类风湿性关节炎中骨髓水肿与软骨损伤的MR研究

The MRI study on bone marrow edema and cartilage damage at the wrist in rheumatoid arthritis

目的利用3.0T磁共振探讨类风湿性关节炎中腕骨骨髓水肿和软骨损伤之间的相关性。方法通过对38例类风湿性关节炎患者和28例正常对照者先后两年进行腕关节磁共振检查,对腕关节软骨损伤、骨髓水肿及骨侵蚀、滑膜炎进行评分并探讨其统计学意义。结果 RA与对照组之间两年MRI软骨评分在评分者1中P值为0.048,评分者2中P值为0.038,均具有统计学差异。两个时间点MRI软骨评分在RA中MRI软骨分数明显增加(评分者1和2分别P=0.046、P=0.033)并具有统计学意义。RA损伤各种影响因素分析结果发现MRI软骨评分(R^2=0.67)优于MRI骨侵蚀评分(R^2=0.47)。两年间分别出现在桡骨、月骨及舟状骨的骨髓水肿与相邻软骨的MRI软骨分数增加具有统计学意义(P值分别为0.0001、0.0012)。结论类风湿性关节炎中出现骨髓水肿和滑膜炎之前已经出现软骨损伤,因此软骨损伤可作为导致关节畸形的独立致病因素。

Objective To explore the relationship between carpal bone marrow edema and cartilage damage in rheumatoid arthritis(RA)using 3.0 T magnetic resonance.Methods Magnetic resonance imaging(MRI)of the wrist was performed in 38 patients with rheumatoid arthritis and 28 normal controls for two years.The carpal articular cartilage injury,bone marrow edema and bone erosion,synovitis and investigate its statistical significance.Results In two years,MRI cartilage score between the RA and the control group in the raters 1 and 2 showed statistically sighificant(P=0.048,P=0.038,respectively).The difference was statistically significant between the RA and the control group.At two time points,the MRI cartilage score increased significantly in RA with MRI cartilage scores(raters 1 and 2,P=0.046,P=0.033,respectively)and statistically significant.RA damage analysis revealed that the MRI cartilage score(R 2=0.67)was better than the MRI bone erosion score(R 2=0.47).Radius,lunate and scaphoid bone marrow edema and adjacent cartilage cartilage MRI fraction in two years increased with statistical significance(P=0.0001,0.0012,respectively).Conclusion Cartilage lesions have been present in RA with bone marrow edema and synovitis.Therefore,Cartilage damage can be an independent causative factor for joint deformities.