients without MS. In multivariable analyses, subclinical synovitis [OR 1.77 (95% CI 1.16, 2.69)] and CRP [OR 1.78 (95% CI 1.17-2.69)] remained independently associated with MS. In CSA patients who later developed RA, and thus in retrospect were 'pre-RA' at the time of CSA, MS was more strongly associated with subclinical synovitis [OR 2.56 (95% CI 1.04, 6.52)] and CRP [OR 3.86 (95% CI 1.45, 10.24)]. Furthermore, associations increased with longer MS durations.
Inflammation associates with MS in the CSA phase that preceded clinical arthritis. These results increase our understanding of MS when assessing arthralgia in clinical practice.
晨僵（MS）是 RA 的特征之一，与 RA 患者的全身和局部炎症标志物相关。在出现关节痛的患者中，MS 是识别有 RA 发展风险的关节痛（即临床可疑关节痛（CSA））的主要症状。在 CSA 中，MS 也被认为反映了炎症，但这从未被研究过。因此，我们旨在研究 CSA 患者的 MS 是否与全身和亚临床关节炎症相关。
共有 575 名出现 CSA 的患者接受了实验室检查和手和前足的对比增强 1.5T MRI（根据类风湿关节炎 MRI 评分方法进行评分）。使用逻辑回归确定 MS（持续时间≥60 分钟）与亚临床关节炎症（滑膜炎、腱鞘炎和骨炎）和 CRP 升高（≥5mg/l）的存在之间的关联。此外，还研究了 MS 持续时间（≥30、≥60 和≥120 分钟）的影响。
共有 195 名（34%）CSA 患者出现 MS。这些患者更常出现亚临床滑膜炎[34% vs 21%；比值比（OR）1.95（95%置信区间 1.32-2.87）]、亚临床腱鞘炎[36% vs 26%；OR 1.59（95% CI 1.10-2.31）]和 CRP 升高[31% vs 19%；OR 1.93（95% CI 1.30-2.88）]比没有 MS 的患者。在多变量分析中，亚临床滑膜炎[OR 1.77（95% CI 1.16-2.69）]和 CRP[OR 1.78（95% CI 1.17-2.69）]仍然与 MS 独立相关。在后来发展为 RA 的 CSA 患者中，因此在回顾性分析时，他们在 CSA 时已经是“前 RA”，MS 与亚临床滑膜炎[OR 2.56（95% CI 1.04-6.52）]和 CRP[OR 3.86（95% CI 1.45-10.24）]的相关性更强。此外，随着 MS 持续时间的延长，相关性增加。
在临床关节炎之前的 CSA 阶段，炎症与 MS 相关。这些结果增加了我们对临床实践中评估关节痛时 MS 的理解。
