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Manger B. New developments in imaging for diagnosis and therapy monitoring in rheumatic diseases. Best Pract Res Clin Rheumatol 2005; 18:773-81. [PMID: 15501182 DOI: 10.1016/j.berh.2004.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The availability of therapeutic modalities that are able to stop inflammatory joint damage has also markedly influenced recent developments in muskuloskeletal imaging. One focus of interest is the detection of joint pathology as early as possible in order to prevent erosive bony changes. Ultrasonography and magnetic resonance imaging are the most valuable technologies in this respect. Another focus is on the exact assessment and documentation of joint damage using scoring systems not only in therapeutic trials, but also in clinical practice. In addition to these recent advances in peripheral and axial joint imaging, this chapter also discusses advances in vascular imaging and scintigraphy in rheumatoid diseases as well as interventional procedures guided by imaging technologies.
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Affiliation(s)
- Bernhard Manger
- Department of Medicine III, Institute for Clinical Immunology and Rheumatology, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstrasse 12, D-91054 Erlangen, Germany.
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Abstract
Imaging can play a vital role in the evaluation of patients with early arthritis. Various imaging methods can be utilized to aid with diagnosis, predict prognosis and follow disease progression and treatment response. Previously, conventional radiography was the principal method used to evaluate and follow bone damage in patients with inflammatory arthritis. More recently the use of magnetic resonance imaging and ultrasonography has gained wider acceptance and popularity due to the ability of these multiplanar techniques to image both bone changes and soft tissue abnormalities, including synovitis. This chapter discusses the current imaging modalities used in the evaluation of patients with early arthritis, as well as the use of imaging in establishing the extent of disease, in prognosis and in monitoring disease course. Current data on imaging of patients with early arthritis due to rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis is reviewed.
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Affiliation(s)
- Amy Evangelisto
- Academic Department of Musculoskeletal Medicine, First Floor, Old Nurses Home, Leeds General Infirmary, Great George Street, Leeds LSI 3EX, UK
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103
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Abstract
The importance of ultrasonography in rheumatology has increased dramatically within the last few years both with regard to clinical practice and to research. High-resolution colour Doppler ultrasound equipment is, to date, widely available. Colour and power Doppler studies of intra-articular and peritendinous blood flow allow an estimation of the inflammatory activity and aid in distinguishing anatomical structures. Contrast agent increases the ability of ultrasonography to detect even minor perfusion. These findings have a practical clinical impact on the management of inflammatory rheumatic diseases. The resolution of ultrasonography is superior to that of magnetic resonance imaging (MRI) and computed tomography (CT) with regard to superficial anatomical structures. Furthermore, ultrasonography can depict the artery wall in contrast to angiography. In temporal arteritis and Takayasu's arteritis, ultrasonography depicts characteristic, homogenous wall thickening, stenoses and acute occlusions. These pathologies resolve quickly with treatment in the temporal arteries and much more slowly in larger arteries.
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Affiliation(s)
- Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Karower Str. 11, 13125 Berlin, Germany.
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104
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Taylor PC. Serum vascular markers and vascular imaging in assessment of rheumatoid arthritis disease activity and response to therapy. Rheumatology (Oxford) 2005; 44:721-8. [PMID: 15644394 DOI: 10.1093/rheumatology/keh524] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Vascular pathology, in the form of angiogenesis, is important in the perpetuation of rheumatoid arthritis (RA) and, in the form of endothelial dysfunction, contributes to associated cardiovascular co-morbidity. Emerging evidence suggests that TNFalpha blockade may modify vascular pathology in RA. Serum concentrations of vascular endothelial growth factor (VEGF), a potent endothelial cell-specific growth factor that is up-regulated by pro-inflammatory cytokines and by hypoxia, are elevated in RA and correlate with disease activity. Serum levels of VEGF at first presentation in RA predict radiographic progression of the disease over the subsequent year. Power Doppler ultrasonography is a sensitive method for demonstrating the presence of blood flow in small vessels and the vascular signal correlates with histopathological quantification of the vascular density of synovial tissue. Recent data indicate that high-frequency ultrasound and power Doppler are sensitive tools for evaluation of disease activity and assessment of response to therapy. Power Doppler imaging may also have the potential to predict those patients most at risk of accelerated joint destruction. However, much work has yet to be done to standardize the use of these imaging technologies.
