血清阴性类风湿关节炎患者与血清阳性患者具有不同的表型：一项临床和超声研究。
Patients with seronegative rheumatoid arthritis have a different phenotype than seropositive patients: A clinical and ultrasound study.
作者信息
Carbonell-Bobadilla Natalia, Soto-Fajardo Carina, Amezcua-Guerra Luis M, Batres-Marroquín Ana Beatriz, Vargas Tania, Hernández-Diazcouder Adrian, Jiménez-Rojas Valentin, Medina-García Ana Cristina, Pineda Carlos, Silveira Luis H
机构信息
Department of Rheumatology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico City, Mexico.
Rheumatology Division, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
出版信息
Front Med (Lausanne). 2022 Aug 16;9:978351. doi: 10.3389/fmed.2022.978351. eCollection 2022.
INTRODUCTION
Rheumatoid arthritis (RA) is an inflammatory disease whose clinical phenotype largely depends on the presence of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA). Seronegative RA appears to be a less severe disease, but this remains controversial. This study aimed to assess whether seronegative patients show a less severe disease than seropositive patients.
METHODS
A cross-sectional study was conducted on RA outpatients from a single center. Clinical activity scales, laboratory evaluations, and cardiovascular risk scores were assessed. Musculoskeletal ultrasound (US) examinations were performed.
RESULTS
One hundred and fourteen patients were enrolled. Eighty-five were seropositive (76% women) and 29 seronegative (93% women). Seropositive patients had a younger age at disease onset (43 ± 14 vs. 54 ± 11; = 0.001) and used sulfasalazine (47 vs. 17%; = 0.004) and glucocorticoids (36 vs. 10%; = 0.007) more frequently. No differences in clinical activity scales and in 10-year cardiovascular risk were observed. Pathological US data were found more frequently in seropositive patients in the 2 metacarpophalangeal (MCP) joint, both in grayscale (71 vs. 38%; = 0.008) and in power Doppler (PD; 53 vs. 9%; < 0.001); erosions (36 vs. 9%; = 0.020) were also more frequent. We found greater severity of PD signals in the 2nd MCP and 3rd MCP joints of the seropositive patients, while synovitis severity was higher only in the 2nd MCP joints. The percentage of total joints with erosions (9 vs. 1%; < 0.001) and 2nd MCP joints with erosions (25 vs. 7%; < 0.001) was higher in seropositive patients.
CONCLUSION
RA patients show a differentiated phenotype according to their ACPA and RF status. In seronegative patients, RA begins later in life and has a lower requirement for antirheumatic therapies. On US evaluation, seropositive patients show more joint damage, especially in MCP joints. Despite this, long-term cardiovascular risk is similar among RA patients, regardless of their RF and ACPA status.
引言
类风湿关节炎（RA）是一种炎症性疾病，其临床表型很大程度上取决于类风湿因子（RF）和抗瓜氨酸化蛋白抗体（ACPA）的存在。血清阴性类风湿关节炎似乎病情较轻，但这一点仍存在争议。本研究旨在评估血清阴性患者的病情是否比血清阳性患者轻。
方法
对来自单一中心的类风湿关节炎门诊患者进行了一项横断面研究。评估了临床活动量表、实验室检查结果和心血管风险评分。进行了肌肉骨骼超声（US）检查。
结果
共纳入114例患者。85例为血清阳性（76%为女性），29例为血清阴性（93%为女性）。血清阳性患者发病年龄较轻（43±14岁 vs. 54±11岁；P = 0.001），更频繁使用柳氮磺胺吡啶（47% vs. 17%；P = 0.004）和糖皮质激素（36% vs. 10%；P = 0.007）。在临床活动量表和10年心血管风险方面未观察到差异。在2个掌指关节（MCP）中，血清阳性患者更常出现病理性超声数据，无论是在灰阶（71% vs. 38%；P = 0.008）还是在能量多普勒（PD）方面（53% vs. 9%；P < 0.001）；侵蚀（36% vs. 9%；P = 0.020）也更常见。我们发现血清阳性患者第2和第3 MCP关节的PD信号更严重，而滑膜炎严重程度仅在第2 MCP关节更高。血清阳性患者有侵蚀的关节总数百分比（9% vs. 1%；P < 0.001）和有侵蚀的第2 MCP关节百分比（25% vs. 7%；P < 0.001）更高。
结论
类风湿关节炎患者根据其ACPA和RF状态表现出不同的表型。血清阴性患者发病较晚，对抗风湿治疗的需求较低。超声评估显示，血清阳性患者关节损伤更多，尤其是在MCP关节。尽管如此，无论类风湿关节炎患者的RF和ACPA状态如何，其长期心血管风险相似。
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