Wolfe F, Sharp J T
Arthritis Research Center and University of Kansas School of Medicine, Wichita, USA.
Arthritis Rheum. 1998 Sep;41(9):1571-82. doi: 10.1002/1529-0131(199809)41:9<1571::AID-ART7>3.0.CO;2-R.
To describe the longitudinal radiographic course of rheumatoid arthritis (RA), and to identify and quantitate predictors of radiographic progression.
This prospective, longitudinal study of radiographic progression and clinical predictors of RA involved 256 patients with RA who were seen within the first 2 years of disease (mean 0.77 years) and were followed up for up to 19 years. Participants underwent a total of 6,278 clinical assessments (mean 24.5) and 934 paired radiographs (mean 3.1, range 2-6). Clinical assessments at every visit included determination of the erythrocyte sedimentation rate (ESR), grip strength, pain scores, tender joint counts, and anxiety and depression measurements. Regression analyses utilized time-integrated predictors.
Overall, radiographic progression rates, as measured by the summary Sharp scores, appeared constant over the course of RA. The strongest correlate of progression was the time-integrated ESR (rho=0.53). This association grew stronger with time. At 0-5 years, 5-10 years, 10-15 years, and 15-20 years, correlations were 0.40, 0.50, 0.65, and 0.74, respectively, and for the period 10-20 years, the correlation was 0.67. In multivariate models, the mean ESR, mean grip strength, rheumatoid factor positivity, and tender joint count were independent predictors of radiographic progression.
Radiographic damage occurs at a constant rate in RA, and is not greater early in RA or reduced later in the course of the illness. Acute-phase reactants are, by far, the strongest determinants of progression.
描述类风湿关节炎（RA）的影像学纵向病程，并识别和量化影像学进展的预测因素。
这项关于RA影像学进展和临床预测因素的前瞻性纵向研究纳入了256例RA患者，这些患者在疾病的前2年内就诊（平均0.77年），并随访长达19年。参与者共接受了6278次临床评估（平均24.5次）和934对X光片检查（平均3.1次，范围2 - 6次）。每次就诊时的临床评估包括测定红细胞沉降率（ESR）、握力、疼痛评分、压痛关节计数以及焦虑和抑郁测量。回归分析采用时间积分预测因素。
总体而言，通过汇总Sharp评分衡量的影像学进展率在RA病程中似乎保持恒定。进展的最强相关因素是时间积分ESR（rho = 0.53）。这种关联随时间增强。在0 - 5年、5 - 10年、10 - 15年和15 - 20年时，相关性分别为0.40、0.50、0.65和0.74，在10 - 20年期间，相关性为0.67。在多变量模型中，平均ESR、平均握力、类风湿因子阳性和压痛关节计数是影像学进展的独立预测因素。
RA中的影像学损伤以恒定速率发生，在RA早期并不更严重，在病程后期也不会减轻。到目前为止，急性期反应物是进展的最强决定因素。
