Elucidation of the relationship between synovitis and bone damage - A randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis
Elucidation of the relationship between synovitis and bone damage - A randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis
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DOI：
10.1002/art.10747
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发表时间：
2003-01-01
影响因子：
--
通讯作者：
Emery, P
中科院分区：
文献类型：
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作者：
Conaghan, PG;O'Connor, P;Emery, P
Objective.同时对早期类风湿关节炎（RA）的骨和滑膜进行成像。40例早期未经治疗的RA患者在就诊时、3个月和12个月时对优势手的第二至第五掌指关节进行钆增强磁共振成像（MRI）。在第一阶段（0-3个月），患者随机接受甲氨蝶呤（MTX）或MTX和关节内皮质类固醇（MTX + IAST）治疗临床活动性RA。单用MTX组在第二阶段（3-12个月）之前不再使用皮质类固醇，两组均接受标准治疗。在第一阶段，MTX + IAST比单独MTX更能降低滑膜炎评分。MRI显示前者有新侵蚀的关节明显少于后者。在第二阶段，滑膜炎评分相当，每组中相似数量的关节在MRI上显示新的侵蚀。在这两个阶段，滑膜炎的程度和新的糜烂的数量之间有密切的相关性，MRI滑膜炎的曲线下面积是骨损伤进展的唯一重要预测因素。在单个关节中，滑膜炎的程度对新骨损伤有阈值效应;无滑膜炎的关节未发生侵蚀。在早期RA中，滑膜炎似乎是主要的异常，并且骨损伤的发生与滑膜炎的水平成比例，但不是在其不存在时。在RA患者的治疗中，结局指标和治疗应侧重于滑膜炎。
Objective. To simultaneously image bone and synovium in the individual joints characteristically involved in early rheumatoid arthritis (RA).Methods. Forty patients with early, untreated RA underwent gadolinium-enhanced magnetic resonance imaging (MRI) of the second through fifth metacarpophalangeal joints of the dominant hand at presentation, 3 months, and 12 months. In the first phase (0-3 months), patients were randomized to receive either methotrexate alone (MTX) or MTX and intraarticular corticosteroids (MTX + IAST) into all joints with clinically active RA. The MTX-alone group received no further corticosteroids until the second phase (3-12 months), when both groups received standard therapy.Results. In the first phase, MTX + IAST reduced synovitis scores more than MTX alone. There were significantly fewer joints with new erosions on MRI in the former group compared with the latter. During the second phase, the synovitis scores were equivalent and a similar number of joints in each group showed new erosions on MRI. In both phases, there was a close correlation between the degree of synovitis and the number of new erosions, with the area under the curve for MRI synovitis the only significant predictor of bone damage progression. In individual joints, there was a threshold effect on new bone damage related to the level of synovitis; no erosions occurred in joints without synovitis.Conclusion. In early RA, synovitis appears to be the primary abnormality, and bone damage occurs in proportion to the level of synovitis but not in its absence. In the treatment of patients with RA, outcome measures and therapies should focus on synovitis.