From the Departments of Clinical Immunology and Rheumatology.
Radiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
J Clin Rheumatol. 2022 Mar 1;28(2):e511-e516. doi: 10.1097/RHU.0000000000001785.
Reactive arthritis (ReA) is a unique subgroup of spondyloarthritis with acute presentation and tendency to develop chronicity. Magnetic resonance imaging (MRI) has enabled identification of sensitive markers of response to therapy.
A longitudinal pilot study of acute ReA with knee joint involvement satisfying the Braun's criteria was undertaken. Magnetic resonance imaging of the knee was assessed at baseline, and agreement with ultrasonography was assessed. Clinical details were recorded using a detailed and structured case record form. Patients were followed up, and MRI predictors of transition to chronic arthritis were looked for.
In 25 patients with ReA, synovial thickening was the most common feature. Enthesitis was observed on MRI in 20%. Urethritis-related and HLA-B27-positive ReA had higher synovial thickening scores (p = 0.007). Agreement was poor between MRI and ultrasonography (synovial hypertrophy: k = 0.04). On follow-up, 34% (n = 7/21 for >12 months) continued to have active disease. None of the clinical or radiological features were predictive of chronicity.
Posturethritis and B27-positive ReA was more severe than postenteritis ReA and RA on MRI. One third develop chronic disease on follow-up. Magnetic resonance imaging is superior to sonography, although baseline imaging is not predictive of chronicity. The results of this pilot exploratory study argue for larger studies on MRI in ReA.
反应性关节炎（ReA）是一种具有急性表现和发展为慢性倾向的独特的脊柱关节炎亚组。磁共振成像（MRI）使识别对治疗反应的敏感标志物成为可能。
对满足 Braun 标准的膝关节受累的急性反应性关节炎进行了一项纵向试点研究。在基线时评估膝关节 MRI，并评估与超声检查的一致性。使用详细的结构化病例记录表记录临床详细信息。对患者进行随访，并寻找 MRI 预测慢性关节炎的指标。
在 25 例反应性关节炎患者中，滑膜增厚是最常见的特征。MRI 观察到附着点炎 20%。与尿道炎相关和 HLA-B27 阳性的反应性关节炎滑膜增厚评分更高（p=0.007）。MRI 和超声检查的一致性较差（滑膜肥厚：k=0.04）。随访时，34%（n=7/21 随访>12 个月）持续存在活动性疾病。没有任何临床或放射学特征可预测慢性疾病。
尿道炎后和 B27 阳性反应性关节炎比尿道炎后和 RA 更严重。三分之一的患者在随访中发展为慢性疾病。磁共振成像优于超声检查，尽管基线成像不能预测慢性疾病。这项初步探索性研究的结果表明，需要对反应性关节炎的 MRI 进行更大规模的研究。
