Development and validation of rheumatoid arthritis magnetic resonance imaging inflammation thresholds associated with lack of damage progression.
Development and validation of rheumatoid arthritis magnetic resonance imaging inflammation thresholds associated with lack of damage progression.
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发表时间：
2017-01
影响因子：
3.7
通讯作者：
J. Baker;M. Østergaard;P. Emery;D. Baker;P. Conaghan
中科院分区：
文献类型：
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作者：
J. Baker;M. Østergaard;P. Emery;D. Baker;P. Conaghan
目的确定与结构性损伤进展低风险相关的类风湿性关节炎（RA）磁共振成像评分（RAMRIS）阈值。方法：在第0、24和52周对优势手进行MRI检查，并确定RAMRIS评分。进行X线检查并测定货车van der Heijde-Sharp评分（vdHS）。在一个发展队列（n=297）中，在24周至52周的时间间隔内确定MRI侵蚀评分和vdHS评分的变化，进展定义为变化>0.5。我们确定了滑膜炎和骨炎的24周阈值，其在24 - 52周间隔内提供了>90%的成像进展灵敏度。在验证队列（n=217）中检验了这些临界值的性能。结果：在发育队列中，24周时滑膜炎或骨炎评分≤3与MRI和X线进展概率低相关。在预测X线和MRI进展的模型中，骨炎的系数强于滑膜炎。因此，总炎症评分对骨炎进行加权（x2）。炎症评分≤9比DAS 28缓解更常见（64 vs. 38），并且无论是否达到临床缓解，进展概率均较低。在验证队列中，滑膜炎[OR 0.27（0.086，0.82）p=0.02]、骨炎[OR 0.20（0.085，0.49）p<0.001]和炎症评分[OR 0.12（0.033，0.41）p=0.001]较低的患者MRI进展的几率较低。结论：低MRI单侧滑膜炎和骨炎并不少见，预示着RA缺乏结构性进展，与临床缓解无关。
OBJECTIVES To determine thresholds for rheumatoid arthritis (RA) magnetic resonance imaging scores (RAMRIS) associated with a low risk of structural damage progression. METHODS MRI of the dominant hand was performed and RAMRIS scores determined at weeks 0, 24, and 52. X-rays were performed and van der Heijde-Sharp scores (vdHS) determined. In a development cohort (n=297) the changes in MRI erosion score and vdHS score were determined over the 24-week to 52-week interval and progression was defined as change >0.5. We identified 24-week thresholds for synovitis and osteitis that provided >90% sensitivity for imaging progression over the 24 to 52-week interval. The performance of these cut-offs was tested in a validation cohort (n=217). RESULTS In the development cohort, synovitis or osteitis scores ≤3 by 24 weeks were associated with a low probability of progression on MRI and x-ray. The coefficient for osteitis was stronger than that of synovitis in models predicting x-ray and MRI progression. Therefore, a total inflammation score was weighted on osteitis (x2). An inflammation score ≤9 was more frequently attained than DAS28 remission (64 vs. 38) and was associated with low probability of progression regardless of attainment of clinical remission. In the validation cohort, there was a low odds of MRI progression among those with low synovitis [OR 0.27 (0.086,0.82) p=0.02], osteitis [OR 0.20 (0.085, 0.49) p<0.001] and inflammation scores [OR 0.12 (0.033, 0.41) p=0.001]. CONCLUSIONS Attainment of low MRI single-hand synovitis and osteitis is not uncommon and predicts a lack of structural progression in RA, independent of clinical remission.