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Sanmartí R, García-Rodríguez S, Álvaro-Gracia JM, Andreu JL, Balsa A, Cáliz R, Fernández-Nebro A, Ferraz-Amaro I, Gómez-Reino JJ, González-Álvaro I, Martín-Mola E, Martínez-Taboada VM, Ortiz AM, Tornero J, Marsal S, Moreno-Muelas JV. 2014 update of the Consensus Statement of the Spanish Society of Rheumatology on the use of biological therapies in rheumatoid arthritis. ACTA ACUST UNITED AC 2015; 11:279-94. [PMID: 26051464 DOI: 10.1016/j.reuma.2015.05.001] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 05/05/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To establish recommendations for the management of patients with rheumatoid arthritis (RA) to serve as a reference for all health professionals involved in the care of these patients, and focusing on the role of available synthetic and biologic disease-modifying antirheumatic drugs (DMARDs). METHODS Consensual recommendations were agreed on by a panel of 14 experts selected by the Spanish Society of Rheumatology (SER). The available scientific evidence was collected by updating three systematic reviews (SR) used for the EULAR 2013 recommendations. A new SR was added to answer an additional question. The literature review of the scientific evidence was made by the SER reviewer's group. The level of evidence and the degree of recommendation was classified according to the Oxford Centre for Evidence-Based Medicine system. A Delphi panel was used to evaluate the level of agreement between panellists (strength of recommendation). RESULTS Thirteen recommendations for the management of adult RA were emitted. The therapeutic objective should be to treat patients in the early phases of the disease with the aim of achieving clinical remission, with methotrexate playing a central role in the therapeutic strategy of RA as the reference synthetic DMARD. Indications for biologic DMARDs were updated and the concept of the optimization of biologicals was introduced. CONCLUSIONS We present the fifth update of the SER recommendations for the management of RA with synthetic and biologic DMARDs.
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Affiliation(s)
- Raimon Sanmartí
- Servicio de Reumatología, Hospital Clínic de Barcelona, Barcelona, España.
| | | | | | - José Luis Andreu
- Servicio de Reumatología, Hospital Universitario Puerta de Hierro, Madrid, España
| | - Alejandro Balsa
- Servicio de Reumatología, Hospital Universitario La Paz, Madrid, España
| | - Rafael Cáliz
- Servicio de Reumatología, Hospital Universitario Virgen de las Nieves, Granada, España
| | - Antonio Fernández-Nebro
- Unidad de Gestión Clínica de Reumatología, Instituto de Investigación Biomédica de Málaga, Hospital Regional Universitario de Málaga, Universidad de Málaga, Málaga, España
| | - Iván Ferraz-Amaro
- Servicio de Reumatología, Hospital Universitario de Canarias, Tenerife, España
| | - Juan Jesús Gómez-Reino
- Servicio de Reumatología, Hospital Clínico Universitario de Santiago, Santiago de Compostela, A Coruña, España
| | | | | | | | - Ana M Ortiz
- Servicio de Reumatología, Hospital Universitario de la Princesa, Madrid, España
| | - Jesús Tornero
- Servicio de Reumatología, Hospital Universitario de Guadalajara, Guadalajara, España
| | - Sara Marsal
- Servicio de Reumatología, Hospital Universitario Vall d́Hebron, Barcelona, España
| | - José Vicente Moreno-Muelas
- Servicio de Reumatología, Hospital Universitario Vall d́Hebron, Barcelona, España; Sociedad Española de Reumatología, Madrid, España
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302
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Kawashiri SY, Suzuki T, Nishino A, Nakashima Y, Horai Y, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Isomoto I, Uetani M, Aoyagi K, Kawakami A. Automated Breast Volume Scanner, a new automated ultrasonic device, is useful to examine joint injuries in patients with rheumatoid arthritis. Mod Rheumatol 2015; 25:837-41. [PMID: 25867232 DOI: 10.3109/14397595.2015.1040226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To explore the clinical application of automated scanning of wrist and finger joints by an Automated Breast Volume Scanner (ABVS) in patients with rheumatoid arthritis (RA). METHODS A total of 140 metacarpophalangeal (MCP) joints and 28 wrist joints from the 14 active RA patients were examined by both an ABVS system (the ACUSON S2000) from dorsal sites and by conventional ultrasonography (US) from multiple directions on the same day. We used a semiquantitative scale from 0 to 3 of synovial hypertrophy and the presence of bone erosion by grayscale for both methods; the efficacy of the two methods for identifying synovial hypertrophy and bone erosion were evaluated by kappa coefficient. RESULTS The scanning time of the ABVS was 2 min per patient and that of conventional US was 15 min per patient. The kappa coefficients of synovial hypertrophy in the MCP joints were 0.60 and 0.79 in wrist joints. These values were increased in the joints where synovial hypertrophy was moderate to severe (scores greater than 2). The kappa coefficients for the presence of bone erosion in the MCP joints were 0.74 and 0.93 in wrist joints. CONCLUSION The present data showed a substantial agreement between ABVS and conventional US for assessments of the synovial hypertrophy and bone erosion of wrist and finger joints in patients with RA. Since ABVS can scan the wrist and finger joints automatically in a short time, ABVS is a helpful new ultrasonic method to examine joint injuries in patients with RA.
