影响类风湿关节炎X线平片进展的临床多因素分析

Objective To investigate the clinical factors related to radiological progression in rheumatoid arthritis(RA) and the role of radiology in the assessment of RA outcomes. Methods A total of 178 cases of active rheumatic arthritis were enrolled in a 2-year trial given radiological assessment at baseline and during follow up. These cases were classified into three groups, namely groups 1, 2 and 3 for mild,moderate and severe based on baseline X-ray images of joint damage. Radiological progression, clinical remission and Health Assessment Questionnaire (HAQ) were used in the two-year follow-up and analyzed for the correlation between each other. Results At the end point, groups 1 and 2 did not differ in radiological progression (P＞0.05). Significant difference was found between group 1 (15.4%, 12/78)and group 2 (30.0%,9/30) (P＜0.05) , as well as between group 3 (11.9% , 7/59) and group 3 (P＜0.05) , suggesting that radiological damages may deteriorate more in patients with higher level of bone erosion at baseline. After 2years of medications, the rate of clinical remission in all the cases was 85.0% (142/167) and was not different among the three groups (P＞0.05), which indicated that clinical remission had no relevance with radiological progression. Conclusion Female gender, positive rheumatoid factor, high HAQ scores and peri- articular lesions are risk factors for radiological progression in RA. Early use of disease-modifying antirheumatic drugs (within less than 6 months) is beneficial for patients with radiological progression. X-ray is sufficiently effective to confirm, re-evaluate and determine the articular erosion. Clinical remission may not necessarily indicate suspension of radiological progression and routine X-ray is required in the whole follow up process of RA in order to modify medications based on progression of articular lesions.

Multi-variate analysis related to radiological progression in rheumatoid arthritis