Wu Su, Griffith James Francis, Xiao Fan, Yiu Chungwun, Leung Jason C S, Tam Lai-Shan
Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Hong Kong, China.
Jockey Club Centre for Osteoporosis Care and Control, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China.
Eur Radiol. 2025 Mar 18. doi: 10.1007/s00330-025-11493-5.
To determine how inflammatory and structural parameters change long-term on standard treatment in rheumatoid arthritis patients and which baseline parameter best predicts long-term structural damage.
Prospective study of early rheumatoid arthritis (ERA) patients (symptom duration ≤ 24 months) who underwent identical clinical, serological, radiographic, and dynamic contrast-enhanced MRI of the wrist assessments at baseline, year-1, and year-8. MR images were analyzed semi-quantitatively (Rheumatoid Arthritis Magnetic Resonance Imaging Score [RAMRIS]) and quantitatively (synovial volume (cm); synovial perfusion; bone marrow edema (BME) proportion [%]). Multivariate analyses and receiver operating curves were applied to find the best predictor of long-term structural damage.
81 patients (61 ± 12 years, F/M:67/14) were studied. MRI-detected inflammatory parameters markedly improved from baseline to year-1 and slightly deteriorated from year-1 to year-8 (synovial volume:6.7 ± 5.0→2.6 ± 2.9→3.6 ± 3.3 cm (p < 0.01); BME proportion:13.1 ± 9.3→7.4 ± 5.0→9.2 ± 9.7% [p < 0.01]). Structural damage progressively deteriorated from baseline to year-8. Two long-term structural damage pattern groups were apparent, namely a "non-progressive structural damage pattern" (62%, 50/81) and a "progressive structural damage pattern" (38%, 31/81). Functional impairment was more frequent and more severe at year-8 in patients with progressive structural damage. MRI-detected bone erosion score better predicted (AUC = 0.81, CI: 0.71-0.91) year-8 structural damage than clinical (SDAI AUC = 0.61, CI: 0.48-0.74), serological (CRP AUC = 0.60, CI: 0.47-0.73), or radiographic (AUC = 0.59, CI: 0.45-0.72) assessment.
In ERA patients, two distinct structural damage patterns are evident. Baseline bone erosion score is better than clinical, serological, or radiographic assessment at predicting long-term structural damage.
Questions The value of MRI in predicting long-term structural damage in ERA patients is not clear. Findings This study identified two distinct long-term structural damage progression patterns of ERA patients. MRI can better differentiate between these two groups at baseline than clinical, serological, or radiographic assessment. Clinical relevance MRI examination should be performed in all ERA patients at baseline to determine their structural damage pattern. This will allow a better prediction of patient outcomes in the long-term.
确定类风湿关节炎患者在标准治疗下炎症和结构参数的长期变化情况，以及哪个基线参数最能预测长期结构损伤。
对早期类风湿关节炎（ERA）患者（症状持续时间≤24个月）进行前瞻性研究，这些患者在基线、第1年和第8年接受了相同的临床、血清学、影像学检查，以及手腕的动态对比增强磁共振成像（MRI）评估。对MR图像进行半定量分析（类风湿关节炎磁共振成像评分[RAMRIS]）和定量分析（滑膜体积（cm）；滑膜灌注；骨髓水肿（BME）比例[%]）。应用多变量分析和受试者工作特征曲线来寻找长期结构损伤的最佳预测指标。
研究了81例患者（61±12岁，女性/男性：67/14）。MRI检测到的炎症参数从基线到第1年显著改善，从第1年到第8年略有恶化（滑膜体积：6.7±5.0→2.6±2.9→3.6±3.3 cm（p<0.01）；BME比例：13.1±9.3→7.4±5.0→9.2±9.7%[p<0.01]）。结构损伤从基线到第8年逐渐恶化。出现了两种明显的长期结构损伤模式组，即“非进行性结构损伤模式”（62%，50/81）和“进行性结构损伤模式”（38%，31/81）。在第8年，进行性结构损伤患者的功能障碍更频繁且更严重。MRI检测到的骨侵蚀评分比临床（疾病活动指数[SDAI]曲线下面积[AUC]=0.61，可信区间[CI]：0.48 - 0.74）、血清学（C反应蛋白[CRP] AUC=0.60，CI：0.47 - 0.73）或影像学（AUC=0.59，CI：0.45 - 0.72）评估能更好地预测第8年的结构损伤。
在ERA患者中，有两种明显不同的结构损伤模式。基线骨侵蚀评分在预测长期结构损伤方面优于临床、血清学或影像学评估。
问题MRI在预测ERA患者长期结构损伤中的价值尚不清楚。研究结果本研究确定了ERA患者两种明显不同的长期结构损伤进展模式。在基线时，MRI比临床、血清学或影像学评估能更好地区分这两组。临床意义应在所有ERA患者基线时进行MRI检查，以确定其结构损伤模式。这将有助于更好地预测患者的长期预后。