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Affiliation(s)
- Shin-Ya Kawashiri
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan.,b Department of Public Health , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Takahisa Suzuki
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Ayako Nishino
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Yoshikazu Nakashima
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Yoshiro Horai
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Naoki Iwamoto
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kunihiro Ichinose
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Mami Tamai
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hideki Nakamura
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Tomoki Origuchi
- c Health Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Ichiro Isomoto
- d Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Masataka Uetani
- d Radiological Sciences, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kiyoshi Aoyagi
- b Department of Public Health , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Atsushi Kawakami
- a Departments of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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303
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Mendonça JA. Ultrasound Color histogram assessment allows better view of echotexture damage. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 57:S0482-5004(15)00061-3. [PMID: 26620580 DOI: 10.1016/j.rbr.2014.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 12/01/2014] [Accepted: 12/07/2014] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The colored ultrasound images can better highlight the joint echotexture damage. OBJECTIVE To detect echotexture changes in joints of patients with rheumatic diseases, through a color histogram, and to correlate the area measurements with the gray scale (GS). METHODS Four patients with chondrocalcinosis, 5 patients with osteoarthritis and 1 patient with psoriatic arthritis were evalutated. A total of 104 synovitis (SYN) and calcifications (calcif) measurements in cm2 were performed in the dorsal radiocarpal joint (DRR); triangular fibrocartilage complex (TFC); dorsal metacarpophalangeal joints (MCP) and lateral and medial knee suprapatellar recesses. For each GS measure, one was performed for each standard color image. Spearman was used for correlation analysis. RESULTS Mean±SD of image patterns: RGB (Red, Green and Blue) SYN 16.96±0.25cm2; indigo SYN 6.43±0.07cm2, RGB Calcif 0.03±0.00cm2; indigo Calcif 0.06±0.03cm2; GS SYN 16.13±0.35cm2 and GS Calcif 0.56±0.01cm2. Correlations of color images patterns RGB DRR SYN and indigo DRR SYN: r=1, p<0.001; indigo DRR SYN and RGB suprapattelar SYN: r=1, p<0.001; RGB MCP SYN and indigo MCP SYN: r=1, p<0.001; indigo DRR calcif and RGB TFC calcif: r=1 p<0.001; the RGB and indigo measurement standards when correlated with GS for SYN and calcifs were not statistically significant (p=0.333 to 0.667). CONCLUSION The RGB and indigo patterns seem to better define these echotexture damage.
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Affiliation(s)
- José Alexandre Mendonça
- Departamento de Reumatologia, Pontifícia Universidade Católica de Campinas (PUC-Campinas), Campinas, SP, Brasil.
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304
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Pereira DF, Gutierrez M, de Buosi ALP, Ferreira FBMD, Draghessi A, Grassi W, Natour J, Furtado RNV. Is articular pain in rheumatoid arthritis correlated with ultrasound power Doppler findings? Clin Rheumatol 2015; 34:1975-9. [PMID: 25956957 DOI: 10.1007/s10067-015-2964-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 04/12/2015] [Accepted: 04/28/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The study is addressed to determine if there is a correlation between intra-articular power Doppler (PD) and pain symptoms in patients with rheumatoid arthritis (RA). METHODS A cross-sectional study of patients with established RA was rolled out. Seventy-two patients with chronic swelling at metacarpophalangeal (MCP) joints were consecutively enrolled in the study and divided into two groups (painful and painless). In the painful group, the inclusion criteria were pain in the visual analog scale (VAS), from 0 to 10 cm, of at least 4 cm and 0 in the painless group. All two to five MCP joints, bilaterally, were scanned by ultrasound (US) searching for intra-articular PD presence. Any value of p < 0.05 was considered significant. RESULTS Patients in the painful group had longer morning stiffness, worse 28-joint disease activity score (DAS 28), and health assessment questionnaire (HAQ) indexes. There were no association between pain and gray scale (GS) synovitis, odds ratio (OR) = 0.9 (0.6-1.2), p = 0.485; and pain and intra-articular PD, OR = 0.8 (0.6-1.2), p = 0.244. CONCLUSION Intra-articular PD was not correlated with pain symptom in this study.
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Affiliation(s)
- Daniele Freitas Pereira
- Rheumatology Division, Universidade Federal de São Paulo, Rua Botucatu, 740, CEP 04023-900, São Paulo, Brazil
| | - Marwin Gutierrez
- Clinica Reumatologica, Rheumatology Division, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | | | | | - Antonella Draghessi
- Clinica Reumatologica, Rheumatology Division, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Walter Grassi
- Clinica Reumatologica, Rheumatology Division, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Jamil Natour
- Rheumatology Division, Universidade Federal de São Paulo, Rua Botucatu, 740, CEP 04023-900, São Paulo, Brazil.
| | - Rita Nely Vilar Furtado
- Rheumatology Division, Universidade Federal de São Paulo, Rua Botucatu, 740, CEP 04023-900, São Paulo, Brazil
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305
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The Role of Power Doppler Ultrasonography as Disease Activity Marker in Rheumatoid Arthritis. DISEASE MARKERS 2015; 2015:325909. [PMID: 26063952 PMCID: PMC4433665 DOI: 10.1155/2015/325909] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 04/07/2015] [Indexed: 11/28/2022]
Abstract
Structural damage in rheumatoid arthritis (RA) occurs early if inflammation is not treated promptly. Treatment targeted to reduce inflammation, in particular, that of synovial inflammation in the joints (synovitis), has been recommended as standard treat-to-target recommendations by rheumatologists. The goal is to achieve disease remission (i.e., no disease activity). Several accepted remission criteria have not always equated to the complete absence of true inflammation. Over the last decade, musculoskeletal ultrasonography has been demonstrated to detect subclinical synovitis not appreciated by routine clinical or laboratory assessments, with the Power Doppler modality allowing clinicians to more readily appreciate true inflammation. Thus, targeting therapy to Power Doppler activity may provide superior outcomes compared with treating to clinical targets alone, making it an attractive marker of disease activity in RA. However, more validation on its true benefits such as its benefits to patients in regard to patient related outcomes and issues with standardized training in acquisition and interpretation of power Doppler findings are required.
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306
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Troum OM, Pimienta OL, Schmidt WA, Ostergaard M, D'Agostino MA, Gaylis N, Arnold W, Ben-Artzi A, Ranganath V, Seraphine JL, Peterfy C. Proceedings from the 7th Annual International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) conference. Semin Arthritis Rheum 2015; 45:115-21. [PMID: 25908178 DOI: 10.1016/j.semarthrit.2015.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 02/19/2015] [Accepted: 02/25/2015] [Indexed: 12/17/2022]
Abstract
The International Society for Musculoskeletal Imaging in Rheumatology (ISEMIR) was founded in 2005 with the goal of discussing matters related to imaging in rheumatology, particularly, validation, education, and use in clinical practice and research. Because the field of musculoskeletal (MSK) imaging is rapidly evolving, continuous education in the field is imperative. ISEMIR's international faculty and world-renowned experts presented the newest information as it relates to the use of magnetic resonance imaging (MRI) and ultrasound (US) at the 7th annual ISEMIR meeting which took place on April 12-14, 2014 in Santa Monica, California. Presentations from the meeting can be viewed at www.isemir.org.
