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Defining Rheumatoid Arthritis From
Radiographic Erosive Abnormalities in the Light of the ACR/EULAR
2010 Criteria
Cédric
Lukas, Montpellier 1 University,
Lapeyronie Hospital, 371, Avenue du Doyen Gaston Giraud, 34295
Montpellier Cedex 5, France, Montpellier, France, R. Knevel, LUMC,
Department of Rheumatology, Leiden, Netherlands, Annette H.M. van
der Helm-van Mil, Leiden University Medical Center, Leiden,
Netherlands, Nathalie Rincheval, Institut Universitaire de
Recherche Clinique, Montpellier, France, Désirée van der Heijde,
Department of Rheumatology, Leiden University Medical Center,
Leiden, Netherlands and Bernard G. Combe, Hopital Lapeyronie,
Montpellier, France
Presentation
Number: 311
Background/Purpose: Definition of
rheumatoid arthritis (RA) with regard to the new 2010 ACR/EULAR
criteria can be made based on the presence of radiographic
abnormalities ("erosions typical of RA"). This work reports
results from a EULAR taskforce aiming at defining these RA-specific
erosive lesions.
Method: Patients from the
French observational ESPOIR cohort had arthritis (≥1 swollen joint)
lasting for between 6 weeks and 6 months, and had not been treated
before inclusion. The relationship between baseline radiography
(eroded joints on hands and feet) and the start of methotrexate
(MTX) during the first 12 months of the disease was evaluated. The
test characteristics/performance of radiography (sensitivity,
specificity, negative and positive- predictive values and
likelihood ratios) were tested against the start of a treatment
(regarded as the gold standard to define RA, similarly as in the
development of the new diagnostic criteria). Different number and
sites of eroded joints were considered to define "abnormal
radiography", and the respective characteristic tests were
derived.
Result: 723 patients (77%
women) had both clinical follow-up and baseline radiographic
assessment suitable for the scheduled analyses: 46% were rheumatoid
factor-, 39% anti-CCP2 positive. 325 patients (45%) had no
detectable erosion, 398 (55%) had at least 1, and 134 (19%) at
least 4 eroded joints. Expectedly, definition of "radiographic
abnormality" by an increasing number of eroded joint was
related to increased specificity and decreased sensitivity.
Presence of more than 4 eroded joints resulted in the highest
specificity (92%) and positive predictive value (92%). Influence of
the eroded site (MCP, MTP, IP or wrist
joints) or their combinations had no clear influence, except
for the wrist involvement which showed low sensitivity (12%) but
high specificity (91%) of being treated by
MTX.
Conclusion: These results show
that the presence of erosions in the wrist or in more than 4 joints
is very specific for RA. Further discussion
should aim at choosing an optimal cutoff to define "typical
abnormalities" of RA.
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根据ACR/EULAR 2010
标准定义RA放射学侵蚀病变
Lukas C, et al. ACR 2011. Present No: 311.
背景/目的:按照新的2010 ACR／EULAR标准,
类风湿性关节炎(RA)定义可以根据影像学异常的存在(“RA的典型侵蚀”)。本研究结果来自致力于RA特异性侵蚀定义的EULAR工作组。
方法:患者来自法国ESPOIR研究队列,
关节炎(≥1肿胀关节)持续六周至6个月,
入组前未接受任何治疗。评价患者基线水平的影像学(双手和双足的侵蚀)与最初12个月内开始甲氨蝶呤(MTX)治疗的相关性。并参考治疗开始的时间（作为RA诊断的金标准,
同样应用于在新标准的开发中）,
对影像学表现的性能特征(敏感性,特异性,阳性和阴行预测价值和可能性的比率)进行检测。不同数量和部位的关节侵蚀被定义为“放射学异常”,并衍生出相应特点的测试模型。
结果:723例患者(77%女性)同时有临床随访资料和影像学基线评估,
适合本研究。其中46%类风湿因子阳性,39%anti-CCP2阳性。325例患者(45%)没有检出侵蚀病变,398例(55%)至少有1个侵蚀关节,134位(19%)至少4个侵蚀关节。和预期的一样,
侵蚀关节数越多的
“影像学异常”特异性越高而敏感度越低。超过4个侵蚀关节的特异度和阳性预测值最高,
均为92%。侵蚀的关节部位(MCP,MTP、IP或腕关节)或其组合没有明显影响,
除了腕关节受累显示出 MTX治疗患者的低敏感性(12%)和高特异性(91%)。
结论:这些结果显示腕关节或超过4个关节的侵蚀存在是RA非常特异的表现。深入的讨论应当针对RA“典型异常”
的定义优化。
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