Von der Destruktion zur Heilung im Röntgenbild bei der rheumatoiden Arthritis (RA)[1]

Zusammenfassung

Aus persönlicher Sicht wird zunächst die Entwicklung der Scoringmethoden zur Progressionsmessung der radiologischen Destruktion bei der RA betrachtet. Näher eingegangen wird danach auf die Geschichte der radiologischen Heilung. Einzelkasuistiken und kleine Fallserien wurden von Experten bezweifelt. Später konnte die Existenz von Heilungen besonders durch Studien des Healing Committees der OMERACT-Organisation bewiesen werden. In einzelnen klinischen Prüfungen der Kombination von TNF-Inhibitoren mit MTX überwog das Ausmaß der Reparation, gemessen als Zahl der Patienten mit negativem Änderungsscore, das der Destruktion. Negative Änderungsscore-Werte erfassen Heilung aber erst, wenn neugebildeter Knochen zu einer ausgeprägten Verkleinerung der Erosion geführt hat. Gestützt auf morphologische Kriterien sollten auch jene Heilungsfälle beschrieben werden, die keinen negativen Änderungsscore bewirken. Heilung bedeutet aktive Reparation mit Besserung der Funktion und stellt somit einen bedeutsamen neuen Outcome-Parameter dar.

Abstract

This is a personal view on the development of scoring methods to measure progression of radiological damage in patients with rheumatoid arthritis. The history of radiological healing or repair, respectively, is discussed in more detail. First, only single case reports or small series have been published but were questioned by experts. Later, the existence of repair could be proven by studies preferentially performed by the Healing Committee of the OMERACT organisation. In some drug trials investigating the combination of TNF blockers with MTX the amount of repair, measured as patients with negative change scores, was greater than that of progression. Negative change scores occur only after the size of the erosion has been significantly reduced by filling in with new bone. Based on certain morphological criteria also those cases of repair should be counted where new bone formation is lacking or too small to reduce the score. Healing means the existence of active repair including functional improvement and therefore is an important new outcome parameter.

Schlüsselwörter

rheumatoide Arthritis - Bildgebung - Scoringmethoden - Heilung - Reparation

Key words

rheumatoid arthritis - imaging - scoring methods - healing - repair

1 Nach einem einleitenden Vortrag auf dem Düsseldorfer Imaging-Kurs am 6.9.2010. Dem Andenken an meinen Freund John T. Sharp gewidmet, der sich große Verdienste um die Entwicklung der Scoringmethoden erworben und die Diskussion um mögliche Heilungen kritisch aber fördernd begleitet hat.

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1 Nach einem einleitenden Vortrag auf dem Düsseldorfer Imaging-Kurs am 6.9.2010. Dem Andenken an meinen Freund John T. Sharp gewidmet, der sich große Verdienste um die Entwicklung der Scoringmethoden erworben und die Diskussion um mögliche Heilungen kritisch aber fördernd begleitet hat.

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