Kisten Yogan, Arnaud Laurent, Levitsky Adrian, Györi Noémi, Larsson Per, Hensvold Aase, Catrina Anca, Af Klint Erik, Rezaei Hamed
Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
Hôpitaux Universitaires de Strasbourg Service de Rhumatologie, National Reference Center for Rare Systemic Autoimmune Diseases, Strasbourg, Alsace-Champagne-Ardenne, France.
ACR Open Rheumatol. 2023 Sep;5(9):474-480. doi: 10.1002/acr2.11599. Epub 2023 Aug 7.
To investigate whether digital activity fluorescence optical imaging (FOI) patterns of inflammation can identify distinct rheumatoid arthritis (RA) phenotypes.
The hands of newly diagnosed patients with RA were evaluated by clinical examination, musculoskeletal ultrasound, and FOI. Inflammation on FOI was defined when capillary leakage and/or fluorophore perfusion was present. The FOI composite image was quantified into a digital disease activity (DACT) score, using novel computerized algorithms. Unsupervised clustering on FOI inflammatory patterns was used to identify subgroups of patients relative to anticyclic citrullinated peptides (ACPA) and/or rheumatoid factor (RF).
Of 1326 examined hand joints in 39 patients with RA (72% female; 56% ever-smokers; 54% RF positive and 69% ACPA positive), 400 (30%) showed inflammation by FOI, and 95% (37 of 39) of patients had DACT-FOI scores greater than 1. Unsupervised analysis on FOI patterns revealed two patient clusters, cluster 1 (n = 29) and cluster 2 (n = 10). The proportion of seropositive patients was significantly higher in cluster 1 versus cluster 2 (90%, 26 of 29 vs. 30%, 3 of 10; P < 0.01), whereas C-reactive-protein levels (minimum-maximum) were significantly higher in cluster 2 (20 mg/l [1-102]) versus cluster 1 (2 mg/l [0-119]; P = 0.01). A wider variety and proportion of inflamed joints emerged for patients with RA in cluster 2 versus cluster 1, in which inflammation was more concentrated around the wrists and the right metacarpophalangeal 2 (MCP2), bilateral MCP3, and, to a lesser degree, left MCP2 and proximal interphalangeal joint and tendon regions. Cluster 1 displayed lower mean (±SD) DACT scores compared with cluster 2 (3.6 ± 2.1 vs. 5.4 ± 2.1; P = 0.03).
FOI-based digital quantification of hand joint inflammation revealed two distinct RA subpopulations with and without ACPA and RF related autoantibodies.
探讨炎症的数字活动荧光光学成像（FOI）模式是否能识别不同的类风湿关节炎（RA）表型。
通过临床检查、肌肉骨骼超声和FOI对新诊断的RA患者的手部进行评估。当存在毛细血管渗漏和/或荧光团灌注时，定义为FOI上的炎症。使用新型计算机算法将FOI复合图像量化为数字疾病活动（DACT）评分。对FOI炎症模式进行无监督聚类，以识别相对于抗环瓜氨酸肽（ACPA）和/或类风湿因子（RF）的患者亚组。
在39例RA患者（72%为女性；56%为曾经吸烟者；54%为RF阳性，69%为ACPA阳性）的1326个检查手部关节中，400个（30%）在FOI上显示炎症，95%（39例中的37例）患者的DACT-FOI评分大于1。对FOI模式的无监督分析揭示了两个患者聚类，聚类1（n = 29）和聚类2（n = 10）。聚类1中血清阳性患者的比例显著高于聚类2（90%，29例中的26例对30%，10例中的3例；P < 0.01），而聚类2中的C反应蛋白水平（最小值 - 最大值）显著高于聚类1（20 mg/l [1 - 102]）对聚类1（2 mg/l [0 - 119]；P = 0.01）。与聚类1相比，聚类2中RA患者出现炎症的关节种类更多、比例更高，其中炎症更集中在手腕和右手第2掌指关节（MCP2）、双侧MCP3，以及程度较轻的左手MCP2和近端指间关节及肌腱区域。聚类1的平均（±标准差）DACT评分低于聚类2（3.6 ± 2.1对5.4 ± 2.1；P = 0.03）。
基于FOI对手部关节炎症进行数字量化，揭示了有无ACPA和RF相关自身抗体的两个不同的RA亚群。
