No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study
No overall progression and occasional repair of erosions despite persistent inflammation in adalimumab-treated rheumatoid arthritis patients: results from a longitudinal comparative MRI, ultrasonography, CT and radiography study
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DOI：
10.1136/ard.2009.123729
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发表时间：
2011-02-01
影响因子：
27.4
通讯作者：
Ostergaard, Mikkel
中科院分区：
文献类型：
--
作者：
Dohn, Uffe Moller;Ejbjerg, Bo;Ostergaard, Mikkel
目的应用MRI和超声监测阿达木单抗/甲氨蝶呤联合治疗类风湿关节炎（RA）患者的关节炎症和破坏。评估MRI和超声检查对CT上侵蚀进展的预测价值，并比较MRI/超声检查/X线检查对侵蚀检测/监测的作用。方法对52例未经生物学治疗的侵蚀性RA患者进行重复MRI/超声检查/X线检查阿达木单抗治疗期间（0/6/12个月）和临床/生化评估/结果在6个月或12个月时未观察到总体糜烂进展或修复（Wilcoxon; p > 0.05），但使用最小可检测变化截止值观察侵蚀进展者和消退者。MRI滑膜炎、灰度滑膜炎（GSS）和能量多普勒超声评分在6个月和12个月后降低（p < 0.05），DAS 28、HAQ和压痛和肿胀关节计数也降低（p < 0.001）。CT显示进展的患者基线MRI骨水肿评分较高。有基线MRI骨水肿的骨与无基线MRI骨水肿的骨中CT进展的RR为3.8（95% CI 1.5至9.3），时间积分MRI骨水肿、能量多普勒和GSS评分在有CT进展的骨/关节中较高（Mann-Whitney; p < 0.05）。以CT为参考方法，MRI、超声和X线检查对掌指关节侵蚀的敏感性/特异性分别为68%/92%、44%/95%和26%/98%。结论阿达木单抗/甲氨蝶呤联合治疗后，滑膜炎总体上无进展或修复，但MRI显示单个滑膜炎修复，MRI和超声检查滑膜炎减少。MRI和超声检查显示的炎症，尤其是MRI骨水肿，可预测骨/关节水平CT检查显示的侵蚀进展，MRI骨水肿也可预测患者水平。
Aim To monitor joint inflammation and destruction in rheumatoid arthritis (RA) patients receiving adalimumab/methotrexate combination therapy using MRI and ultrasonography. To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring.Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/ radiography (0/6/12 months) and clinical/biochemical assessments during adalimumab/methotrexate combination therapy.Results No overall erosion progression or repair was observed at 6 or 12 months (Wilcoxon; p > 0.05), but erosion progressors and regressors were observed using the smallest detectable change cut-off. Scores of MRI synovitis, grey-scale synovitis (GSS) and power Doppler ultrasonography decreased after 6 and 12 months (p < 0.05), as did DAS28, HAQ and tender and swollen joint counts (p < 0.001). Patients with progression on CT had higher baseline MRI bone oedema scores. The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 (95% CI 1.5 to 9.3) and time-integrated MRI bone oedema, power Doppler and GSS scores were higher in bones/joints with CT progression (Mann-Whitney; p < 0.05). With CT as the reference method, sensitivities/specificities for erosion in metacarpophalangeal joints were 68%/92%, 44%/95% and 26%/98% for MRI, ultrasonography and radiography, respectively. Median intraobserver correlation coefficient was 0.95 (range 0.44-0.99).Conclusion During adalimumab/methotrexate combination therapy, no overall erosive progression or repair occurred, whereas repair of individual erosions was documented on MRI, and MRI and ultrasonography synovitis decreased. Inflammation on MRI and ultrasonography, especially MRI bone oedema, was predictive for erosive progression on CT, at bone/joint level and MRI bone oedema also at patient level.