INTRODUCTION Arthralgia and MRI-detected subclinical inflammation can precede the development of clinically evident rheumatoid arthritis (RA). However, part of the patients presenting with clinically suspect arthralgia (CSA) do not progress to RA. In these 'non-progressors', we aimed to study the frequencies of spontaneous improvement of arthralgia and its relation with the course of subclinical inflammation. METHODS Between April 2012 and April 2015, 241 patients were considered at risk for RA based on the clinical presentation and included in the CSA cohort. One hundred fifty-two patients with complete data on clinical follow-up did not develop clinical arthritis, of which 98 underwent serial 1.5T MRI scans (wrist, MCP2-5, and MTP1-5 joints) at baseline and after 2 years. MRI scans were scored for synovitis, tenosynovitis, and bone marrow oedema (summed: MRI inflammation score). MRI scores were compared to scores of symptom-free persons. RESULTS After a 2-year follow-up, 33% of the 'non-progressors' had complete resolution of symptoms; 67% had no symptom resolution and were diagnosed as persistent CSA (44%), osteoarthritis (10%), and tendinomuscular complaints (13%). With symptom-free controls as a reference, patients without resolution did not have increased MRI scores at any time point. However, patients achieving resolution of symptoms had increased MRI inflammation scores at baseline (4.0 vs. 2.6, p = 0.037), but not after 2 years (3.0 vs. 2.6; p = 0.57), and during follow-up, their MRI inflammation score decreased significantly (p = 0.036). CONCLUSIONS A subgroup of CSA patients that did not progress to RA had spontaneous improvement of symptoms and resolution of subclinical joint inflammation. This time relationship suggests that symptoms and inflammation were causally related in these patients. Further research is needed to identify the mechanisms underlying the resolution of inflammation.

中文翻译：

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临床上可疑关节痛的症状改善和亚临床关节炎症的缓解：对未进展为临床关节炎的患者的纵向研究。

简介关节痛和MRI检测到的亚临床炎症可以先于临床明显的类风湿关节炎（RA）的发展。但是，部分患有临床可疑关节痛（CSA）的患者并未进展为RA。在这些“非进展者”中，我们旨在研究关节痛自发性改善的频率及其与亚临床炎症过程的关系。方法在2012年4月至2015年4月之间，根据临床表现，将241例患者视为有RA风险，并纳入了CSA队列。152例具有完整临床随访数据的患者未发展为临床关节炎，其中98例在基线和两年后接受了连续1.5T MRI扫描（手腕，MCP2-5和MTP1-5关节）。对滑膜炎，腱鞘炎，和骨髓水肿（总结：MRI炎症评分）。将MRI得分与无症状者得分进行比较。结果经过2年的随访，有33％的“非进展者”完全缓解了症状。67％的患者没有症状缓解，被诊断为持续性CSA（44％），骨关节炎（10％）和肌腱疾病（13％）。以无症状对照为参考，无症状的患者在任何时间点的MRI评分均未升高。但是，达到症状缓解的患者在基线时的MRI炎症评分增加（4.0 vs. 2.6，p = 0.037），但在2年后没有升高（3.0 vs. 2.6； p = 0.57），并且在随访期间，他们的MRI炎症得分显着降低（p = 0.036）。结论未进展为RA的CSA患者亚组具有症状的自发改善和亚临床关节炎症的缓解。这段时间的关系表明这些患者的症状和炎症是因果相关的。需要进一步的研究来确定炎症消退的潜在机制。