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Affiliation(s)
- P C Taylor
- Kennedy Institute of Rheumatology Division, Imperial College Faculty of Medicine, 1 Aspenlea Road, London W6 8LH, U.K.
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Klauser A, Frauscher F, Halpern EJ, Mur E, Springer P, Judmaier W, Schirmer M. Remitting seronegative symmetrical synovitis with pitting edema of the hands: Ultrasound, color doppler ultrasound, and magnetic resonance imaging findings. ACTA ACUST UNITED AC 2005; 53:226-33. [PMID: 15818642 DOI: 10.1002/art.21067] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the value of gray-scale ultrasound (US), color Doppler ultrasound (CDUS), contrast-enhanced CDUS, and magnetic resonance imaging (MRI) in the diagnostic evaluation of the hands in patients with remitting seronegative symmetrical synovitis with pitting edema (RS3PE). METHODS Eight patients (5 men, 3 women; mean +/- SD age 69.3 +/- 7.2 years) with clinical diagnosis of RS3PE syndrome underwent US, CDUS, contrast-enhanced CDUS, and MRI. US was performed with a linear array transducer operating at 12 MHz. The US contrast agent (SHU 508; Levovist, Schering, Germany) was intravenously infused in a concentration of 300 mg/ml at a rate of 1 ml/minute. RESULTS All patients showed symmetric subcutaneous edema and synovitis of tendons and finger joints on both US and MRI. Vascularity was detected subcutaneously in tendon sheaths and in the joint synovia on CDUS and MRI. Detection of increased vascularity was improved after contrast administration compared with unenhanced CDUS (P < 0.01). CONCLUSION Ultrasound, CDUS, contrast-enhanced CDUS, and MRI are valuable tools in the diagnostic evaluation of involved anatomic structures in patients with RS3PE. Contrast-enhanced CDUS is superior to CDUS in assessment of inflammatory edema, effusion, and synovitis.
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106
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Fiocco U, Ferro F, Vezzù M, Cozzi L, Checchetto C, Sfriso P, Botsios C, Ciprian L, Armellin G, Nardacchione R, Piccoli A, Todesco S, Rubaltelli L. Rheumatoid and psoriatic knee synovitis: clinical, grey scale, and power Doppler ultrasound assessment of the response to etanercept. Ann Rheum Dis 2004; 64:899-905. [PMID: 15567814 PMCID: PMC1755540 DOI: 10.1136/ard.2004.025585] [Citation(s) in RCA: 111] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the effect of tumour necrosis factor alpha (TNFalpha) blockade with etanercept in refractory knee joint synovitis (KJS) in rheumatoid and psoriatic arthritis, by local and systemic disease activity assessment and combined grey scale and power Doppler ultrasonographic monitoring. METHODS 27 knees affected by rheumatoid KJS (n = 12) and psoriatic KJS (n = 8) were assessed before receiving treatment and at 3 and 12 months' follow up. Time dependent clinical changes in disease activity were monitored by C reactive protein, erythrocyte sedimentation rate (ESR), global health status (GHS), and Ritchie (RAI) and knee joint articular (KJAI) indices; synovial changes were monitored by ultrasonographic and power Doppler indices for grey scale synovial thickening and for distinct intrasynovial vessel power Doppler flow configurations (fluid/synovium interface (F/SI-PD) and pannus/cartilage interface (P/CI-PD)). Interobserver and intraobserver variability of grey scale and power Doppler ultrasonographic was evaluated. Response to treatment was assessed by analysis of variance for repeated measures on clinical and ultrasonographic variables. RESULTS Rapid (3 months) reduction in F/SI-PD flow (p<0.001), parallel to reductions of C reactive protein (p<0.05), ESR (p<0.001), KJAI (p<0.002), RAI, and GHS (p<0.001), was sustained at 12 months when it was accompanied by reduction in both synovial thickening and P/CI-PD flow (p<0.001). No differences (ANOVA) were noted at baseline or at 12 months in clinical and ultrasonographic variables between either the rheumatoid or the psoriatic KJS groups. CONCLUSION Grey scale and power Doppler ultrasonography are reliable measures of long term change in rheumatoid and psoriatic KJS disease activity in response to anti-TNFalpha treatment with etanercept.