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Affiliation(s)
- Orrin M Troum
- Keck School of Medicine, University of Southern California, Santa Monica, CA
| | - Olga L Pimienta
- Keck School of Medicine, University of Southern California, Santa Monica, CA
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Mikkel Ostergaard
- Copenhagen University Hospital at Hvidovre and Herly, Copenhagen, Denmark
| | | | - Norman Gaylis
- Arthritis and Rheumatic Disease Specialties, Aventura, FL
| | | | - Ami Ben-Artzi
- University of California Los Angeles, Los Angeles, CA
| | | | - Judy L Seraphine
- International Society for Musculoskeletal Imaging in Rheumatology, Suite 301. 342 N. Main St, Suite 301, West Hartford, CT 06117.
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307
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Coates LC, Helliwell PS. Treat to Target in Psoriatic Arthritis—Evidence, Target, Research Agenda. Curr Rheumatol Rep 2015; 17:517. [PMID: 25903668 DOI: 10.1007/s11926-015-0517-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Laura C Coates
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK,
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308
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Møller-Bisgaard S, Hørslev-Petersen K, Ejbjerg BJ, Boesen M, Hetland ML, Christensen R, Møller J, Krogh NS, Stengaard-Pedersen K, Østergaard M. Impact of a magnetic resonance imaging-guided treat-to-target strategy on disease activity and progression in patients with rheumatoid arthritis (the IMAGINE-RA trial): study protocol for a randomized controlled trial. Trials 2015; 16:178. [PMID: 25896862 PMCID: PMC4417239 DOI: 10.1186/s13063-015-0693-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/30/2015] [Indexed: 12/14/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is a chronic, progressive joint disease, which frequently leads to irreversible joint deformity and severe functional impairment. Although patients are treated according to existing guidelines and reach clinical remission, erosive progression still occurs. This demonstrates that additional methods for prognostication and monitoring of the disease activity are needed. Bone marrow edema (BME) detected by magnetic resonance imaging (MRI) has proved to be an independent predictor of subsequent radiographic progression. Guiding the treatment based on the presence/absence of BME may therefore be clinically beneficial. We present the design of a randomized controlled trial (RCT) aiming to evaluate whether an MRI-guided treatment strategy compared to a conventional treatment strategy in anti-CCP-positive erosive RA is better to prevent progression of erosive joint damage and increase the remission rate in patients with low disease activity or clinical remission. Methods/design The study is a non-blinded, multicenter, 2-year RCT with a parallel group design. Two hundred anti-CCP-positive, erosive RA patients characterized by low disease activity or remission, no clinically swollen joints and treatment with synthetic disease-modifying antirheumatic drugs (DMARDs) will be included. Patients will be randomized to either a treatment strategy based on conventional laboratory and clinical examinations (control group) or a treatment strategy based on conventional laboratory and clinical examinations as well as MRI (intervention group). Treatment is intensified according to a predefined treatment algorithm in case of inflammation defined as a disease activity score (DAS28) >3.2 and at least one clinically swollen joint (control and intervention groups) and/or MRI-detected BME (intervention group only). The primary outcome measures are DAS28 remission (DAS28 < 2.6) and radiographic progression (Sharp/vdHeijde score). Discussion The perspectives, strengths and weaknesses of this study are discussed. This study has been approved by The Regional Scientific Ethical Committees for Southern Denmark, S-20110109. Dissemination will occur through presentations and publication in international peer-reviewed journals. Trial registration The study is registered in http://www.ClinicalTrials.gov identifier: NCT01656278 (5 July 2012) Electronic supplementary material The online version of this article (doi:10.1186/s13063-015-0693-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Signe Møller-Bisgaard
- Department of Rheumatology, Copenhagen University Hospital, Slagelse, Denmark. .,DANBIO registry and Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark.
| | - Kim Hørslev-Petersen
- King Christian 10th Hospital for Rheumatic Diseases, Graasten and Institute of Regional Health research, University of Southern Denmark, Odense, Denmark.
| | - Bo Jannik Ejbjerg
- Department of Rheumatology, Copenhagen University Hospital, Slagelse, Denmark.
| | - Mikael Boesen
- Department of Radiology and the imaging unit, The Parker institute, Copenhagen University Hospital, Bispebjerg-Frederiksberg, Copenhagen F, Denmark.
| | - Merete Lund Hetland
- DANBIO registry and Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark.
| | - Robin Christensen
- Musculoskeletal Statistics Unit, The Parker Institute, Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen F, Denmark.
| | - Jakob Møller
- Department of radiology, Copenhagen University Hospital, Herlev, Denmark.
| | | | | | - Mikkel Østergaard
- DANBIO registry and Copenhagen Centre for Arthritis Research, Centre for Rheumatology and Spine Diseases, Copenhagen University Hospital, Glostrup, Denmark.
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309
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Torp-Pedersen S, Christensen R, Szkudlarek M, Ellegaard K, D'Agostino MA, Iagnocco A, Naredo E, Balint P, Wakefield RJ, Torp-Pedersen A, Terslev L. Power and color Doppler ultrasound settings for inflammatory flow: impact on scoring of disease activity in patients with rheumatoid arthritis. Arthritis Rheumatol 2015; 67:386-95. [PMID: 25370843 DOI: 10.1002/art.38940] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 10/28/2014] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine how settings for power and color Doppler ultrasound sensitivity vary on different high- and intermediate-range ultrasound machines and to evaluate the impact of these changes on Doppler scoring of inflamed joints. METHODS Six different types of ultrasound machines were used. On each machine, the factory setting for superficial musculoskeletal scanning was used unchanged for both color and power Doppler modalities. The settings were then adjusted for increased Doppler sensitivity, and these settings were designated study settings. Eleven patients with rheumatoid arthritis (RA) with wrist involvement were scanned on the 6 machines, each with 4 settings, generating 264 Doppler images for scoring and color quantification. Doppler sensitivity was measured with a quantitative assessment of Doppler activity: color fraction. Higher color fraction indicated higher sensitivity. RESULTS Power Doppler was more sensitive on half of the machines, whereas color Doppler was more sensitive on the other half, using both factory settings and study settings. There was an average increase in Doppler sensitivity, despite modality, of 78% when study settings were applied. Over the 6 machines, 2 Doppler modalities, and 2 settings, the grades for each of 7 of the patients varied between 0 and 3, while the grades for each of the other 4 patients varied between 0 and 2. CONCLUSION The effect of using different machines, Doppler modalities, and settings has a considerable influence on the quantification of inflammation by ultrasound in RA patients, and this must be taken into account in multicenter studies.
