原文

译文

OP0244

EVALUATION OF THE PATIENTS WITH EARLY ARTHRITIS BY 2010 ACR/EULAR CRITERIA IN CONJUNCTION WITH MRI OF WRISTS AND FINGER JOINTS

M. Tamai ^{1, 2,*}, K. Arima ^{1, 3}, N. Iwamoto ¹, A. Okada ¹, J. Kita ¹, T. Koga ¹, S.-Y. Kawashiri ¹, S. Yamasaki ¹, H. Nakamura ¹, T. Origuchi ⁴, M. Uetani ⁵, K. Aoyagi ⁶, K. Eguchi ⁷, A. Kawakami ¹

¹Department of Immunology and Rheumatology, ²Center for Health and Community Medicine, Nagasaki University, ³Department of Medical Gene Technology, Atomic Bomb Disease Institute, Nagasaki University, ⁴Nagasaki University School of Health Scineces, ⁵Department of Radiology and Radiation Research, ⁶Department of Public Health, Nagasaki University, ⁷Sasebo City General Hospital, Nagasaki, Japan

Background: 2010 ACR/EULAR criteria for rheumatoid arthritis (RA) is developed last year. We have also been investigating a prediction rule for RA using MRI of wrists and finger joints at Nagasaki University.

Objectives: We have evaluated the utility of 2010 ACR/EULAR criteria in conjunction with MRI of wrists and finger jointstoward patients with early undifferentiated arthritis at our cohort.

Methods: Two hundred eight patients with early arthritis patients, whose mean duration of symptoms at entry is 4 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 MRI of both wrists and finger joints. Patients were evaluated by the 2010 ACR/EULAR criteria for RA at the initial visit. Diagnosis of RA was defined by the initiation of disease-modifying antirheumatic drugs(DMARDs) therapy during the first year. Diagnostic performanceof 2010 ACR/EULAR criteria with or without the rule of MRI-proven joint injury were investigated.

Results: Eighty-seven patients were defined as RA whereas 121 patients were not by the use of DMARDs. The 2010 ACR/EULAR criteria diagnosed RA at sensitivity 61.0 %, specificity 83.3 %, positive predictive value(PPV) 82.8 %, negative predictive value (NPV) 62.0 % and accuracy 70.7 %. Forty-five patients, who were not considered as RA by 2010 ACR/EULAR criteria at entry, have been diagnosed as RA during the first year. These 45 patients showed 79.6% of MRI-proven symmetrical synovitis, 40.9% of MRI-proven bone edema and 25.0% of MRI-proven bone erosion at entry.

Conclusions: The present study indicates that 2010 ACR/EULAR criteria as well as our prediction ruleefficiently classify the early arthritis patients as RA. MRI of wrist and finger joints is suggested to be clinically useful to predict RA who is not classified as RA at entry by 2010 ACR/EULAR criteria.

References: 1. Aletaha D, Neogi T, Silman AJ, et al. 2010 rheumatoid arthritis classification critieria: an American College of Rheumatology/European League Against Rheumatism Arthritis Rheum. 2010 Sep;62(9):2569-81.

MRI检查腕和指间关节并联合新版RA分类标准用于评估早期关节炎患者

M. Tamai, EULAR 2011. Present No: OP0244

背景:2010 ACR/EULAR 的RA分类标准于去年确立。我们已经在Nagasak大学进行了腕和指关节MRI对RA预测的研究。

目标：对我们患者人群中的早期未分化关节炎患者，应用2010 ACR/EULAR标准并结合腕和指关节MRI进行评估。

方法：共有208例早期关节炎患者连续入组，入组时平均病程为4个月。由日本风湿病学院资质认证的风湿病医生对患者进行至少1年的随访。入组时，所有患者都接受双手腕和指关节MRI检查。应用2010 ACR/EULAR RA分类标准对患者首次就诊时的情况作出评估。RA的诊断以第一年中开始DMARDs治疗为准。评价2010 ACR/EULAR标准结合有或没有MRI证实的关节损伤对RA的诊断价值。

结果： 87例患者诊断为RA，而另外121例患者因为没有应用DMARDs治疗被视为非RA。2010 ACR/EULAR 的RA分类标准的敏感度为61.0%，特异度83.3%，阳性预测值（PPV）为82.8%，阴性预测值（NPV）为62.0%，准确性为70.7%。 入组时根据2010 ACR/EULAR 标准未诊断RA的患者中有45例患者在随访的第一年中被诊断为RA。这些患者在入组时有79.6%存在MRI证实的对称性滑膜炎，40.9%存在MRI证实的骨水肿，25%存在MRI证实的骨侵蚀。

结论：目前的研究表明2010 ACR/EULAR 标准和我们的预测规则一样能有效地从早期关节炎患者中鉴别出RA。并提示腕和手关节MRI的临床应用将有助于预测入组时2010 ACR/EULAR标准尚不能诊断的RA患者。