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MESH Headings
- Adult
- Aged
- Antirheumatic Agents/therapeutic use
- Arthritis, Psoriatic/complications
- Arthritis, Psoriatic/diagnostic imaging
- Arthritis, Psoriatic/drug therapy
- Arthritis, Rheumatoid/complications
- Arthritis, Rheumatoid/diagnostic imaging
- Arthritis, Rheumatoid/drug therapy
- Etanercept
- Female
- Follow-Up Studies
- Humans
- Immunoglobulin G/therapeutic use
- Knee Joint/diagnostic imaging
- Male
- Middle Aged
- Neoplasm Proteins/therapeutic use
- Prospective Studies
- Receptors, Tumor Necrosis Factor/therapeutic use
- Receptors, Tumor Necrosis Factor, Type II
- Severity of Illness Index
- Synovitis/diagnostic imaging
- Synovitis/drug therapy
- Synovitis/etiology
- Tumor Necrosis Factor Decoy Receptors
- Ultrasonography, Doppler/methods
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Affiliation(s)
- U Fiocco
- Division of Rheumatology, Department of Medical and Surgical Sciences, University of Padua, Via Giustiniani 2, 35128 Padua, Italy.
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Terslev L, Torp-Pedersen S, Qvistgaard E, von der Recke P, Bliddal H. Doppler ultrasound findings in healthy wrists and finger joints. Ann Rheum Dis 2004; 63:644-8. [PMID: 15140770 PMCID: PMC1755031 DOI: 10.1136/ard.2003.009548] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the presence of flow by Doppler ultrasound (DUS) in the wrist and finger joints (carpometacarpal 1 (CMC1), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints) of healthy controls. METHODS Twenty seven healthy volunteers (15 women, 12 men; mean age 45 years, range 18-93) with a total of 324 joints were examined by DUS. The synovial vascularisation was determined by colour Doppler and the spectral Doppler resistive index (RI). Patients were only included if no synovitis was suspected at the clinical examination and the values for biochemical analysis were within the normal range. RESULTS We found colour pixels in 15 of the 27 examined wrist scans and in 8 of these a measurable RI. In the CMC1 joint, colour pixels were found in 11 of the 27 scans and in 9 of these a measurable RI. For the MCP joints, colour pixels were found in 10 out of 135 scans and in 3 of these a measurable RI. The mean RI for all three types of joints was 0.85 and the mean pixel fraction varied from 0.05 to 0.08. Only one PIP joint scan was found to have colour pixels and a flow with an RI of 0.67. CONCLUSION Synovial vascularisation may be detected in healthy subjects using DUS. Newer US machines have higher Doppler sensitivity, and it is necessary to be able to distinguish normal from pathological synovial flow.
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Affiliation(s)
- L Terslev
- The Parker Institute, Department of Rheumatology, Frederiksberg Hospital, DK 2000 Frederiksberg, Denmark.