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Affiliation(s)
- Søren Torp-Pedersen
- Copenhagen University Hospital, Frederiksberg, Denmark, and Copenhagen University Hospital at Glostrup, Glostrup, Denmark
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310
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Michaud K, Strand V, Shadick NA, Degtiar I, Ford K, Michalopoulos SN, Hornberger J. Outcomes and costs of incorporating a multibiomarker disease activity test in the management of patients with rheumatoid arthritis. Rheumatology (Oxford) 2015; 54:1640-9. [PMID: 25877911 PMCID: PMC4536857 DOI: 10.1093/rheumatology/kev023] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The multibiomarker disease activity (MBDA) blood test has been clinically validated as a measure of disease activity in patients with RA. We aimed to estimate the effect of the MBDA test on physical function for patients with RA (based on HAQ), quality-adjusted life years and costs over 10 years. METHODS A decision analysis was conducted to quantify the effect of using the MBDA test on RA-related outcomes and costs to private payers and employers. Results of a clinical management study reporting changes to anti-rheumatic drug recommendations after use of the MBDA test informed clinical utility. The effect of treatment changes on HAQ was derived from 5 tight-control and 13 treatment-switch trials. Baseline HAQ scores and the HAQ score relationship with medical costs and quality of life were derived from published National Data Bank for Rheumatic Diseases data. RESULTS Use of the MBDA test is projected to improve HAQ scores by 0.09 units in year 1, declining to 0.02 units after 10 years. Over the 10 year time horizon, quality-adjusted life years increased by 0.08 years and costs decreased by US$457 (cost savings in disability-related medical costs, US$659; in productivity costs, US$2137). The most influential variable in the analysis was the effect of the MBDA test on clinician treatment recommendations and subsequent HAQ changes. CONCLUSION The MBDA test aids in the assessment of disease activity in patients with RA by changing treatment decisions, improving the functional status of patients and cost savings. Further validation is ongoing and future longitudinal studies are warranted.
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Affiliation(s)
- Kaleb Michaud
- University of Nebraska Medical Center, Omaha, NE, National Data Bank for Rheumatic Diseases, Wichita, KS
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University, Palo Alto, CA
| | - Nancy A Shadick
- Brigham & Women's Hospital, Division of Rheumatology, Immunology and Allergy, Boston, MA
| | | | - Kerri Ford
- Crescendo Bioscience, San Francisco, CA, USA and
| | | | - John Hornberger
- Cedar Associates, Menlo Park, CA, Department of Internal Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
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311
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Colombel JF, Reinisch W, Mantzaris GJ, Kornbluth A, Rutgeerts P, Tang KL, Oortwijn A, Bevelander GS, Cornillie FJ, Sandborn WJ. Randomised clinical trial: deep remission in biologic and immunomodulator naïve patients with Crohn's disease - a SONIC post hoc analysis. Aliment Pharmacol Ther 2015; 41:734-46. [PMID: 25728587 DOI: 10.1111/apt.13139] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 12/09/2014] [Accepted: 02/04/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND As treatment goals in Crohn's disease (CD) evolve, targets now include clinical remission (CR), mucosal healing (MH) and biological remission [C-reactive protein normalisation (CRPnorm )]. AIMS To evaluate the association of baseline factors and treatment with the achievement of different composite remission parameters at week 26. METHODS This post hoc analysis of the SONIC trial evaluated different composite remission measures at week 26 in a subgroup of patients with Crohn's disease activity index (CDAI) scores, CRP, and endoscopic data available at baseline and week 26 (N = 188). Assessed composite remission measures were: CR (CDAI < 150) and MH (absence of any mucosal ulcerations), previously referred to as 'deep remission;' and alternative composite endpoints: CR + CRPnorm (CRP < 0.8 mg/dL); CRPnorm + MH; and CR + CRPnorm + MH. RESULTS Among analysed patients, 136/188 (72.3%) achieved CR and 90/188 (47.9%) achieved MH at week 26. All composite outcomes were significantly greater (Bonferroni significance level, P ≤ 0.016) with combination therapy (i.e. infliximab and azathioprine; 52.3-63.6%) vs. azathioprine monotherapy (12.9-29.0%; p ≤ 0.005 for all comparisons). Composite remission rates including MH were significantly greater with combination therapy (52.3-56.9%) vs. infliximab (25.6-32.3%; P ≤ 0.015 for all comparisons except CRPnorm + MH, P = 0.017) and vs. azathioprine monotherapy (12.9-20.4%; P ≤ 0.002 for all comparisons). Median serum trough infliximab concentrations among patients who achieved MH or CR + MH were greater when compared with those among patients who did not achieve MH (P = 0.018) or CR + MH (P = 0.053). Among the subgroup of patients with early Crohn's disease, MH alone or in combination with composite remission criteria significantly improved clinical outcomes of patients who received combination therapy. CONCLUSIONS Combination therapy was more effective in achieving various composite remission measures vs. azathioprine or infliximab monotherapy. These data illustrate that 'deep remission' is achievable with combination therapy in a high percentage of patients with early Crohn's disease. ClinicalTrials.gov number: NCT00094458.
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Affiliation(s)
- J-F Colombel
- The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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312
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Slooter MD, Bierau K, Chan AB, Löwik CWGM. Near infrared fluorescence imaging for early detection, monitoring and improved intervention of diseases involving the joint. Connect Tissue Res 2015; 56:153-60. [PMID: 25689091 DOI: 10.3109/03008207.2015.1012586] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Joints consist of different tissues, such as bone, cartilage and synovium, which are at risk for multiple diseases. The current imaging modalities, such as magnetic resonance imaging, Doppler ultrasound, X-ray, computed tomography and arthroscopy, lack the ability to detect disease activity before the onset of anatomical and significant irreversible damage. Optical in vivo imaging has recently been introduced as a novel imaging tool to study the joint and has the potential to image all kinds of biological processes. This tool is already exploited in (pre)clinical studies of rheumatoid arthritis, osteoarthritis and cancer. The technique uses fluorescent dyes conjugated to targeting moieties that recognize biomarkers of the disease. This review will focus on these new imaging techniques and especially where Near Infrared (NIR) fluorescence imaging has been used to visualize diseases of the joint. NIR fluorescent imaging is a promising technique which will soon complement established radiological, ultrasound and MRI imaging in the clinical management of patients with respect to early disease detection, monitoring and improved intervention.
