摘要 目的 为证实很早期关节炎患者2年后出现一处以上骨糜烂的指标，并建立预测模型。 方法 2处以上关节肿胀持续4周~6个月且未用改善病情药（DMARD）及激素的的成年患者共310例，在0、6、12和24个月进行骨糜烂的评估，评价指标包括临床标准（DAS，HAQ）、CRP、ESR、自身抗体、骨和软骨标记物、手骨密度和HLA-II共享抗原决定簇。对符合ACR关于类风湿关节炎标准患者或未分化关节炎进行密切随访和治疗：三分之一的类风湿关节炎和四分之三的未分化关节炎患者在2年内未使用DMARD，第一年有1.8%的患者使用了生物制剂。主要的判定标准为2年时出现一处以上的骨糜烂。结果 2年时有219例患者进行评估发现，31.3%的类风湿关节炎和11.6%的未分化关节炎患者有一处以上的骨糜烂，Logistic回归分析显示，骨糜烂与血清IgA-RF及吡啶啉水平强烈相关，190例患者在基线无糜烂，相应ROC 曲线下的AUC= 0.77 [95% CI: 0.64-0.86]。预测模型：IgA-RF阈值为 5和25 IU/ml，吡啶啉为10 nM/l; 风险比从1（IgA-RF <5 iu/ml和吡啶啉<10 nm/l）到50.75（iga-rf≥5 iu/ml和吡啶啉 ≥ 10 nm/l）。 结论:血清iga-rf 和吡啶啉浓度能预测很早期的关节炎患者2年后1处以上的骨糜烂。

附原文 Abstract OBJECTIVE.: To identify, in conservatively treated, very-early arthritis patients, predictors of >/=1 erosion(s) at 2 years and to construct a prediction model. METHODS.: Community-based adults (n=310) with DMARD- and steroid-na?ve swelling of 2 or more joints persisting >4 weeks and lasting <6 months were recruited. erosion status was assessed at 0, 6, 12 and 24 months; evaluations comprised of clinical criteria (das, haq), crp, esr, autoantibodies, bone and cartilage markers, hand densitometry; hla class-ii shared epitopes. patients meeting acr rheumatoid arthritis (ra) criteria or with undifferentiated arthritis (ua) were followed and treated conservatively: one-third of ra and three-fourths of ua patients received no dmards during 2 years; a biologic was given to 1.8% of the patients during the first year. the main judgment criterion was>/=1 erosion(s) at 2 years. RESULTS.: At 2 years, 219 patients were assessed; 31.3% with RA and 11.6% with UA had >/=1 erosion(s). Logistic-regression analysis at that time showed erosion(s) strongly associated with serum IgA-RF and pyridinoline levels for the 190 patients with no baseline erosions, with the corresponding ROC curve having an AUC = 0.77 [95% CI: 0.64-0.86]. A prediction model was constructed with IgA-RF thresholds of 5 and 25 IU/ml and pyridinoline (10 nM/l); odds ratios ranged from 1, for IgA-RF <5 iu/ml and pyridinoline <10 nm/l to 50.75 for the association of iga-rf>/=5 IU/ml and pyridinoline >/=10 nM/l. CONCLUSION.: This model, using serum IgA-RF and pyridinoline concentrations, was able to predict >/=1 erosion(s) at 2 years in very-early arthritis patients.

引自 Le Lo?t X, Brazier M, Mejjad O, et al. Serum IgA rheumatoid factor and pyridinoline in very-early arthritis are predictors of erosion(s) at 2 years: A simple model of prediction from the conservatively treated community-based inception VErA cohort. Arthritis Care Res (Hoboken). 2010 Aug 25. [Epub ahead of print]