MRI骨水肿是早期未分化关节炎演变为RA的独立预测预测因素

原文

译文

Arthritis & Rheumatism DOI: 10.1002/art.30396

MRI bone edema is an independent predictor of development of rheumatoid arthritis in patients with early undifferentiated arthritis

1. Anne Duer-Jensen MD^1,*,†,

2. Kim Hørslev-Petersen MD, DMSc²,

3. Merete Lund Hetland MD, PhD¹,

4. Lene Bak MD³,

5. Bo Jannik Ejbjerg MD, PhD⁴,

6. Michael Sejer Hansen MD, PhD⁵,

7. Julia Sidenius Johansen MD, DMSc⁶,

8. Hanne Merete Lindegaard MD, PhD⁷,

9. Henrik Vinterberg MD⁸,

10. Jakob M Møller MSc⁹,

11. Mikkel Østergaard MD, PhD, DMSc¹

Abstract

Objectives:

To study magnetic resonance imaging (MRI) as a tool for early diagnosis of rheumatoid arthritis (RA) in patients with early undifferentiated arthritis (UA).

Methods:

116 patients without a specific rheumatological diagnosis, but with ≥2 tender and/or swollen metacarpophalangeal, proximal interphalangeal, wrist or metatarsophalangeal (MTP) joints for >6 weeks but <24 months, underwent clinical, biochemical, conventional radiography and MRI examinations and were followed for >12 months for final RA/non-RA diagnosis.

Based on univariate analyses, clinical, biochemical and imaging parameters were selected for inclusion as explanatory variables in multiple logistic regression analysis with development of RA as dependent variable. A prediction model was developed, and its performance tested and compared with a previous model by van der Helm-van Mil et al (vdHvM).

Results:

27 patients (23.3%) developed RA. A prediction model consisting of presence of hand arthritis, positive rheumatoid factor (RF), morning stiffness >1 hour and OMERACT sum score of bone edema in MTP and wrist joints correctly identified 82% of patients, who eventually developed RA or not RA (sensitivity/specificity 81%/82%). Another cut-off in the model would allow higher specificity (98%) and accuracy (83%), but lower sensitivity (36%). The vdHvM-model predicted RA/non-RA in 60.2% of the population.

Conclusion:

MRI bone edema in MTP and wrist joints is an independent predictor of future RA in patients with early UA. A prediction model, including clinical hand arthritis, morning stiffness, positive RF and MRI bone edema score in MTP and wrist joints correctly identified the development of RA or non-RA in 82% of patients. © 2011 American College of Rheumatology.

MRI骨水肿是早期未分化关节炎演变为RA的独立预测预测因素

Duer-Jensen A, et al. Arthritis Rheum. DOI: 10.1002/art.303.

目的: 探究核磁共振成像术(MRI)对于早期未分化关节炎(UA)演变为类风湿关节炎(RA)的早期诊断价值。

方法: 有炎性关节炎症状且病程>6周但<24月的116例尚未确诊病例纳入本研究。他们有≥2个肿胀和/或压痛的炎性关节，包括掌指关节(MCP)、近端指间关节(PIP)、腕关节或跖趾关节(MTP)。通过>12个月的定期临床体检、生化、常规放射学和MRI检查，以跟踪疾病演进。利用单变量分析筛选出临床、生化和影像学参数作为多元逻辑回归分析的解释变量，以病情演变为RA作为因变量。本研究开发了一个预测模型，并与之前由van der Helm-van Mil等人开发的模型进行了比较。

结果: 随访结束时共有27例(23.3%)演变为RA。预测模型纳入的参数包括手关节炎、类风湿因子(RF)阳性、晨僵>1小时以及MTP和腕关节的OMERACT骨水肿总分。该模型正确地预测了82%病人演变为RA或非RA(敏感性: 81%，特异性: 82%)。经调整界限值，该模型可有更高的特异性(98%)和正确率(83%)，但敏感性降低(36%)。vhHvM模型预测RA/非RA的正确率为60.2%。