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108
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Kasukawa R, Takahashi A, Yamadera Y, Takeda I, Kanno T. Two localization patterns of vascularity demonstrated by power Doppler sonography at the suprapatellar recess in knee joints of patients with rheumatoid arthritis: intracapsular and supracortical. Mod Rheumatol 2004. [DOI: 10.3109/s10165-004-0296-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Østergaard M, Wiell C. Ultrasonography in rheumatoid arthritis: a very promising method still needing more validation. Curr Opin Rheumatol 2004; 16:223-30. [PMID: 15103249 DOI: 10.1097/00002281-200405000-00010] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Through recent technological advances, ultrasonography allows high-resolution visualization of inflammatory and destructive changes in the small superficial joints of hands and feet, and ultrasonography is increasingly used by rheumatologists for assessment of rheumatoid arthritis patients. It is, therefore, highly relevant to consider the validity of ultrasonographic measures of rheumatoid joint inflammation and damage. RECENT FINDINGS Organized by type of validity, data on ultrasonography in rheumatoid arthritis are reviewed. Encouraging reports of high agreement of ultrasonographic findings between observers, with MRI and, in knee and hip joints, histopathologic assessments were recently published. New quantitative and semiquantitative evaluation methods have been suggested, and the first systematic follow-up studies suggest an ability of ultrasonography to monitor joint inflammation and damage. However, a number of essential issues are still largely unexplored, including interscanner variability, sensitivity to change, prognostic value, and value in the diagnosis of rheumatoid arthritis. Suggested areas of priority in research and development of ultrasonography in rheumatoid arthritis are outlined. SUMMARY Ultrasonography is a very promising method in the assessment of rheumatoid arthritis joints, but still needs more validation before it can take up its expected role on a scientific basis as an important tool for diagnosis, monitoring, and prognostication of patients with rheumatoid arthritis and suspected rheumatoid arthritis.
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Affiliation(s)
- Mikkel Østergaard
- Department of Rheumatology, Copenhagen University Hospital at Hvidovre, Kettegaard alle 30, DK-2650 Hvidovre, Denmark.
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110
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Klauser A, Frauscher F, Schirmer M. Value of contrast-enhanced power Doppler ultrasonography (US) of the metacarpophalangeal joints on rheumatoid arthritis. Eur Radiol 2004; 14:545-6; author reply 547-8. [PMID: 12819918 DOI: 10.1007/s00330-003-1955-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2003] [Accepted: 03/22/2003] [Indexed: 10/26/2022]
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Lerch K, Borisch N, Paetzel C, Grifka J, Hartung W. Proposal for a sonographic classification of target joints in rheumatoid arthritis. Rheumatol Int 2003; 25:215-9. [PMID: 14658006 DOI: 10.1007/s00296-003-0418-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2003] [Accepted: 10/18/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purpose of this study was to classify sonographically the joint damage of target joints in patients with rheumatoid arthritis (RA). METHODS During a 3-year cross-sectional study, standardized arthrosonography of symptomatic target joints was performed in patients with RA. According to those findings, a classification with progressive deterioration of joint alteration in RA was created that grades visible morphological changes of the joint components. Using elbow joints as a subgroup, inter- and intraobserver reliability was calculated. RESULTS Examined and included in this study were 1211 joints of 425 patients with RA. The mean disease activity score was 5.2 (range 0.75-7.79). Sonographically visible changes could be classified and divided into six stages. A standardized sonographic evaluation system was developed. In reference to the elbow joint, overall percentages for intra- and interobserver reliability of sonography were 90.8% and 88.8%, respectively. CONCLUSION Sonography is a valuable tool for assessing and classifying joint alteration in RA. Particularly in early stages of joint affection, ultrasound is superior to X-ray in detecting soft tissue changes and minor erosions.
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Affiliation(s)
- Klaus Lerch
- Department of Orthopedic Surgery, University of Regensburg, Kaiser-Karl-V. Allee 3, Bad Abbach, Germany.
