Copenhagen Center for Arthritis Research, Center for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.
Department of Rheumatology, Ghent University Hospital, Ghent, Belgium.
Rheumatology (Oxford). 2023 Jun 1;62(6):2130-2138. doi: 10.1093/rheumatology/keac567.
The aim of this study was to investigate the reliability, validity, and sensitivity to change of a novel MRI scoring system in early peripheral SpA (pSpA).
MRI of the pelvis and lower extremities was performed before initiation of the TNF inhibitor golimumab in 56 patients and repeated in 46 patients who achieved sustained clinical remission after 24, 36 or 48 weeks. Three readers applied a semi-quantitative MRI scoring system for lower-extremity joint and entheseal inflammation. Four lesion types were assessed: entheseal osteitis, entheseal soft-tissue inflammation, joint osteitis, and joint synovitis/effusion. MRI response was defined as a decrease in MRI lower-extremity inflammation index (sum of scores from 75 sites, each scored 0-3) above the smallest detectable change (SDC).
At follow-up, the MRI index decreased in 34 of 46 patients (74%), and 15 (33%) patients achieved MRI response, i.e. a decrease above SDC of 2.8. When restricting the analysis to patients with clinical involvement of lower-extremity sites that were assessed by MRI, 13 of 28 (46%) achieved MRI response. Interreader reliability was very good, with an average-measure intraclass correlation coefficient of 0.92 (95% CI: 0.85-0.95) for status scores and 0.89 (0.80-0.94) for change in scores. The MRI index correlated with other measures of disease activity, including CRP [Spearman's rho 0.41 (0.23-0.56)], swollen joint count of 6 joints [0.47 (0.27-0.63)], tender enthesis count of 14 entheses [0.32 (0.12-0.50)] and pain score [0.28 (0.08-0.46)], all P < 0.05.
The proposed MRI lower-extremity inflammation index demonstrated reliability, validity, and sensitivity to change in patients with early pSpA.
Clinicaltrials.gov, http://clinicaltrials.gov, NCT01426815.
本研究旨在探讨一种新的早期外周型脊柱关节炎（pSpA）MRI 评分系统的可靠性、有效性和对变化的敏感性。
56 例患者在开始使用 TNF 抑制剂戈利木单抗前进行了骨盆和下肢 MRI 检查，并在 24、36 或 48 周后达到持续临床缓解的 46 例患者中重复进行。3 位阅片者采用半定量 MRI 评分系统评估下肢关节和附着点炎症。评估了 4 种病变类型：附着点骨炎、附着点软组织炎症、关节骨炎和关节滑膜炎/积液。MRI 反应定义为 75 个部位评分总和（每个部位评分为 0-3）高于最小可检测变化（SDC）的下降。
在随访时，46 例患者中有 34 例（74%）MRI 指数下降，15 例（33%）患者达到 MRI 反应，即下降超过 SDC 的 2.8。当将分析仅限于通过 MRI 评估的下肢受累部位的患者时，28 例中有 13 例（46%）达到 MRI 反应。观察者间可靠性非常好，状态评分的平均测量组内相关系数为 0.92（95%CI：0.85-0.95），评分变化的为 0.89（0.80-0.94）。MRI 指数与其他疾病活动测量指标相关，包括 CRP[Spearman 相关系数 0.41（0.23-0.56）]、6 个关节肿胀关节计数[0.47（0.27-0.63）]、14 个压痛附着点计数[0.32（0.12-0.50）]和疼痛评分[0.28（0.08-0.46）]，均 P<0.05。
在早期 pSpA 患者中，提出的 MRI 下肢炎症指数显示出可靠性、有效性和对变化的敏感性。
Clinicaltrials.gov，http://clinicaltrials.gov，NCT01426815。