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Roth J, Jousse-Joulin S, Magni-Manzoni S, Rodriguez A, Tzaribachev N, Iagnocco A, Naredo E, D'Agostino MA, Collado P. Definitions for the sonographic features of joints in healthy children. Arthritis Care Res (Hoboken) 2015; 67:136-42. [PMID: 25047864 DOI: 10.1002/acr.22410] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 07/15/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Musculoskeletal ultrasonography (US) has potential in the assessment of disease activity and structural damage in childhood arthritides. In order to assess pathology, the US characteristics of joints in healthy children need to be defined first. The aim of this study was to develop definitions for the various components of the normal pediatric joint. METHODS The definitions were developed by an expert group and applicability was assessed on a collection of standardized scans of the knee and ankle joints by scoring the scans on a Likert scale. The definitions were then modified and applicability was reassessed before sending the definitions for approval to a larger panel of experts. A final scoring on stored images of all relevant joints at different ages followed. RESULTS Five definitions were developed addressing the articular bone, cartilage, joint capsule, epiphyseal ossification center, and synovial membrane. In total, 224 US images of knees and ankles were acquired, of which 172 were selected for scoring. An agreement of ≥80% was not met for any of the definitions, but after modifications, 81-97% agreement was reached. This version of the definitions was approved by 15 US experts. In the final validation exercise, all definitions reached an agreement of ≥80% for the shoulder, elbow, wrist, metacarpophalangeal hip, knee, ankle and metatarsophalangeal joint. CONCLUSION US definitions for the normal pediatric joint were successfully developed through a Delphi process and validated in a practical exercise. These results provide the basis to develop definitions for pathology and to support the standardized use of US in pediatric rheumatology.
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Naredo E, Valor L, De la Torre I, Montoro M, Bello N, Martínez-Barrio J, Martínez-Estupiñán L, Nieto JC, Ovalles-Bonilla JG, Hernández-Flórez D, González CM, López-Longo FJ, Monteagudo I, Carreño L. Predictive value of Doppler ultrasound-detected synovitis in relation to failed tapering of biologic therapy in patients with rheumatoid arthritis. Rheumatology (Oxford) 2015; 54:1408-14. [DOI: 10.1093/rheumatology/kev006] [Citation(s) in RCA: 87] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Indexed: 12/20/2022] Open
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Mangnus L, Schoones JW, van der Helm-van Mil AHM. What is the prevalence of MRI-detected inflammation and erosions in small joints in the general population? A collation and analysis of published data. RMD Open 2015; 1:e000005. [PMID: 26509042 PMCID: PMC4613156 DOI: 10.1136/rmdopen-2014-000005] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 11/27/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction MRI sensitively depicts erosions, bone marrow edema (BME) and synovitis in rheumatoid arthritis (RA). Recently developed European League Against Rheumatism (EULAR) recommendations stated that MRI is valuable to improve the certainty of a considered diagnosis and to detect structural damage at an early time point. However, these recommendations were mainly based on the data of patients with RA; prevalences of MRI features in the general population were not extensively explored. We reviewed the literature on MRI studies including symptom-free persons to assess the occurrence of MRI features. Methods Medical literature databases up to September 2013 were systematically reviewed for symptom-free persons with MRI data on metacarpophalangeal, wrist and metatarsophalangeal joints. Data were extracted and summarised. When allowed because of comparable scanning and scoring protocols, a mean frequency of features was calculated. Results Of the 338 articles screened, 31 studies evaluated MRI findings in symptom-free persons (n=516 in total). Both the imaging techniques (<1/≥1 T, with/without contrast enhancement) and the scoring methods (non-validated or RA MRI score (RAMRIS)) varied widely, prohibiting direct comparisons of the results of many studies. 15 studies scored data according to RAMRIS; combining data of similar joint regions showed that erosions (RAMRIS ≥1) were present in 33–52% of symptom-free persons. Similarly, synovitis was present in 27% and BME in 0–16% of symptom-free persons. The prevalence of MRI-detected erosions increased with age. Conclusions MRI features, erosions in particular, occur frequently in symptom-free persons. Before MRI can be implemented in the diagnostic process, larger studies should be conducted determining the degree and combination of MRI features that are disease specific.
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Affiliation(s)
- Lukas Mangnus
- Department of Rheumatology , Leiden University Medical Center , Leiden , The Netherlands
| | - Jan W Schoones
- Walaeus Library, Leiden University Medical Center , Leiden , The Netherlands
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Mendonça JA, Yazbek MA, Costallat BL, Gutiérrez M, Bértolo MB. [The modified US7 score in the assessment of synovitis in early rheumatoid arthritis]. REVISTA BRASILEIRA DE REUMATOLOGIA 2015; 54:287-94. [PMID: 25627224 DOI: 10.1016/j.rbr.2014.03.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/19/2014] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To evaluate the modified US7 score (MUS7 score SYN) in the assessment of patients with early rheumatoid arthritis (ERA). In addition, dorsal and palmar recesses of the wrists as well as of small joints of the hands and feet were examined for the presence of synovitis by means of a global assessment of joints. METHODS The study sample comprised 32 patients treated for arthritis, with an average disease duration of 13 months. An ultrasound machine with high frequency transducer was used. Hands were also X-rayed and analysed by Larsen score. RESULTS Out of the 832 examined joints, synovitis was detected in 173 (20,79%), tenosynovitis in 22 (4,91%), and erosions in 3 (1,56%). Synovitis was predominantly detected in the dorsal recess (73,38%) of MCP and PIP joints, when compared with palmar recess (26%). The presence of synovitis in the joints evaluated correlated with clinical (HAQ-DI, DAS28), laboratory (ACPA, RF, CRP), and ultrasound results (r = 0,37 to r = 0,42; p = 0,04 to p = 0,003). We found correlation of the MUS7 score SYN of the gray scale US or of the power Doppler US with DAS28 (PCR) values (r = 0,38; p = 0,0332), and with CRP results (r = 0,39; p = 0,0280), respectively. CONCLUSION The dorsal recess, the wrist, and small joints can be considered as important sites to detect synovitis by the MUS7 score SYN in patients with ERA.
