An Explanation for the Apparent Dissociation Between Clinical Remission and Continued Structural Deterioration in Rheumatoid Arthritis
An Explanation for the Apparent Dissociation Between Clinical Remission and Continued Structural Deterioration in Rheumatoid Arthritis
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DOI：
10.1002/art.23945
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发表时间：
2008-10-01
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：
Brown, A. K.;Conaghan, P. G.;Emery, P.
Objective.实现缓解是类风湿性关节炎（RA）治疗的目标。这应该代表最小的关节炎活动，并确保最佳的疾病结果。然而，我们之前已经证明了在临床缓解的RA患者中，影像学检测到的滑膜炎症的患病率很高。本研究的目的是评估亚临床滑膜炎的长期意义及其与结构结局的关系。我们研究了102例接受常规治疗的RA患者，他们的顾问风湿病学家判断他们处于缓解期，以及17例正常对照组。受试者在12个月内接受了临床、实验室、功能和生活质量评估。除了手和脚的标准X线摄影外，在基线和12个月时，使用经验证的采集和评分技术，通过肌肉骨骼超声（US）和常规1.5T磁共振成像（MRI）进行手和手腕的成像。尽管他们在临床缓解，19%的患者在研究期间显示放射学关节损伤恶化。基线时，单个关节的肌肉骨骼US滑膜肥大、能量多普勒（PD）和MRI滑膜炎评估评分与进行性放射学损伤显著相关（分别为P = 0.032、P < 0.001和P = 0.002）。此外，在完全无症状的掌指关节中，基线时的肌肉骨骼US PD评分与12个月内的结构进展之间存在显著相关性（P = 0.004），而在PD信号增加的关节中，关节恶化的几率高出12倍（比值比12.21，P < 0.001）。通过影像学技术检测到的亚临床关节炎症解释了接受常规治疗的临床缓解期RA患者的结构恶化。我们的研究结果加强了成像的实用性，准确评估疾病状态和预测结构的结果。
Objective. Achieving remission is the aim of treatment in rheumatoid arthritis (RA). This should represent minimal arthritis activity and ensure optimal disease outcome. However, we have previously demonstrated a high prevalence of imaging-detected synovial inflammation in RA patients who were in clinical remission. The purpose of this study was to evaluate the long-term significance of subclinical synovitis and its relationship to structural outcome.Methods. We studied 102 RA patients receiving conventional treatment who had been judged by their consultant rheumatologist to be in remission, as well as 17 normal control subjects. Subjects underwent clinical, laboratory, functional, and quality of life assessments over 12 months. In addition to standard radiography of the hands and feet, imaging of the hands and wrists was performed with musculoskeletal ultrasonography (US) and conventional 1.5T magnetic resonance imaging (MRI) at baseline and 12 months, using validated acquisition and scoring techniques.Results. Despite their being in clinical remission, 19% of the patients displayed deterioration in radiographic joint damage over the study period. Scores on musculoskeletal US synovial hypertrophy, power Doppler (PD), and MRI synovitis assessments in individual joints at baseline were significantly associated with progressive radiographic damage (P = 0.032, P < 0.001, and P = 0.002, respectively). Furthermore, there was a significant association between the musculoskeletal US PD score at baseline and structural progression over 12 months in totally asymptomatic metacarpophalangeal joints (P = 0.004) and 12 times higher odds of deterioration in joints with increased PD signal (odds ratio 12.21, P < 0.001).Conclusion. Subclinical joint inflammation detected by imaging techniques explains the structural deterioration in RA patients in clinical remission who are receiving conventional therapy. Our findings reinforce the utility of imaging for the accurate evaluation of disease status and the prediction of structural outcome.