原文

譯文

Arthritis & Rheumatism DOI:?10.1002/art.30396

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MRI bone edema is an independent predictor of development of rheumatoid arthritis in patients with early undifferentiated arthritis

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1.?????? Anne Duer-Jensen MD^1,*,?,

2.?????? Kim H?rslev-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 M?ller MSc⁹,

11.?? Mikkel ?stergaard MD, PhD, DMSc¹

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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.

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MRI骨水腫是早期未分化關節炎演變為RA的獨立預測預測因素

Duer-Jensen A, et al. Arthritis Rheum. DOI:?10.1002/art.303.

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目的: 探究核磁共振成像術(MRI)對于早期未分化關節炎(UA)演變為類風濕關節炎(RA)的早期診斷價值。

方法: 有炎性關節炎癥狀且病程>6周但<24月的116例尚未確診病例納入本研究。他們有≥2個腫脹和/或壓痛的炎性關節，包括掌指關節(MCP)、近端指間關節(PIP)、腕關節或跖趾關節(MTP)。通過>12個月的定期臨床體檢、生化、常規放射學和MRI檢查，以跟蹤疾病演進。利用單變量分析篩選出臨床、生化和影像學參數作為多元邏輯回歸分析的解釋變量，以病情演變為RA作為因變量。本研究開發了一個預測模型，并與之前由van der Helm-van Mil等人開發的模型進行了比較。

結果: 隨訪結束時共有27例(23.3%)演變為RA。預測模型納入的參數包括手關節炎、類風濕因子(RF)陽性、晨僵>1小時以及MTP和腕關節的OMERACT骨水腫總分。該模型正確地預測了82%病人演變為RA或非RA(敏感性: 81%，特異性: 82%)。經調整界限值，該模型可有更高的特異性(98%)和正確率(83%)，但敏感性降低(36%)。vhHvM模型預測RA/非RA的正確率為60.2%。

結論: MTP和腕關節MRI骨水腫是早期UA未來演變為RA的一個獨立預測因素。納入臨床手關節炎、晨僵、RF陽性、MTP和腕關節MRI骨水腫評分的預測模型的預測正確率為82%。

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