Clinical Study On X-ray,musculoskeletal Ultrasound,and MRI In Patients With ACPA Positive Rheumatoid Arthritis

Objective:(1)To investigate the serological indicators,imaging changes of wrist joint X-ray,muscle bone ultrasound(MSUS),and magnetic resonance imaging(MRI)in patients with anti citrullinated protein antibody(ACPA)positive rheumatoid arthritis(RA)and ACPA negative RA,and to explore the imaging similarities and differences between ACPA positive RA patients and ACPA negative RA patients;Understand whether ACPA positive RA patients are more prone to imaging changes or progression.Methods : A total of 246 newly diagnosed RA patients who visited the Affiliated Hospital of Guilin Medical University or the rheumatology and Immunology Department of the Nanxishan Hospital of Guangxi Zhuang Autonomous Region from June 2018 to October 2021 were selected,and all patients met the diagnostic criteria for RA.Among them,133 RA patients underwent wrist joint X-ray imaging,staging according to X-ray standards(stages I-IV),and Sharp scoring was performed;48 patients underwent musculoskeletal ultrasound,and 65 patients underwent MRI examination to observe synovitis,tendon/tenosynovitis,bone erosion,blood flow signals,and bone marrow edema in the wrist joint(WR),metacarpophalangeal joint(MCP),and proximal interphalangeal joint(PIP)of both hands.In addition,basic data,serological indicators,DAS28 scores,etc.of RA patients were collected,and statistical methods were used to analyze the relationship between clinical basic data,serological inflammatory indicators,joint lesions(X-ray,musculoskeletal ultrasound,MRI)of ACPA positive RA patients and ACPA negative patients.Results:(1)The difference in disease duration between RA patients in the ACPA positive group and those in the negative group was statistically significant(t=2.46,P=0.015);The comparison of joint swelling between the two groups showed that the ACPA positive group had more joint swelling than the negative group,with a statistically significant difference(t=4.01,P=0.045);The ESR between the two groups was significantly higher in the ACPA positive group than in the negative group(t=5.58,P<0.001);The comparison of hs CRP between the two groups showed that the hs CRP in the ACPA positive group was larger than that in the negative group,with a statistically significant difference(t=2.66,P=0.009).(2)The DAS28 scores of patients in the ACPA positive and negative groups were compared,and the positive group was higher than the negative group,with a statistically significant difference(t=2.60,P=0.010).When the DAS28 score is high disease activity,the DAS28 score of the ACPA positive group is higher than that of the negative group,with a statistically significant difference(t=2.35,P=0.021).(3)Compared with the negative group,the bone density of ACPA positive RA patients was significantly lower in the positive group than in the negative group(t=-2.87,P=0.005).(4)Compared with the negative group,the Sharp score of ACPA positive RA patients was significantly higher in the positive group than in the negative group,with a statistically significant difference(t=5.37,P<0.001).Moreover,multiple linear regression analysis showed that there was a statistically significant difference in the correlation between ACPA and Sharp score(t=2.67,P=0.009).(5)In the X-ray detection of joint lesions,the detection rates of stage II,III,and IV joint lesions in patients with ACPA positive were higher than those in patients with ACPA negative,and the differences were statistically significant(P<0.05).(6)In the MSUS detection of joint lesions,the detection rates of synovitis,tendon/tenosynovitis,and bone erosion joint lesions were compared between the ACPA positive group and the negative group.The ACPA positive group was higher than the negative group,and the differences were statistically significant(P<0.05).(7)In the MRI detection of joint lesions,the detection rates of synovitis,tendon/tenosynovitis,bone erosion,and bone marrow edema in the ACPA positive group were higher than those in the negative group,with statistical significance(P<0.001).Conclusions:(1)There is a positive correlation between ACPA positivity and ESR,hs CRP,and DAS28 in patients with rheumatoid arthritis;(2)ACPA positive RA patients have more severe osteoporosis;(3)ACPA positive RA patients have a higher Sharp score for bone erosion,indicating a higher risk of bone erosion,It is an independent risk factor for bone erosion in RA patients;(4)ACPA positive RA patients are more likely to develop synovitis,tenosynovitis/tenosynovitis,and bone erosion detected by MSUS.(5)ACPA positive RA patients are more prone to MRI detected synovitis,tendon/tenosynovitis,bone erosion,and bone marrow edema.