Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
RMD Open. 2022 Jul;8(2). doi: 10.1136/rmdopen-2021-002128.
In the last decade, much research has focused on the development of rheumatoid arthritis (RA) and the symptomatic phase preceding the onset of clinical arthritis. Observational studies on imaging have revealed that subclinical joint inflammation in patients with arthralgia at risk for RA precedes and predicts the onset of clinically apparent arthritis. Moreover, the results of two placebo-controlled randomised proof-of-concept trials in patients with arthralgia and MRI-detected subclinical inflammation studies will soon be available. The initial results are encouraging and suggest a beneficial effect of DMARD treatment on subclinical inflammation. Since this may increase the necessity to detect subclinical joint inflammation in persons with arthralgia that are at risk for RA, we will here review what has been learnt about subclinical inflammation in at-risk individuals by means of imaging. We will focus on MRI as this method has the best sensitivity and reproducibility. We evaluate the prognostic value of MRI-detected subclinical inflammation and assess the lessons learnt from MRIs about the tissues that are inflamed early on and are associated with the clinical phenotype in arthralgia at risk for RA, for example, subclinical tenosynovitis underlying pain and impaired hand function. Finally, because long scan times and the need for intravenous-contrast agent contribute to high costs and limited feasibility of current MRI protocols, we discuss progress that is being made in the field of MRI and that can result in a future-proof way of imaging that is useful for assessment of joint inflammation on a large scale, also in a society with social distancing due to COVID-19 restrictions.
在过去的十年中，大量的研究集中在类风湿关节炎 (RA) 的发展和临床关节炎发病前的症状阶段。对影像学的观察性研究表明，在有发生 RA 风险的关节痛患者中，亚临床关节炎症先于并预测临床明显关节炎的发生。此外，两项针对有亚临床炎症的关节痛患者和 MRI 检测到的亚临床炎症研究的安慰剂对照随机概念验证试验的初步结果即将公布。初步结果令人鼓舞，表明 DMARD 治疗对亚临床炎症有有益的效果。由于这可能增加了检测有发生 RA 风险的关节痛患者亚临床炎症的必要性，我们将在这里回顾通过影像学手段在有发生 RA 风险的个体中了解到的亚临床炎症。我们将重点关注 MRI，因为这种方法具有最好的敏感性和可重复性。我们评估了 MRI 检测到的亚临床炎症的预后价值，并评估了从 MRI 中了解到的有关组织的经验教训，这些组织在有发生 RA 风险的关节痛中很早就发生炎症，并与临床表型相关，例如，潜在疼痛和手部功能障碍的亚临床腱鞘炎。最后，由于长时间的扫描时间和对静脉内造影剂的需求导致成本增加，并且当前的 MRI 方案的可行性有限，因此我们将讨论在 MRI 领域取得的进展，这些进展可以为未来的成像方式提供保障，从而在由于 COVID-19 限制而需要保持社交距离的社会中，对大规模的关节炎症评估也具有实用性。
