The Natural Sequence in Which Subclinical Inflamed Joint Tissues Subside or Progress to Rheumatoid Arthritis: A Study of Serial MRIs in the TREAT EARLIER Trial.

Autor: Krijbolder DI; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., Matthijssen XME; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., van Dijk BT; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., van Steenbergen HW; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., Boeters DM; Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands., Willemze A; Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands., Schouffoer AA; Department of Rheumatology, Leiden University Medical Center, Leiden, and Department of Rheumatology, Haga Hospital, The Hague, The Netherlands., van der Helm-van Mil AHM; Department of Rheumatology, Leiden University Medical Center, Leiden, and Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands.
Jazyk: angličtina
Zdroj: Arthritis & rheumatology (Hoboken, N.J.) [Arthritis Rheumatol] 2023 Sep; Vol. 75 (9), pp. 1512-1521. Date of Electronic Publication: 2023 Jul 11.
DOI: 10.1002/art.42527
Abstrakt: Objective: The natural trajectory of clinical arthritis progression at the tissue level remains elusive. We hypothesized that subclinical inflammation in different joint tissues (synovitis, tenosynovitis, osteitis) increases in a distinct temporal order in patients with clinically suspect arthralgia (CSA) who develop rheumatoid arthritis (RA) and subsides in a different sequence when CSA spontaneously resolves.
Methods: We studied 185 serial magnetic resonance images (MRIs) from CSA patients with subclinical joint inflammation from the placebo arm of the TREAT EARLIER trial: 52 MRIs from 21 RA progressors (MRIs conducted at 1 year before, at 4 months before, and upon RA development), and 133 MRIs from 35 patients with spontaneous resolution of pain (MRIs conducted at baseline and at 4, 12, and 24 months). MRIs were scored for osteitis, synovitis, and tenosynovitis. We used cross-lagged models to evaluate 2 types of time patterns between pairs of inflamed tissues: a simultaneous pattern (coinciding changes) and a subsequent pattern (inflammatory changes in 1 tissue preceding changes in another tissue).
Results: In patients who developed RA, synovitis, tenosynovitis, and osteitis increased simultaneously. Increasing osteitis occurred in the final 4 months before RA diagnosis, following incremental tenosynovitis and synovitis changes during the 1 year to 4 months before diagnosis (P < 0.01). In anti-citrullinated protein antibody (ACPA)-positive and ACPA-negative patients who progressed to RA, osteitis increased just before RA development. In patients with pain resolution, simultaneous decreases in synovitis, tenosynovitis, and osteitis occurred, with tenosynovitis decreasing in the first 4 months after CSA onset preceding decreasing synovitis and osteitis during 4-12 months (P = 0.02 and P < 0.01).
Conclusion: We identified natural sequences of subclinical inflammation in different joint tissues, which deepens our understanding of clinical arthritis and RA development. During RA progression, increasing osteitis followed previous increases in tenosynovitis and synovitis. During pain resolution, tenosynovitis decreased first, followed by decreasing synovitis and osteitis.
(© 2023 The Authors. Arthritis & Rheumatology published by Wiley Periodicals LLC on behalf of American College of Rheumatology.)
Databáze: MEDLINE
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