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Affiliation(s)
- José Alexandre Mendonça
- Departamento de Reumatologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil.
| | - Michel Alexandre Yazbek
- Departamento de Reumatologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil
| | | | | | - Manoel Barros Bértolo
- Departamento de Reumatologia, Universidade Estadual de Campinas (UNICAMP), Campinas, SP, Brasil
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Kubicki SL, Richardson ML, Martin T, Rohren E, Wei W, Amini B. The acetabular fossa hot spot on 18F-FDG PET/CT: epidemiology, natural history, and proposed etiology. Skeletal Radiol 2015; 44:107-14. [PMID: 25283982 DOI: 10.1007/s00256-014-2011-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 09/02/2014] [Accepted: 09/15/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe a benign focus of increased activity in the acetabular fossa (the acetabular fossa hot spot, AFHS) on (18) F-FDG PET/CT that can mimic a neoplasm. MATERIALS AND METHODS (18)F-FDG PET/CT images from four patient populations were examined. Group 1 (n = 13) was collected from a search of radiology reports and used to define the AFHS and for hypothesis generation. Group 2 (n = 1,150) was used for prevalence of AFHS. Group 3 (n = 1,213) had PET/CT and MRI pelvis within a week of each other and was used to correlate metabolic and anatomic findings. Group 4 (n = 100) was used to generate the control group. Data were collected on demographics, common comorbidities, underlying cancer diagnosis and status, and hip symptoms. RESULTS Prevalence of AFHS was 0.36 % (95 % CI 0.10-0.91 %). None progressed to malignancy or was associated with cancer status. The majority (71 %) were on the left, and 6 % were bilateral. Mean SUVmax of the AFHS was 4.8 (range, 2.7-7.8). Male patients were more likely to have the AFHS (OR = 8.69, 95 % CI 1.88-40.13). There was no difference with respect to other collected data, including hip symptoms. Average minimum duration of AFHS was 346 days (range, 50-1,010 days). Readers did not detect corresponding hip abnormalities on MRIs. CONCLUSIONS AFHS is a benign finding that may be caused by subclinical ligamentum teres injury, focal synovitis, or degeneration of acetabular fossa fat. Despite uncertainty regarding its etiology, recognition of AFHS as a benign finding can prevent morbidity associated with unnecessary biopsy or initiation of therapy.
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318
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Kane D. Musculoskeletal ultrasound. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00042-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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319
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Churchman SM, El-Jawhari JJ, Burska AN, Parmar R, Goëb V, Conaghan PG, Emery P, Ponchel F. Modulation of peripheral T-cell function by interleukin-7 in rheumatoid arthritis. Arthritis Res Ther 2014; 16:511. [PMID: 25533722 PMCID: PMC4298067 DOI: 10.1186/s13075-014-0511-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 12/11/2014] [Indexed: 01/26/2023] Open
Abstract
Introduction Interleukin-7 (IL-7) is a cytokine essential for T-cell lymphopoiesis, survival and polarization with an emerging role in autoimmunity. We previously demonstrated reduced levels of circulating IL-7 in rheumatoid arthritis (RA), although high amounts are expressed in joints, suggesting differences between systemic and synovial effects. We observed healthy levels of IL-7 in 48% of RA patients in clinical remission (CR) and aimed to investigate the consequences of IL-7 deficiency on T-cell responses. Methods We used RA patients with active disease and in CR presenting various levels of IL-7, to investigate its modulatory effects on T cells by analysing responses to phyto-haemagglutinin (PHA), expression of polarization or survival factors, or suppression by regulatory T cells (Tregs). Results IL-7 levels were normal (>10 pg/ml) in 48% of RA patients in CR. Amongst 63 CR patients followed up for 18 months, lack of IL-7 recovery was observed in 13 out of 15 (86%) patients experiencing relapse but only 11 out of 48 (23%) of those who did not (P = 0.0002). Binary regressions showed high significance for below normal IL-7 levels for self-reported maternal family history of arthritis (odds ratio (OR): 7.66, P = 0.006) and a trend for smoking (OR: 3.33, P = 0.068) with no further demographic or clinical associations. Serum IL-7 correlated with restored CD4+T-cell response to PHA (rho = 0.879); this was not related to an increase in T-cell proliferation capacity or expression of survival factors B-cell lymphoma 2 (BCL2) and BCL2-associated protein X (BAX). Expression of Th1 polarization factor (TBET) was also dependent on exposure to IL-7 in vivo (rho = 0.600). In contrast CD25highTregs’ response to PHA was not affected by in vivo IL-7, but their suppression capabilities were related to circulating IL-7 (rho = 0.589). Co-stimulation with IL-7 (mimicking the joint environment) increased responsiveness of CD4+T-cells to PHA, lowering the ability of CD25highTregs to suppress them. Conclusions Our data demonstrate that IL-7 has a critical role in modulating T-cell function in vivo, possibly explaining opposing effects observed systemically and in the joint. Lack of IL-7 recovery in CR by maintaining a suppressed immune system may be a determinant factor in the occurrence of relapse. Electronic supplementary material The online version of this article (doi:10.1186/s13075-014-0511-3) contains supplementary material, which is available to authorized users.
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Tokai N, Ogasawara M, Gorai M, Matsuki Y, Yamada Y, Murayama G, Sugisaki N, Nemoto T, Ando S, Minowa K, Kon T, Tada K, Matsushita M, Yamaji K, Tamura N, Makino S, Takasaki Y. Predictive value of bone destruction and duration of clinical remission for subclinical synovitis in rheumatoid arthritis patients. Mod Rheumatol 2014; 25:540-5. [DOI: 10.3109/14397595.2014.987421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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321
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Gibson DS, Bustard MJ, McGeough CM, Murray HA, Crockard MA, McDowell A, Blayney JK, Gardiner PV, Bjourson AJ. Current and future trends in biomarker discovery and development of companion diagnostics for arthritis. Expert Rev Mol Diagn 2014; 15:219-34. [PMID: 25455156 DOI: 10.1586/14737159.2015.969244] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Musculoskeletal diseases such as rheumatoid arthritis are complex multifactorial disorders that are chronic in nature and debilitating for patients. A number of drug families are available to clinicians to manage these disorders but few tests exist to target these to the most responsive patients. As a consequence, drug failure and switching to drugs with alternate modes of action is common. In parallel, a limited number of laboratory tests are available which measure biological indicators or 'biomarkers' of disease activity, autoimmune status, or joint damage. There is a growing awareness that assimilating the fields of drug selection and diagnostic tests into 'companion diagnostics' could greatly advance disease management and improve outcomes for patients. This review aims to highlight: the current applications of biomarkers in rheumatology with particular focus on companion diagnostics; developments in the fields of proteomics, genomics, microbiomics, imaging and bioinformatics and how integration of these technologies into clinical practice could support therapeutic decisions.
