BACKGROUND Magnetic resonance imaging (MRI) and ultrasonography (US) are more sensitive than clinical evaluation in assessing inflammation in rheumatoid arthritis (RA). Data is scarce regarding potential link between patient-reported flares and inflammation on imaging. The aim of the study was to explore the pattern and longitudinal associations of inflammatory lesions detected by serial MRI and US in relation to patient-reported flares in patients with RA. METHODS Eighty RA patients with baseline DAS28CRP < 3.2 and no swollen joints were examined at baseline and followed for 1 year. Patients were requested to contact the hospital in case of patient-reported hand flare accompanied by ≥ 1 tender and swollen joint. The 29 patients who reported hand flare had four extra visits within 4 months from flare onset comprising clinical examination, patient-reported outcomes, MRI, and US of wrists and hands. MRI synovitis/tenosynovitis/bone marrow edema (BME) and US synovitis/tenosynovitis were scored. MRI and US scores at and after the flare were compared to baseline before the flare, and associations were explored by linear mixed models for repeated measurements. RESULTS Synovitis and tenosynovitis by MRI/US increased significantly at flare onset. Synovitis waned quickly, as did US tenosynovitis. BME showed delayed increase yet persisted, once the patient-reported flare had resolved, as did MRI tenosynovitis. In univariate models, patient-reported flares were associated with all MRI and US inflammatory markers, except for BME, which was only associated with SJC28 and long-lasting flares > 14 days. Independent associations were observed between patient-reported flares and tenosynovitis by MRI and US (p < 0.05). CONCLUSIONS Patient-reported flares were linked to inflammation detected by serial MRI and US. Differential patterns of inflammatory lesion evolution were observed by serial imaging with early synovial and tenosynovial inflammation, followed by delayed-onset BME.

中文翻译：

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连续磁共振成像和超声检查显示，类风湿关节炎患者报告爆发后，软组织和骨骼中的炎症性病变模式不同。

背景技术在评估类风湿性关节炎（RA）中的炎症时，磁共振成像（MRI）和超声检查（US）比临床评估更敏感。关于患者报告的耀斑与影像学上的炎症之间潜在联系的数据很少。这项研究的目的是探讨由MRI和US检测出的炎症性病变的模式和纵向相关性与RA患者的患者报告的耀斑相关。方法80例基线DAS28CRP <3.2且无关节肿胀的RA患者在基线进行了检查，并随访1年。如果患者报告手部爆发并伴有≥1个压痛和肿胀，请要求患者与医院联系。这29名报告有手部耀斑的患者在耀斑发作后4个月内进行了四次额外的就诊，包括临床检查，患者报告的结果，手腕和手的MRI和US。对MRI滑膜炎/腱鞘炎/骨髓水肿（BME）和US滑膜炎/腱鞘炎进行评分。将耀斑及其后的MRI和US得分与耀斑之前的基线进行比较，并通过线性混合模型探索关联以进行重复测量。结果MRI / US引起的滑膜炎和腱鞘炎在发作时显着增加。滑膜炎迅速消退，美国腱鞘炎也迅速消退。一旦患者报告的耀斑消退，BME就会显示出延迟的增加，但仍然持续，MRI腱鞘炎也是如此。在单变量模型中，患者报告的耀斑与所有MRI和US炎性标志物相关，BME除外，BME仅与SJC28和> 14天的持久耀斑相关。通过MRI和US观察到患者报告的耀斑和腱鞘炎之间存在独立的关联（p <0.05）。结论患者报告的耀斑与通过连续MRI和US检测到的炎症有关。通过对早期滑膜和腱鞘炎进行连续成像，然后进行延迟发作的BME，通过连续成像观察到了炎性病变演变的不同模式。