ACR2010_TEAR研究揭示RA强化治疗后MRI总炎症评分与疾病活动度相关

与单项相比， MRI 总炎症复合评分与标准核心组临床疗效参数、患者报告的疼痛和僵硬所评估的RA疾病活动度相关性更好。
            

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[1779] - Total MRI Inflammatory Score Correlates with Disease Activity Measures after Aggressive Treatment of Rheumatoid Arthritis. Veena K Ranganath, MD1,David A. Elashoff2,Paul Maranian2,Kambiz Motamedi, MD2,Espen Haavardsholm3,Fiona M McQueen, MD4,Theresa McVie5,Stacey S. Cofield5,Larry W Moreland, MD6,Weiling Chen2,Harold E Paulus. 1Rheumatology Department, UCLA, Los Angeles, CA,2UCLA,3Diakonhjemmet Hospital,4Molecular Medicine, Univ of Auckland Sch of Med, Auckland,5University of Birmingham,6Rheumatology & Clinical Immunology, University of Pittsburgh Medical Center, Pittsburgh, PA,7 Purpose: MRI is a sensitive imaging modality to investigate “inflammation” in rheumatoid arthritis(RA) joints. Tenosynovitis, synovitis, and bone edema independently correlate with disease activity measures in RA and suggest radiographic progression. The purpose of this study was to evaluate the relationship of clinical disease activity measures with two composite total MRI inflammatory score measures and their components, after 2 or more years of aggressive treatment of RA. Methods: MRI with gadolinium contrast(1.5 Tesla) of the dominant wrist was obtained in 118 early (RA duration 4.1 ± 10.8 months) seropositive or erosive RA patients after completing the TEAR 2-year controlled clinical trial comparing various combinations of MTX, etanercept, HCQ, and SSZ. Clinical disease activity measures were recorded every 12 weeks during the trial and at the time of MRI. MRIs were scored for tenosynovitis(T: range 0-30), synovitis(S: 0-9), and bone marrow edema(BME: 0-42) using published RA MRI(RAMRIS) and tenosynovitis scoring methods. One method of calculating the total MRI inflammatory score was by: T+ S + BME. Another method produced a weighted measure, by taking the actual values of T, S, and BME and dividing by the range for each component. These values were then added together to give the weighted total MRI inflammatory score. Results: After 2 years of aggressive RA treatment, the patients' average age was approximately 51 years. The mean DAS28 and clinical disease activity index(CDAI) fit into the mild disease activity categories, 2.9 and 9.2 respectively. More clinical core set measures correlated significantly with the weighted and un-weighted total MRI inflammatory score than with the individual components of the scores(T, S, and BME), and the Rho values were also higher. T correlated significantly with only the physician global and swollen joint count. S correlated with CDAI, physician global, patient global, ESR, pain, stiffness, and arthritis severity. BME correlated with age, CDAI, physician global, stiffness, and swollen joint count. No single correlation coefficient was greater than >0.4. Weighting the MRI inflammatory score components did not improve the correlations. Conclusions: The total composite MRI inflammatory score was shown to correlate better than the individual components of the MRI scores, with residual disease activity as assessed by standard core set measures and patient self-reported pain and stiffness.	TEAR研究揭示RA强化治疗后MRI总炎症评分与疾病活动度相关   Ranganath VK, et al. ACR 2010. Present No: 1779.      目的: MRI是一种检测RA关节炎症的敏感方法。腱鞘炎、滑膜炎和骨水肿分别与RA疾病活动度相关，且提示影像学进展。本研究旨在评估RA强化治疗≥2年后，临床疾病活动度与两种MRI总炎症的复合评分方法及各组分之间的相关性。 方法: 118例早期（病程4.1 ± 10.8个月）、血清阳性或侵蚀性RA患者在完成TEAR试验的2年对照临床研究（比较MTX、依那西普、HCQ、SSZ的各种组合）后，优势腕关节行钆增强MRI检查。采用已发表的RA MRI评分（RAMRIS）和腱鞘炎评分方法，根据腱鞘炎（T: 0-30）、滑膜炎（S: 0-9）、骨髓水肿（BME: 0-42）对MRI进行评分。一种计算MRI总炎症评分的方法是T+S+BME。另一种方法采用加权计算，将T、S、BME的实际值除以各自的范围，将这些值相加，即为加权的MRI总炎症评分。 结果: 经过2年强化治疗后，患者平均年龄为51岁。平均DAS28和临床疾病活动度指数（CDAI）属于轻度疾病活动度范围之内，分别为2.9和9.2。与T、S、BME单独评分相比，加权和未加权的MRI总炎症评分与很多临床核心组指标显著相关，Rho值更高。T仅与医生总体评价和肿胀关节数相关。S与CDAI、医生总体评价、患者总体评价、ESR、疼痛、僵硬和关节炎严重度相关。BME与年龄、CDAI、医生总体评价、僵硬、肿胀关节数相关。其相关系数均<0.4。加权后并不提高相关性。 结论: 与单项相比，MRI总炎症复合评分与标准核心组临床疗效参数、患者报告的疼痛和僵硬所评估的RA疾病活动度相关性更好。
表1. 临床评估参数的描述性数据以及与MRI评分之间的相关系数 临床参数 (均值(SD)) N 均值 SD 腱鞘炎* (7.1(3.2)) 滑膜炎* (3.7(1.5)) 骨髓水肿** (3.5(5.3)) 炎症评分* (14.3(7.8)) 炎症评分 (加权)* 年龄,岁 (50.5(13)) 118 50.53 12.99 <0.01 0.03 0.23^ 0.07 0.05 RA病程,年 (0.3(0.9)) 118 0.34 0.89 0.02 0.02 <0.01 0.01 0.01 DAS28 (2.9(1.4)) 115 2.94 1.37 0.15 0.18 0.06 0.23^ 0.23^ CDAI (9.2(11.1)) 116 9.23 11.12 0.18 0.20^ 0.20^ 0.27^ 0.26^ 医生全面评估(VAS) [1.5(1.8)] 117 1.54 1.81 0.24^ 0.31^ 0.24^ 0.40^ 0.39 血沉 [19.9(20.2)] 114 19.92 20.33 0.13 0.20^ -0.01 0.33^ 0.28^ 病人全面评估(VAS) [2(2.3)] 113 2 2.25 0.06 0.20^ 0.14 0.22^ 0.22^ 疼痛(VAS) [2.5(2.6)] 113 2.48 2.58 0.09 0.20^ 0.16 0.22^ 0.22^ 疲劳感(VAS) [3.0(2.6)] 113 2.96 2.64 -0.07 0.09 0.06 0.09 0.06 晨僵(VAS) [2.4(2.5)] 113 2.4 2.47 0.12 0.34^ 0.24^ 0.34^ 0.36^ 关节炎(VAS) [2.4(2.4)] 113 2.41 2.38 0.06 0.19^ 0.17 0.20^ 0.21^ HAQ-DI [0.6(0.6)] 115 0.61 0.63 0.11 0.18 0.12 0.20^ 0.21^ TJC [2.9(4.8)] 117 2.91 4.77 0.14 0.11 0.11 0.17 0.16 SJC [2.8(4.4)] 117 2.78 4.37 0.18^ 0.16 0.20^ 0.25^ 0.23^ *: Pearson相关性检验；**: Spearman相关性检验；^: p<0.05；Phys=医生；Pt=病人

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