Prediction of MRI erosive progression: a comparison of modern imaging modalities in early rheumatoid arthritis patients.

Bøyesen P, Haavardsholm EA, van der Heijde D, Østergaard M, Hammer HB, Sesseng S, Kvien TK.

Source

Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. pernilleboyesen@gmail.com

Abstract

OBJECTIVES:

To examine the associations between modern imaging modalities and joint damage measured as 1-year MRI erosive progression, in early rheumatoid arthritis (RA) patients.

METHODS:

84 RA patients with disease duration of less than 1 year were included in this inception cohort. Patients were evaluated at baseline, 3, 6 and 12 months by core measures of disease activity, MRI and ultrasound grey-scale (USGS) of inflammation, conventional radiography and digital x-ray radiogrammetry (DXR) bone mineral density (BMD) of cortical hand bone.

RESULTS:

53 of the 79 patients (67%) who completed the follow-up had MRI erosive progression (dependent variable). USGS and MRI bone marrow oedema (BME) were in multivariate analyses independent predictors of 1-year MRI erosive progression. There was a trend towards higher MRI synovitis score and 3-month DXR BMD loss in patients developing MRI erosions. On an individual level, USGS inflammation, MRI synovitis and MRI BME also somewhat better predicted outcome than rheumatoid factor, anticitrullinated protein antibodies and disease activity score 28.

CONCLUSIONS:

USGS inflammation and MRI BME were independent predictors of MRI erosive progression in early RA patients on a group level. The exact prognosis of the individual patients could not be determined by imaging alone.

PMID: 21068093

超声检查预测一年后RA病人的MRI侵蚀进展

Boyesen P, et al. Ann Rheum Dis. 2011;70: 176-9.

目的: 探究在早期类风湿关节炎(RA)患者中，基线时敏感影像学检查的发现与随访一年后MRI侵蚀病变进展之间的相关性。

方法: 病程小于1年的84例RA患者被纳入这个起始队列研究。病人评估时间点为基线、3个月、6个月和12个月。重要检查包括疾病活动性、MRI和灰阶超声 (USGS)评估炎症、传统放射学平片、数字X射线计量仪(DXR)测量手皮质骨骨密度(BMD)。

结果: 79例病人完成随访，其中有53(67%)出现MRI证实的侵蚀进展(因变量)。多变量分析发现USGS和MRI证实的骨髓水肿(BME)是1年后MRI侵蚀病变进展的独立预测因素。有一个趋势显示MRI侵蚀患者的MRI滑膜炎评分较高，而且3个月时DXR-BMD下降。在个体水平，USGS炎症、MRI滑膜炎和MRI骨髓水肿也较类风湿因子、抗CCP抗体以及DAS28更好地预测结局。

结论: 在组水平的分析发现，USGS炎症和MRI骨髓水肿是早期RA病人MRI侵蚀进展的独立预测因素。但是单凭影像学并不能准确判断每个病人的预后。