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112
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Schirmer M, Klauser A, Wenger M, Baltaci M, Moncayo R. New perspectives of imaging techniques for diagnosis of organ manifestations in Behçet's disease. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2003; 528:445-8. [PMID: 12918741 DOI: 10.1007/0-306-48382-3_90] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Michael Schirmer
- Department of Internal Medicine, University Hospital, University of Innsbruck, Innsbruck, Austria
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113
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Ostergaard M, Szkudlarek M. Imaging in rheumatoid arthritis--why MRI and ultrasonography can no longer be ignored. Scand J Rheumatol 2003; 32:63-73. [PMID: 12737323 DOI: 10.1080/03009740310000058] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Implementing the modern treatment strategy in rheumatoid arthritis (RA), i.e. early initiation and optimal adjustments of aggressive therapies, requires methods for early diagnosis and sensitive monitoring of the disease process. In rheumatoid arthritis clinical trials and routine management, conventional radiography is the pivotal method for diagnosing and monitoring structural joint damage. However, it is insensitive to bone damage at its earliest stages and totally incapable of capturing the primary feature of rheumatoid disease, the synovitis. In comparison with radiography, magnetic resonance imaging (MRI) offers assessment of bone damage with improved sensitivities to early pathology and to change. In addition, detailed assessment of soft tissue changes, including synovitis and tenosynovitis, is possible and MRI findings are of prognostic value for the long-term radiological outcome. Ultrasonography (US) is less validated than MRI, but available data suggests that US offers comparable information on both inflammatory and destructive changes in RA finger and toe joints. Issues of reliability, standardization and documentation limit its value in clinical trials, This article reviews current knowledge on conventional radiography, computed tomography, MRI and US for assessment of peripheral joints in RA. The rationale is provided for MRI being the new gold standard for assessment of RA joints and US becoming a routine bedside tool for improved joint assessments and injections by rheumatologists. Pursuing the goal of improving patient care and disease outcome, rheumatologists can no longer afford to ignore MRI and US as means to measure disease activity and joint damage in rheumatoid arthritis.
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Abstract
Despite the advances made in medical imaging over the past 3 decades and the central role that magnetic resonance imaging and other sophisticated technologies now play in routine clinical practice, patients with rheumatoid arthritis have benefited relatively little from these advances thus far. Over the past few years, however, evidence has accumulated to show that magnetic resonance imaging and ultrasonography can identify joint damage in patients with rheumatoid arthritis earlier and more sensitively than other techniques can, and that these techniques can directly visualize and monitor changes in synovium and bone that precede actual bone erosion. Much of this development is being driven by the pharmaceutical and biotechnology industries as they search for novel therapies to combat this disease. Accordingly, the imaging tools that ultimately will be used to direct patients to specific therapies and then to monitor treatment effectiveness and safety are currently being refined and validated in rigorous multicenter and multinational clinical trials aimed at gaining regulatory approval of these new therapies. As these therapies become available for clinical use, we can anticipate increased demand for expertise and experience in evaluating disease progression and treatment response, and to the emergence of magnetic resonance imaging systems specifically adapted for this application. The following discussion reviews the current status of this development, and notable advances that have been reported in the literature in the past year.
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Mease PJ. Disease-modifying antirheumatic drug therapy for spondyloarthropathies: advances in treatment. Curr Opin Rheumatol 2003; 15:205-12. [PMID: 12707572 DOI: 10.1097/00002281-200305000-00006] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The inflammatory arthritides included in the category of spondyloarthropathy (ankylosing spondylitis, psoriatic arthritis, reactive arthritis, undifferentiated spondyloarthropathy, and arthritis associated with inflammatory bowel disease) may cause significant, progressive morbidity. Therapy with nonsteroidal antiinflammatory drugs and traditionally used disease-modifying antirheumatic drugs, such as methotrexate, often fails in patients with more severe peripheral arthropathy and axial involvement, and alternative treatment options have been limited. With increased understanding of the pathologic processes involved in these disorders, new therapeutics have arisen and are being investigated in the various subtypes of spondyloarthropathy. This article reviews recent progress in disease-modifying therapy for spondyloarthropathy, including new biologic response modifiers, such as the tumor necrosis factor-alpha inhibitors etanercept and infliximab.
