类风湿关节炎（RA）的临床阶段之前是亚临床炎症阶段。MRI可以检测到亚临床炎症，作为判断临床关节炎发展阶段的依据。然而，关节炎在关节层面如何发展还不得而知，也无法预知亚临床型炎症是否正在向临床关节炎转化，无从了解临床关节炎的关节有多大几率在关节痛的前一阶段患有局部亚临床炎症。对发展为关节炎的患者的纵向MRI研究可以揭示关节炎发生部位是否仅仅局限于亚临床炎症逐步恶化的部位，从而分析亚临床炎症位置和后期临床关节炎之间是否存在弱关联。
目的本研究针对关节水平的纵向研究贯穿类风湿关节炎前期到类风湿关节炎的整个病程，旨在探究亚临床炎症部位与临床关节炎之间的关系。
方法针对29例关节痛和临床关节炎患者的个小关节（每人4个MCP，1个手腕，5个MTP）在两个时间点用1.5TMRI进行研究。三名不了解临床资料和时间顺序的人员（ICC0.98,0.96和0.97）对MRI进行BME，滑膜炎和腱鞘炎评估。患有BME，滑膜炎和/或腱鞘炎的患者被定义为处于亚临床炎症状态。
结果关节痛发展为临床关节炎的中位时间为17周。伴有关节痛的68个关节有亚临床炎症，关节压痛与局部MRI检测出的亚临床炎症之间无显著关联（OR0.98;95％CI0.48-1.9）。随着时间的推移，68个关节中有21％亚临床炎症消退，60％亚临床炎症持续存在，19％发展为临床关节炎。关节炎发展过程中37个关节出现肿胀。其中24例（65％）在出现关节痛前未出现过亚临床炎症（图）。
结论首次针对初期类风湿关节炎患者的关节进行的纵向核磁共振研究表明大部分发展成临床关节炎的关节未曾（长时间）处于亚临床炎症状态。
原文
ISCLINICALARTHRITISALWAYSPRECEDEDBYSUBCLINICALINFLAMMATION?ALONGITUDINALSTUDYATJOINTLEVELINPATIENTSWITHARTHRALGIATHATDEVELOPEDARTHRITIS
Background:
TheclinicalphaseofRheumatoidarthritis(RA)isprecededbyaphasewithsubclinicalinflammation.MRIcandetectsubclinicalinflammationand,atpatientlevel,thisispredictiveforthedevelopmentofclinicalarthritis.However,atjointlevelitisunknownhowarthritisdevelops.Itisunknownhowfrequentlyjointswithsubclinicalinflammationprogresstoclinicalarthritis,andviceversa,howoftenjointsthatdevelopedclinicalarthritishadlocalsubclinicalinflammationduringtheprecedingphaseofarthralgia.AlongitudinalMRIstudyinpatientsthatdevelopedarthritiscanunravelifarthritisdevelopmentisrestrictedtosomelocationsinwhichtheseverityofinflammationincreasesovertimeor,alternatively,iftheprocessismoregeneralizedwithaweakassociationbetweenthelocationsofsubclinicalinflammationandsubsequentclinicalarthritis.
Objectives:
Thislongitudinalstudyatjointlevelduringprogressionfrompre-RAtoRAdeterminedtherelationbetweenthelocationofsubclinicalinflammationandclinicalarthritisovertime.
Methods:
smalljoints(4MCPs,1wrist,5MTPsperperson)of29patientsthatpresentedwitharthralgiaanddevelopedclinicalarthritiswerestudiedwith1.5TMRIatbothtime-points.MRIswereevaluatedforBME,synovitisandtenosynovitisbythreereaders(ICCs0.98,0.96and0.97)thatwereblindtoclinicaldataandtheorderintime.SubclinicalinflammationswasdefinedaspresenceofBME,synovitisand/ortenosynovitis
Results:
Themediantimebetweenpresentationwitharthralgiaandclinicalarthritisdevelopmentwas17weeks.Atpresentationwitharthralgia68jointshadsubclinicalinflammationandnosignificantassociationwasfoundbetweenjointtendernessandthepresenceoflocalMRI-detectedsubclinicalinflammation(OR0.98;95%CI0.48–1.9).Overtime,21%of68jointshadresolutionofsubclinicalinflammation,60%hadpersistentsubclinicalinflammationand19%developedclinicalarthritis.Atarthritisdevelopment37jointswereswollen.Ofthese,24(65%)hadnopriorsubclinicalinflammationatthetimeofpresentationwitharthralgia(Figure).
Conclusions:
ThisfirstlongitudinalMRI-studyonjointlevelinpre-RAsuggestedthatthemajorityofjointsthatdevelopedclinicalarthritishadno(long-lasting)precedingphasewithsubclinicalinflammation.
文章出处:
BrinckRT,SteenbergenHV,MilAVDH.EuropeanCongressofRheumatology,14–17June..
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