Department of Rheumatology and Immunology, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, 200003, China.
Peking-Tsinghua Center for Life Sciences, Tsinghua University, Beijing, 100084, China.
Clin Rheumatol. 2023 Sep;42(9):2397-2407. doi: 10.1007/s10067-023-06658-w. Epub 2023 Jun 19.
C-reactive protein (CRP) and magnetic resonance imaging (MRI) are widely used to monitor inflammation in patients with axial spondyloarthritis (axSpA), but the relationship between CRP and MRI-detected inflammation is incompletely understood. The present study was undertaken to assess correlations between CRP and MRI-detected inflammation in axSpA.
A systematic literature search was performed (Medline, Embase, and Cochrane Library) to identify relevant studies concerning CRP and MRI-detected inflammation in axSpA patients. The MRI-detected inflammation was evaluated by MRI-based disease activity score (DAS). The correlation between CRP and MRI-based DAS was integrated by random-effect models.
Eighteen studies reported a total of 1392 axSpA patients which were included in this meta-analysis. CRP was significantly associated with spinal MR DAS (r=0.226, 95%CI [0.149, 0.291], p<0.001, I=23%). We also found a moderate correlation between CRP change and spinal MR DAS change (r[ASspiMRI-a]=0.354, 95%CI [0.282, 0.422], p<0.001, I=48%; r[SPARCC]=0.544, 95%CI [0.345, 0.701], p<0.001, I=19%). CRP at baseline was negatively associated with improvement in spinal MR DAS (r= - 0.327, 95%CI [-0.397, -0.264], p<0.001, I=0%). However, no significant association was found between CRP and sacroiliac joint (SIJ) MR DAS.
In axSpA patients, CRP is associated with MRI-detected inflammation in the spine but not in SIJ. We speculate that CRP could be a reasonable index to reflect spinal inflammation. Therefore, we suggest it is not essential to repeat spinal MRI in a short term, while SIJ MRI may be necessary to provide additional information on inflammation. Key Points • CRP is associated with MRI-detected inflammation in the spine but not in sacroiliac joints. • CRP at baseline was negatively associated with improvement in spinal MR DAS. • It was not essential to repeat spinal MRI frequently, while SIJ MRI may be necessary to provide additional information on inflammation.
C 反应蛋白（CRP）和磁共振成像（MRI）广泛用于监测轴性脊柱关节炎（axSpA）患者的炎症，但 CRP 与 MRI 检测到的炎症之间的关系尚不完全清楚。本研究旨在评估 axSpA 患者中 CRP 与 MRI 检测到的炎症之间的相关性。
系统检索了 Medline、Embase 和 Cochrane 图书馆中关于 axSpA 患者 CRP 和 MRI 检测到的炎症的相关研究。使用基于 MRI 的疾病活动评分（DAS）评估 MRI 检测到的炎症。通过随机效应模型综合 CRP 与 MRI 基于 DAS 的相关性。
共有 18 项研究报告了总共 1392 例 axSpA 患者，这些患者被纳入本荟萃分析。CRP 与脊柱 MRI-DAS 显著相关（r=0.226，95%CI [0.149, 0.291]，p<0.001，I=23%）。我们还发现 CRP 变化与脊柱 MRI-DAS 变化之间存在中度相关性（r[ASspiMRI-a]=0.354，95%CI [0.282, 0.422]，p<0.001，I=48%；r[SPARCC]=0.544，95%CI [0.345, 0.701]，p<0.001，I=19%）。基线时 CRP 与脊柱 MRI-DAS 的改善呈负相关（r= - 0.327，95%CI [-0.397, -0.264]，p<0.001，I=0%）。然而，CRP 与骶髂关节（SIJ）MRI-DAS 之间无显著相关性。
在 axSpA 患者中，CRP 与脊柱 MRI 检测到的炎症相关，但与 SIJ 无关。我们推测 CRP 可能是反映脊柱炎症的合理指标。因此，我们建议在短期内无需频繁重复脊柱 MRI，而 SIJ MRI 可能有必要提供炎症的额外信息。
CRP 与脊柱 MRI 检测到的炎症相关，但与骶髂关节无关。
基线时 CRP 与脊柱 MRI-DAS 的改善呈负相关。
无需频繁重复脊柱 MRI，而 SIJ MRI 可能有必要提供炎症的额外信息。
