Menninger H, Meixner C, Söndgen W
Department of Medicine I, Bavarian Red Cross Hospital for Rheumatic Diseases, Bad Abbach, Germany.
J Rheumatol. 1995 Jun;22(6):1048-54.
To evaluate radiographs of patients with early rheumatoid arthritis (RA) for progression and repair.
Radiographs of hands and forefeet over 3 years were evaluated at 34 joints based on the modified Larsen-index, the number of joints with erosions, the area of osseous defects including erosions and cysts, the radiologic activity of lesions and--in relation to preceding status--the number of joints with qualitative radiologic improvement or deterioration, respectively, not necessarily seen by the other methods.
Counting of joints with erosions and assessment of the area of osseous defects yielded the most impressive results for disease progression with the number of eroded joints being the simplest method. Reparative phenomena included recortication, "filling in" and diminution in size of erosions and paraarticular cysts, newly developing demarcation of a previously indistinct articular outline, and the increase in trabecular structure in the vicinity of erosions. The evaluation of qualitative changes showed reparative phenomena with increasing frequency involving up to 9.3% of the joints during the 3rd year, compared with 7.1% of the deteriorating joints.
Progression in early RA can be quantitated easily by counting joint erosions. This method appears to be more sensitive than Larsen's approach. Repair can be shown early in the course of the disease (as early as the second 6-month observation period) by assessing both radiologic activity and qualitative changes, which are not necessarily apparent in the foregoing quantitative methods. Reparative phenomena associated with healing of erosions and cysts can be noted increasingly during continuous longterm observation. Evaluation for healing phenomena should be standardized and considered for inclusion in therapeutic trials of RA.
评估早期类风湿关节炎（RA）患者的X线片，以观察病情进展及修复情况。
基于改良的拉森指数，对34个关节的手和前足3年的X线片进行评估，包括有侵蚀的关节数量、包括侵蚀和囊肿在内的骨缺损面积、病变的放射学活性，以及与先前状态相比，分别有定性放射学改善或恶化的关节数量，这些情况不一定能用其他方法观察到。
对有侵蚀的关节进行计数以及对骨缺损面积进行评估，在疾病进展方面得出了最显著的结果，其中侵蚀关节数量是最简单的方法。修复现象包括重新皮质化、侵蚀和关节旁囊肿的“填充”及尺寸减小、先前不清晰的关节轮廓出现新的分界，以及侵蚀附近小梁结构增加。对定性变化的评估显示，修复现象出现的频率不断增加，在第3年涉及高达9.3%的关节，而恶化关节为7.1%。
早期RA的病情进展可通过计数关节侵蚀轻松量化。该方法似乎比拉森方法更敏感。通过评估放射学活性和定性变化，可在疾病早期（最早在第二个6个月观察期）显示修复情况，而这些在上述定量方法中不一定明显。在持续的长期观察中，与侵蚀和囊肿愈合相关的修复现象会越来越多地被注意到。对愈合现象的评估应标准化，并考虑纳入RA的治疗试验。
