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Evaluation of the Patients with Early
Arthritis by 2010 RA Criteria in Conjunction with MRI of Wrists and
Finger Joints
Mami Tamai 1, Kazuhiko Arima1,
Masataka Uetani1, Naoki Iwamoto1, Junko Kita1, Akitomo Okada1,
Tomohiro Koga2, Shin-ya Kawashiri1, Kunihiro Ichinose1, Satoshi
Yamasaki1, Hideki Nakamura1, Hiroaki Ida3, Tomoki Origuchi1,
Kiyoshi Aoyagi1, Katsumi Eguchi4 and Atsushi Kawakami1, 1Nagasaki
University Graduate School of Biomedical Sciences, Nagasaki, Japan,
2Nagasaki University School of Medicine, Nagasaki, Japan, 3Kurume
University School of Medicine, Kurume, Japan, 4Sasebo City General
Hospital, Sasebo, Nagasaki, Japan
Presentation Number:
318
Background/Purpose: 2010 rheumatoid
arthritis (RA) criteria was published last year and are going to be
applied in the clinical field of rheumatology. We have also been
investigating a prediction rule for RA using magnetic resonance
imaging (MRI) of wrists and finger joints at Nagasaki University.
We have tried to examine the utility of MRI of wrists and finger
joints in conjunction with 2010 RA criteria toward patients with
early undifferentiated arthritis at our cohort.
Method: Two hundred
patients with early arthritis, who are not better explained by
other diagnosis than RA at entry whose mean duration of symptoms is
3 months, were consecutively enrolled into this study. Japan
College of Rheumatology-certified rheumatologists have examined the
patients for at least 1 year. At entry, all of the patients were
examined by gadolinium-diethylenetriamine pentaacetic acid
(Gd-DTPA)-enhanced MRI of both wrists and finger joints. Patients
were evaluated by 2010 RA criteria at the initial visit. Diagnosis
of RA was defined by the initiation of disease-modifying
antirheumatic drugs (DMARDs) therapy during the first year.
Diagnostic performance of 2010 RA criteria in conjunction with MRI
of wrists and finger joints were investigated.
Result: At least one
swollen joints were found in 138 patients at entry, being examined
for further analysis. 2010 RA criteria classified RA at sensitivity
76.3 %, specificity 70.7 %, positive predictive value (PPV) 86.0 %,
negative predictive value (NPV) 55.8 % and accuracy 76.4 %.
However, twenty-three out of 52 patients, who had not been
classified as RA at entry by 2010 RA criteria, developed RA at 1
year. Bone edema was defined as most RA-specific MRI finding. If we
considered the patients to have RA in case bone edema is found, the
diagnosis of RA was made at sensitivity 87.6% and specificity 65.9%
in whom 2010 RA criteria at entry was less than
6.
Conclusion: MRI findings,
especially bone edema, are quite useful to assist the diagnostic
performance of 2010 RA criteria.
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2010 RA分类标准结合腕、手指关节的MRI表现评估早期关节炎患者
Tamai M, et al.
ACR 2011. Present No: 318.
背景/目的: 2010类风湿性关节炎(RA)分类标准发表于去年,并将应用在风湿病临床领域。此前在Nagasaki大学我们正进行一项运用腕和手指关节的磁共振成像(MRI)对RA的预测研究。本研究试图验证联合腕和手指关节的MRI检查和2010
RA标准对本队列早期未分化关节炎的诊断作用。
方法:
连续入组早期关节炎患者200例,
入组时无法用RA以外疾病诊断,
平均病程3个月。由日本风湿病协会资质认可的风湿病医生随访至少1年。入组时,所有的病人进行了腕和手指关节的二乙三胺五乙酸钆 (Gd-DTPA)增强核磁共振成像。应用2010 RA标准评估患者的首次就诊。RA的诊断定义为第一年中改变病情药物(如DMARDs)的治疗开始。评价腕和手指关节的MRI检查结合2010
RA标准的诊断价值。
结果:入组时有138例患者至少有一个肿胀关节,对其进行进一步分析。2010
RA分类标准敏感性为76.3%,特异性70.7%,阳性预测价值(PPV)86.0%,阴性预测值(NPV)55.8%,准确性为76.4%。然而,有23/52例入组时根据2010
RA标准未能诊断的患者在1年时发展为RA。骨水肿被定义为RA最特异的MRI发现。入组时2010
RA标准积分小于6的患者中,
如果MRI有骨水肿表现其诊断RA的敏感度和特异度分别为87.6%和65.9%。
结论:
磁共振表现特别是骨水肿,对2010 RA的标准有非常重要的协助诊断作用。
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