De Stefano Ludovico, Bozzalla Cassione Emanuele, Sakellariou Garifallia, Sabatelli Federica, Guadalupi Emmanuele, Zampaglione Clelia, Nicrosini Andrea, Manzo Antonio, Montecucco Carlomaurizio, Bugatti Serena
Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy; Istituti Clinici Scientifici Maugeri SpA SB IRCCS, Pavia, Italy.
Semin Arthritis Rheum. 2025 Apr;71:152637. doi: 10.1016/j.semarthrit.2025.152637. Epub 2025 Jan 29.
The interpretation of joint tenderness as a sign of inflammation in patients with autoantibody-negative rheumatoid arthritis (RA) is uncertain. This may hinder disease classification and create selection bias for patient enrollment in clinical trials. Here we tested whether reclassifying the pattern of joint involvement based on swollen joints increases specificity for persistent arthritis in autoantibody-negative early RA.
From a prospective early arthritis cohort in the years 2005-2018, all autoantibody-negative patients fulfilling the 2010 ACR/EULAR RA criteria at enrollment were included. Patients were re-classified for the score of swollen joint involvement (1-3=score 2; 4-10=score 3; >10=score 5). Groups were compared for baseline clinical and ultrasonographic (US) characteristics and outcomes after 12 and 36 months.
Of a total of 354 autoantibody-negative patients with 2010-based RA, 39.5 % had a score of swollen joints=5, 47.5 % score=3, and 13 % score=2. We found equal signs of US synovitis and power Doppler of the wrists and metacarpophalangeal joints. Patients with lower swollen joint scores had similar requirements of treatment intensification within month 12 compared with patients with higher baseline inflammation. These latter had the most favourable outcomes, with lower need of second-line treatment strategies within month 36. Exclusion of patients with concomitant fibromyalgia did not modify the results.
Joint tenderness should be included in the evaluation of the pattern of joint involvement of the 2010 ACR/EULAR criteria to correctly classify patients with autoantibody-negative early RA. A score solely based on joint swelling may lead to the erroneous under-selection of patients with persistent arthritis.
在自身抗体阴性的类风湿关节炎（RA）患者中，将关节压痛解释为炎症迹象尚不确定。这可能会妨碍疾病分类，并在临床试验患者招募中产生选择偏倚。在此，我们测试了基于肿胀关节重新分类关节受累模式是否会提高自身抗体阴性早期RA中持续性关节炎的特异性。
从2005年至2018年的前瞻性早期关节炎队列中，纳入所有在入组时符合2010年美国风湿病学会（ACR）/欧洲抗风湿病联盟（EULAR）RA标准的自身抗体阴性患者。根据肿胀关节受累评分对患者进行重新分类（1 - 3 = 评分2；4 - 10 = 评分3；>10 = 评分5）。比较各组的基线临床和超声（US）特征以及12个月和36个月后的结局。
在总共354例基于2010年标准的自身抗体阴性RA患者中，39.5%的患者肿胀关节评分为5分，47.5%评分为3分，13%评分为2分。我们发现手腕和掌指关节的US滑膜炎和能量多普勒信号相同。与基线炎症较高的患者相比，肿胀关节评分较低的患者在第12个月内强化治疗的需求相似。后者的结局最有利，在第36个月内二线治疗策略的需求较低。排除伴有纤维肌痛的患者并未改变结果。
应将关节压痛纳入2010年ACR/EULAR标准关节受累模式的评估中，以正确分类自身抗体阴性早期RA患者。仅基于关节肿胀的评分可能会导致对持续性关节炎患者的错误漏选。
