MRI骨水肿是早期未分化关节炎演变为RA的独立预测预测因素

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Arthritis & Rheumatism DOI: 10.1002/art.30396   MRI bone edema is an independent predictor of development of rheumatoid arthritis in patients with early undifferentiated arthritis   1.       Anne Duer-Jensen MD1,*,†, 2.       Kim Hørslev-Petersen MD, DMSc2, 3.       Merete Lund Hetland MD, PhD1, 4.       Lene Bak MD3, 5.       Bo Jannik Ejbjerg MD, PhD4, 6.       Michael Sejer Hansen MD, PhD5, 7.       Julia Sidenius Johansen MD, DMSc6, 8.       Hanne Merete Lindegaard MD, PhD7, 9.       Henrik Vinterberg MD8, 10.   Jakob M Møller MSc9, 11.   Mikkel Østergaard MD, PhD, DMSc1   Abstract Objectives: To study magnetic resonance imaging (MRI) as a tool for early diagnosis of rheumatoid arthritis (RA) in patients with early undifferentiated arthritis (UA). Methods: 116 patients without a specific rheumatological diagnosis, but with ≥2 tender and/or swollen metacarpophalangeal, proximal interphalangeal, wrist or metatarsophalangeal (MTP) joints for >6 weeks but <24 months, underwent clinical, biochemical, conventional radiography and MRI examinations and were followed for >12 months for final RA/non-RA diagnosis. Based on univariate analyses, clinical, biochemical and imaging parameters were selected for inclusion as explanatory variables in multiple logistic regression analysis with development of RA as dependent variable. A prediction model was developed, and its performance tested and compared with a previous model by van der Helm-van Mil et al (vdHvM). Results: 27 patients (23.3%) developed RA. A prediction model consisting of presence of hand arthritis, positive rheumatoid factor (RF), morning stiffness >1 hour and OMERACT sum score of bone edema in MTP and wrist joints correctly identified 82% of patients, who eventually developed RA or not RA (sensitivity/specificity 81%/82%). Another cut-off in the model would allow higher specificity (98%) and accuracy (83%), but lower sensitivity (36%). The vdHvM-model predicted RA/non-RA in 60.2% of the population. Conclusion: MRI bone edema in MTP and wrist joints is an independent predictor of future RA in patients with early UA. A prediction model, including clinical hand arthritis, morning stiffness, positive RF and MRI bone edema score in MTP and wrist joints correctly identified the development of RA or non-RA in 82% of patients. © 2011 American College of Rheumatology.

MRI骨水肿是早期未分化关节炎演变为RA的独立预测预测因素 Duer-Jensen A, et al. Arthritis Rheum. DOI: 10.1002/art.303.   目的: 探究核磁共振成像术(MRI)对于早期未分化关节炎(UA)演变为类风湿关节炎(RA)的早期诊断价值。 方法: 有炎性关节炎症状且病程>6周但<24月的116例尚未确诊病例纳入本研究。他们有≥2个肿胀和/或压痛的炎性关节，包括掌指关节(MCP)、近端指间关节(PIP)、腕关节或跖趾关节(MTP)。通过>12个月的定期临床体检、生化、常规放射学和MRI检查，以跟踪疾病演进。利用单变量分析筛选出临床、生化和影像学参数作为多元逻辑回归分析的解释变量，以病情演变为RA作为因变量。本研究开发了一个预测模型，并与之前由van der Helm-van Mil等人开发的模型进行了比较。 结果: 随访结束时共有27例(23.3%)演变为RA。预测模型纳入的参数包括手关节炎、类风湿因子(RF)阳性、晨僵>1小时以及MTP和腕关节的OMERACT骨水肿总分。该模型正确地预测了82%病人演变为RA或非RA(敏感性: 81%，特异性: 82%)。经调整界限值，该模型可有更高的特异性(98%)和正确率(83%)，但敏感性降低(36%)。vhHvM模型预测RA/非RA的正确率为60.2%。 结论: MTP和腕关节MRI骨水肿是早期UA未来演变为RA的一个独立预测因素。纳入临床手关节炎、晨僵、RF阳性、MTP和腕关节MRI骨水肿评分的预测模型的预测正确率为82%。