Contribution of tenosynovitis of small joints to the symptom morning stiffness in patients presenting with undifferentiated and rheumatoid arthritis
Contribution of tenosynovitis of small joints to the symptom morning stiffness in patients presenting with undifferentiated and rheumatoid arthritis
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DOI：
10.1080/03009742.2019.1696404
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发表时间：
2020-03-18
影响因子：
2.1
通讯作者：
van der Helm-van Mil, A. H. M.
中科院分区：
文献类型：
--
作者：
Boer, A. C.;Boeters, D. M.;van der Helm-van Mil, A. H. M.
目的：晨僵（MS）是类风湿关节炎（RA）的特征。尽管它与功能障碍有关，但局部炎症过程在多大程度上导致这种症状尚不清楚。磁共振成像（MRI）检测到的小关节腱鞘炎被认为是RA的早期特征，它也与功能损伤有关。因此，我们评估了MS与mri检测到的炎症，特别是腱鞘炎之间的关系。方法：连续286例新发未分化关节炎和RA患者行（2-5）掌指关节、腕关节和（1-5）跖指关节对比增强1.5 T MRI检查。根据Haavardsholm对腱鞘炎进行扫描评分，类风湿关节炎磁共振成像评分（RAMRIS）对滑膜炎进行扫描评分。MS分为bb0 = 60 min和非bb0 = 60 min。用逻辑回归检验MS与腱鞘炎/滑膜炎之间的关联，对数据进行分类（单独或同时存在滑膜炎/腱鞘炎），并评估是否存在加性相互作用。结果：40%的患者出现多发性硬化症。多发性硬化症患者腱鞘炎的发生率高于非多发性硬化症患者[80% vs 65%，优势比（OR） 2.11, 95%可信区间（1.21;3.69）]。滑膜炎更常见于多发性硬化症患者[58% vs 44%， OR 1.79(1.11;2.91)]。在分类分析中，并发性滑膜炎和腱鞘炎的相关性最大[OR 2.43(1.30;4.54)]，而单发性滑膜炎的相关性最大[OR 0.85(0.21;3.47)]。加性相互作用不显著。所有分析解释的方差都很小（范围4-5%）。结论：小关节处腱鞘炎合并滑膜炎与多发性硬化症有关，并参与多发性硬化症的病理生理。
Objective: Morning stiffness (MS) is characteristic of rheumatoid arthritis (RA). Despite its association with functional disability, the extent to which local inflammatory processes contribute to this symptom is unknown. Magnetic resonance imaging (MRI)-detected tenosynovitis of small joints is recognized as an early feature of RA, which is also associated with functional impairments. It has been proposed that tenosynovitis contributes to MS. Therefore, we assessed the relationship between MS and MRI-detected inflammation, in particular tenosynovitis. Method: In total, 286 consecutive patients newly presenting with undifferentiated arthritis and RA underwent contrast-enhanced 1.5 T MRI of (2-5) metacarpophalangeal, wrist, and (1-5) metatarsophalangeal joints. Scans were scored for tenosynovitis according to Haavardsholm, and for synovitis by Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS). MS was dichotomized as >= 60 min or not. Associations between MS and tenosynovitis/synovitis were tested with logistic regression, data were categorized (solitary or simultaneous presence of synovitis/tenosynovitis), and the presence of an additive interaction was assessed. Results: MS was present in 40% of patients. Tenosynovitis was more often present in patients with MS than without MS [80% vs 65%, odds ratio (OR) 2.11, 95% confidence interval (1.21;3.69)]. Synovitis was more often present in patients with MS [58% vs 44%, OR 1.79 (1.11;2.91)]. In categorized analyses, concurrent synovitis and tenosynovitis had the largest association [OR 2.43 (1.30;4.54)], in contrast to solitary synovitis [OR 0.85 (0.21;3.47)]. The additive interaction was non-significant. The variance explained in all analyses was small (range 4-5%). Conclusion: Tenosynovitis, combined with synovitis, at small joints is associated with MS and contributes to the pathophysiology of MS.