Sint Maartenskliniek, Nijmegen, the Netherlands.
Amsterdam Medical Center (AMC), Amsterdam, and Zuyderland Medical Center, Heerlen, the Netherlands.
Arthritis Care Res (Hoboken). 2024 Apr;76(4):497-502. doi: 10.1002/acr.25271. Epub 2024 Jan 25.
Current recommendations suggest that patients with newly presenting arthritis suspected of rheumatoid arthritis (RA) should undergo routine radiographs of hands and feet (X-HF) as the presence of RA-associated erosions might be of diagnostic and prognostic value. Our objective was to investigate the prevalence, diagnostic, and prognostic value of RA-associated erosions seen on routine X-HF in a large, recent cohort of patients with newly presenting arthritis.
A retrospective cohort study was performed between 2016 and 2019 in patients with newly presenting arthritis suspected of RA. Patients were included if arthritis was present at diagnosis, rheumatoid factor and anticitrullinated protein antibodies were measured, RA was noted in the differential diagnosis, and routine X-HF were conducted. Outcomes were the prevalence of one or more RA-associated erosion(s), and whether diagnostic or prognostic classification were changed by erosivity. Seronegative patients, patients without acute phase reactants, and patients with longer symptom duration were analyzed as subgroups.
RA-associated erosions were found in 32 of 724 patients (4.4%, 95% confidence interval [95% CI] 3.1-6.2). Erosions led to a change of diagnostic classification in two patients (0.3%, 95% CI 0.01-1.1) and changed prognostic classification in three patients (0.4%, 95% CI 0.1-1.3). Seronegative patients and patients without elevated acute phase reactants had significantly lower prevalence of erosions (χ 9.4, P = 0.002, χ 6.5, P = 0.01). Longer symptom duration was not associated with a different prevalence of erosions (χ 0.4, P = 0.81).
The recommendation of conducting routine X-HF in patients with newly presenting arthritis suspected of RA might be reconsidered due to low prevalence of early erosive disease and lack of diagnostic and prognostic value.
目前的建议指出，疑似类风湿关节炎（RA）的新发病例关节炎患者应常规进行手部和足部 X 光片（X-HF）检查，因为存在 RA 相关侵蚀可能具有诊断和预后价值。我们的目的是研究在最近的一个新发病例关节炎患者大队列中，常规 X-HF 中所见的 RA 相关侵蚀的患病率、诊断和预后价值。
2016 年至 2019 年期间对疑似 RA 的新发病例关节炎患者进行了回顾性队列研究。如果关节炎在诊断时存在、测量了类风湿因子和抗瓜氨酸蛋白抗体、在鉴别诊断中注意到 RA 且进行了常规 X-HF，则将患者纳入研究。结果为一个或多个 RA 相关侵蚀的患病率，以及侵蚀性是否改变了诊断或预后分类。分析了血清阴性患者、无急性期反应物患者和症状持续时间较长的患者亚组。
724 例患者中有 32 例（4.4%，95%置信区间 [95%CI] 3.1-6.2）存在 RA 相关侵蚀。侵蚀性在两名患者（0.3%，95%CI 0.01-1.1）中改变了诊断分类，在三名患者（0.4%，95%CI 0.1-1.3）中改变了预后分类。血清阴性患者和无急性期反应物患者的侵蚀患病率明显较低（χ²9.4，P=0.002，χ²6.5，P=0.01）。症状持续时间较长与侵蚀患病率无差异（χ²0.4，P=0.81）。
由于早期侵蚀性疾病的患病率低，且缺乏诊断和预后价值，建议对疑似 RA 的新发病例关节炎患者进行常规 X-HF 检查可能需要重新考虑。