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Affiliation(s)
- David S Gibson
- Northern Ireland Centre for Stratified Medicine, University of Ulster, C-TRIC Building, Altnagelvin Hospital campus, Glenshane Road, Londonderry, BT47 6SB, UK
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322
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Factors influencing ultrasonographic remission in patients with rheumatoid arthritis. Rheumatol Int 2014; 35:485-91. [DOI: 10.1007/s00296-014-3177-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 11/10/2014] [Indexed: 12/18/2022]
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323
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Rifbjerg-Madsen S, Christensen AW, Boesen M, Christensen R, Danneskiold-Samsøe B, Bliddal H, Bartels EM, Locht H, Amris K. Can the painDETECT Questionnaire score and MRI help predict treatment outcome in rheumatoid arthritis: protocol for the Frederiksberg hospital's Rheumatoid Arthritis, pain assessment and Medical Evaluation (FRAME-cohort) study. BMJ Open 2014; 4:e006058. [PMID: 25394817 PMCID: PMC4244416 DOI: 10.1136/bmjopen-2014-006058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Pain in rheumatoid arthritis (RA) is traditionally considered to be of inflammatory origin. Despite better control of inflammation, some patients still report pain as a significant concern, even when being in clinical remission. This suggests that RA may prompt central sensitisation-one aspect of chronic pain. In contrast, other patients report good treatment response, although imaging shows signs of inflammation, which could indicate a possible enhancement of descending pain inhibitory mechanisms. When assessing disease activity in patients with central sensitisation, the commonly used disease activity scores (eg, DAS28-CRP (C reactive protein)) will yield constant high total scores due to high tender joint count and global health assessments, whereas MRI provides an isolated estimate of inflammation. The objective of this study is, in patients with RA initiating anti-inflammatory treatment, to explore the prognostic value of a screening questionnaire for central sensitisation, hand inflammation assessed by conventional MRI, and the interaction between them regarding treatment outcome evaluated by clinical status (DAS28-CRP). For the purpose of further exploratory analyses, dynamic contrast-enhanced MRI (DCE-MRI) is performed. METHOD AND ANALYSIS The painDETECT Questionnaire (PDQ), originally developed to screen for a neuropathic pain component, is applied to indicate the presence of central sensitisation. Adults diagnosed with RA are included when either (A) initiating disease-modifying antirheumatic drug treatment, or (B) initiating or switching to biological therapy. We anticipate that 100 patients will be enrolled, tested and reassessed after 4 months of treatment. DATA COLLECTION INCLUDES Clinical data, conventional MRI, DCE-MRI, blood samples and patient-reported outcomes. ETHICS AND DISSEMINATION This study aims at supporting rheumatologists to define strategies to reach optimal treatment outcomes in patients with RA based on chronic pain prognostics. The study has been approved by The Capital region of Denmark's Ethics Committee; identification number H-3-2013-049. The results will be published in international peer-reviewed journals.
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Affiliation(s)
- Signe Rifbjerg-Madsen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Anton Wulf Christensen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Mikael Boesen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Radiology, Frederiksberg Hospital, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark
| | - Robin Christensen
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Bente Danneskiold-Samsøe
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henning Bliddal
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Else Marie Bartels
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Henning Locht
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Kirstine Amris
- Department of Rheumatology, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Rheumatology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Hiraga M, Ikeda K, Shigeta K, Sato A, Yoshitama T, Hara R, Tanaka Y. Sonographic measurements of low-echoic synovial area in the dorsal aspect of metatarsophalangeal joints in healthy subjects. Mod Rheumatol 2014; 25:386-92. [PMID: 25381730 DOI: 10.3109/14397595.2014.970740] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Assessment of synovitis in the metatarsophalangeal (MTP) joints with ultrasound has been shown to improve the accuracy of assessment of rheumatoid arthritis (RA). However, the presence of intraarticular low-echoic synovial area (LESA) in the MTP joints in healthy subjects complicates the sonographic assessment of these joints. METHOD Healthy subjects with no arthritic symptoms in their MTP joints were recruited. All subjects completed a questionnaire and underwent physical examination and sonographic assessment. LESAs in the dorsal aspect of all MTP joints were measured in the longitudinal view. RESULTS One thousand non-arthritic MTP joints in 100 healthy subjects (female 73, mean age 41.0 years old) were evaluated. Measurable LESAs were identified in all joints assessed. Mean length of LESA in each of the 1st-5th MTP joints was 17.8, 13.9, 11.9, 10.6, and 9.2 mm, respectively, whereas mean thickness was 2.4, 2.4, 1.8, 1.2, and 0.8 mm, respectively. Multivariate linear regression models identified the difference between 1st and 5th MTP joints as the most independently influential factor on the measurement of LESA. CONCLUSIONS Our data provide the normal reference values for the measurements of LESA in Japanese, which should be taken into consideration when the synovitis in MTP joints is evaluated with ultrasound.
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Affiliation(s)
- Masao Hiraga
- Kirishima Medical Center , Kirishima, Kagoshima , Japan
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325
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Hwang YG, Moreland LW. Induction therapy with combination TNF inhibitor and methotrexate in early rheumatoid arthritis. Curr Rheumatol Rep 2014; 16:417. [PMID: 24619653 DOI: 10.1007/s11926-014-0417-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
With the introduction of more objective disease activity measures and the development of biological therapies, there were dramatic changes in the treatment of rheumatoid arthritis (RA). The combination therapy with tumor necrosis factor (TNF) inhibitor and methotrexate (MTX) has unprecedentedly improved prognosis and outcomes, and very low disease activity or remission has been achievable goal in RA. Although the concept of remission induction and maintenance was first discussed in longstanding RA patients, several clinical trials have demonstrated that there is a therapeutic window of opportunity, and early effective control of inflammation in early RA could lead to less joint damage and better long-term outcomes. Emerging evidence suggests that early combination therapy with TNF inhibitor and MTX leads to rapid clinical remission and thereby improved quality of life. Furthermore, remission status may be sustained in some patients even if a TNF inhibitor is discontinued after sustained remission in early RA patients. While there are many potential benefits of early remission induction therapy with the combination of a TNF inhibitor and MTX, the best therapeutic regimen and strategy for remission induction and maintenance in early RA remain controversial. There are no data to decide a priori when and in whom TNF blocker drugs are indicated in early disease-modifying anti-rheumatic drug (DMARD)-naïve RA.
