Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.
Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
RMD Open. 2024 Nov 12;10(4):e004966. doi: 10.1136/rmdopen-2024-004966.
Conventional radiographs of hands and feet are used to depict structural damage in rheumatoid arthritis (RA). This is also commonly done in clinical practice in symptomatic patients at risk for RA (clinically suspect arthralgia (CSA)), but its rationale is unclear. We aimed to investigate the prevalence of radiographic erosive disease in patients with CSA and its progression over time.
Patients with symptomatic arthralgia of the Leiden CSA cohort were studied during 2-year follow-up or until development of inflammatory arthritis (IA). Erosive disease was defined according to the radiologist, or according to the RA-specific erosive definition in light of the American College of Rheumatology (ACR)/European Alliance of Associations for Rheumatology (EULAR) 2010 RA criteria. Serial radiographs were evaluated according to the Sharp van der Heijde Scoring method (SHS) and radiographic erosive progression was determined. Additionally, it was evaluated if baseline erosive disease associated with IA development. Analyses were stratified for anticitrullinated protein antibody status.
1497 radiographs of hands and feet of 749 patients with CSA were studied. Median SHS-erosion score at baseline was 0 (IQR 0-1). RA-specific erosive disease was present in 1.7% according to the radiologist, and 2.5% according to the ACR/EULAR criteria. No patients with CSA progressed ≥5 SHS-erosion points during follow-up. Erosive disease at CSA onset was not associated with IA development (HR 0.98 (95% CI 0.40 to 2.44)).
At CSA onset, radiographic erosive disease is rare. In addition, it is rarely progressive within the CSA phase and not predictive for IA development. Therefore, for clinical practice, routinely made radiographs of hands and feet (such as regularly done at RA diagnosis) can be omitted in the at-risk stage of arthralgia.
常规的手和脚的 X 光片用于描述类风湿关节炎（RA）的结构损伤。在有 RA 风险的症状性患者（临床疑似关节炎（CSA））的临床实践中也常这样做，但其基本原理尚不清楚。我们旨在研究 CSA 患者的放射学侵蚀性疾病的患病率及其随时间的进展。
在 2 年的随访期间或在出现炎症性关节炎（IA）之前，对莱顿 CSA 队列中有症状性关节炎的患者进行研究。根据放射科医生或根据美国风湿病学会（ACR）/欧洲风湿病联盟（EULAR）2010 年 RA 标准的 RA 特异性侵蚀性定义来定义侵蚀性疾病。根据 Sharp van der Heijde 评分（SHS）对连续的 X 光片进行评估，并确定放射学侵蚀性进展。此外，还评估了基线侵蚀性疾病是否与 IA 发展有关。分析按抗瓜氨酸蛋白抗体状态分层。
对 749 例 CSA 患者的 1497 张手和脚的 X 光片进行了研究。基线时 SHS 侵蚀评分的中位数为 0（IQR 0-1）。根据放射科医生的标准，RA 特异性侵蚀性疾病的患病率为 1.7%，根据 ACR/EULAR 标准的患病率为 2.5%。在随访期间，没有 CSA 患者的 SHS 侵蚀评分增加≥5 分。CSA 发病时的侵蚀性疾病与 IA 发展无关（HR 0.98（95%CI 0.40 至 2.44））。
在 CSA 发病时，放射学侵蚀性疾病很少见。此外，在 CSA 阶段内很少进展，也不能预测 IA 的发展。因此，在临床实践中，可以在关节炎风险阶段省略常规拍摄的手和脚的 X 光片（例如在 RA 诊断时常规拍摄）。