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Affiliation(s)
- Philip J Mease
- Seattle Rheumatology Associates, Seattle, Washington 98104, USA.
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116
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Wakefield RJ, Brown AK, O'Connor PJ, Emery P. Power Doppler sonography: improving disease activity assessment in inflammatory musculoskeletal disease. ARTHRITIS AND RHEUMATISM 2003; 48:285-8. [PMID: 12571834 DOI: 10.1002/art.10818] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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117
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Weidekamm C, Köller M, Weber M, Kainberger F. Diagnostic value of high-resolution B-mode and doppler sonography for imaging of hand and finger joints in rheumatoid arthritis. ARTHRITIS AND RHEUMATISM 2003; 48:325-33. [PMID: 12571840 DOI: 10.1002/art.10784] [Citation(s) in RCA: 119] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE High-resolution sonography enables a detailed assessment of intraarticular and extraarticular soft tissue abnormalities of joints affected by rheumatoid arthritis (RA). This study was undertaken to evaluate the diagnostic value of B-mode sonography and power Doppler compared with that of clinical examinations and conventional radiography. METHODS The study group comprised 47 patients (14 men, 33 women) with different grades of RA; 31 patients were rheumatoid factor (RF) positive, and 16 were RF negative. The wrists, first through fifth metacarpophalangeal joints, and second through fifth proximal interphalangeal joints of these patients were scored with ultrasound in B-mode and power Doppler application, using a standardized technique. Involvement and severity of inflammation, as well as vascularization, were scored according to a new 3-point scale. The results were correlated with benchmarks of the clinical and radiologic investigations. Clinical status and conventional radiologic status were determined according to the Disease Activity Score and the Larsen score. RESULTS After preliminary studies in 15 patients, 39% of 704 joints were found to be abnormal by clinical investigation. Erosions were detected by radiography and sonography in 23% and 43% of joints, respectively. Hypervascularization was observed in 34% of 704 joints by power Doppler application. There was a significant correlation (P < 0.001) between the different methods for the detection of the severity of lesions. Use of a modern, state-of-the-art power Doppler program was necessary for semiquantification, and a standardized investigation technique and scoring system provided sufficient quality measures. CONCLUSION Sonography detects 20% more abnormalities than does radiography, and sonography has the potential to provide simple grading of disease activity. The rate of detection of abnormalities was slightly higher with clinical examination compared with sonography.
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Affiliation(s)
- C Weidekamm
- Department of Diagnostic Osteology, Universitaetsklinik fuer Radiodiagnostik, Allgemeines Krankenhaus Wien, Waehringer Guertel 18-20, A-1090, Vienna, Austria.
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118
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Taylor PC. The value of sensitive imaging modalities in rheumatoid arthritis. Arthritis Res Ther 2003; 5:210-3. [PMID: 12932279 PMCID: PMC193731 DOI: 10.1186/ar794] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2003] [Accepted: 07/02/2003] [Indexed: 11/10/2022] Open
Abstract
X-ray evaluation of rheumatoid joints is relatively inexpensive, is widely available and has standardised methods for interpretation. It also has limitations, including the inability to reliably determine structural change in less than 6-12 months, the need for experienced readers to interpret images and the limited acceptance of this technique in routine clinical practice. High-frequency ultrasound, with or without power Doppler, and magnetic resonance imaging of rheumatoid joints permit an increasingly refined analysis of anatomic detail. However, further research using these sensitive imaging technologies is required to delineate pathophysiological correlates of imaging abnormalities and to standardise methods for assessment.
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Affiliation(s)
- Peter C Taylor
- The Kennedy Institute of Rheumatology Division, Faculty of Medicine, Imperial College London, UK.
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Affiliation(s)
- B Taouli
- Department of Radiology, University of California San Francisco, CA 94143, USA.
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