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Affiliation(s)
- Yong Gil Hwang
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, S703 Biomedical Science Tower, 3500 Terrace Street, Pittsburgh, PA, USA,
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326
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Dumitru B, Buch M, Vital EM. Law of the vital few: choosing variables of disease activity in rheumatoid arthritis. J Rheumatol 2014; 41:2097-8. [PMID: 25362705 DOI: 10.3899/jrheum.141038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Bianca Dumitru
- National Institute for Health Research (NIHR) Leeds Biomedical Research Unit, Leeds Teaching Hospitals National Health Service Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Maya Buch
- National Institute for Health Research (NIHR) Leeds Biomedical Research Unit, Leeds Teaching Hospitals National Health Service Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Edward M Vital
- National Institute for Health Research (NIHR) Leeds Biomedical Research Unit, Leeds Teaching Hospitals National Health Service Trust, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.
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327
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Revu S, Neregård P, af Klint E, Korotkova M, Catrina AI. Synovial membrane immunohistology in early-untreated rheumatoid arthritis reveals high expression of catabolic bone markers that is modulated by methotrexate. Arthritis Res Ther 2014; 15:R205. [PMID: 24295447 PMCID: PMC3978873 DOI: 10.1186/ar4398] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 11/19/2013] [Indexed: 12/13/2022] Open
Abstract
Introduction We aimed to investigate the expression and therapeutic modulation of the receptor activator of the NF-κB ligand (RANKL) system in early-untreated rheumatoid arthritis (RA). Methods In this study, 15 patients with newly diagnosed RA (median symptom duration 7 months) were started on methotrexate (MTX) 20 mg weekly. Synovial biopsies were obtained by needle arthroscopy at baseline and 8 weeks after initiation of therapy. X-rays of the hands and feet were obtained at baseline and 1 year after diagnosis. Immunohistochemistry was performed to detect RANKL, receptor activator of nuclear factor-κB (RANK) and osteoprotegerin (OPG) in the synovial biopsies. The in vitro effect of MTX was tested on RA-derived primary fibroblasts and the osteoblasts-like osteosarcoma cell line (rtPCR, Western blot and ELISA) and in osteoclasts (tartrate-resistant acid phosphatase staining and dentine pit formation assay). Results MTX decreased synovial cellularity as well as RANK expression and the RANKL/OPG ratio. We confirmed this effect by a decrease of the mRNA and protein RANKL/OPG ratio in synovial-derived fibroblasts and osteoblasts-like tumoral cells exposed in vitro to methotrexate. Supernatants from MTX treated osteoblasts-like tumoral cells prevented pre-osteoclast formation in the absence of exogenous RANKL. Furthermore, MTX blocked osteoclastogenesis from peripheral blood mononuclear cells despite the presence of macrophage colony stimulating factor and RANKL, which indicates that MTX directly inhibits osteoclastogenesis. Conclusions The synovial membrane of early-untreated RA is characterized by a high RANKL/OPG ratio that can be reversed by methotrexate.
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Ohno S. [Rheumatology: Progress in Diagnosis and Treatments. Topics: I. Progress in Diagnostic Method; 2. Imaging in rheumatoid arthritis]. ACTA ACUST UNITED AC 2014; 103:2401-6. [PMID: 27514187 DOI: 10.2169/naika.103.2401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Suzuki T, Hirota T, Ogishima H, Umeda N, Kondo Y, Yokosawa M, Miki H, Tsuboi H, Matsumoto I, Sumida T. Subclinical inflammation with tocilizumab treatment of rheumatoid arthritis: MRI evaluation for 2 years. Int J Rheum Dis 2014; 18:108-10. [PMID: 25294091 DOI: 10.1111/1756-185x.12460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Takeshi Suzuki
- Department of Internal Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Gent YY, Ahmadi N, Voskuyl AE, Hoetjes N, van Kuijk C, Britsemmer K, Turkstra F, Boers M, Hoekstra OS, van der Laken CJ. Detection of Subclinical Synovitis with Macrophage Targeting and Positron Emission Tomography in Patients with Rheumatoid Arthritis without Clinical Arthritis. J Rheumatol 2014; 41:2145-52. [DOI: 10.3899/jrheum.140059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To determine whether macrophage targeting by (R)-11C-PK11195 positron emission tomography (PET) can visualize subclinical joint inflammation in patients with rheumatoid arthritis (RA) without clinical arthritis during or after treatment, with flare as clinical outcome measure.Methods.(R)-11C-PK11195 PET and contrast-enhanced magnetic resonance imaging (MRI) of hands/wrists were performed in 29 patients with RA without clinical arthritis. (R)-11C-PK11195 PET uptake (semiquantitative score 0–3) in metacarpophalangeal, proximal interphalangeal, and wrist joints (i.e., 22 joints per patient) was scored and summed to obtain a cumulative PET score (range 0–66). Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) was performed on similar joints. Synovitis and bone marrow edema scores (> 1) were summed to obtain a cumulative MRI score (range 0–288). Occurrence of flare was determined during 3-year followup.Results.Flare was observed in 17/29 patients (59%). (R)-11C-PK11195 PET showed enhanced tracer uptake in 16/29 patients (55%), of which 11 (69%) developed a flare. Highest cumulative PET scores (> 6, n = 3) corresponded with highest cumulative MRI scores (> 39) and were related to development of flare in hands/wrists within 6 months. Cumulative PET scores of patients developing a flare were higher than those of patients without a flare [median (interquartile range) 2 (0–4.5) vs 0 (0–1), p < 0.05]. In contrast, no significant differences were found between cumulative MRI scores of patients with and without a flare.Conclusion.(R)-11C-PK11195 PET showed enhanced uptake, pointing to presence of subclinical synovitis in over half of patients without clinical arthritis. (R)-11C-PK11195 PET may be of value for prediction of exacerbation of RA, since cumulative PET scores > 1 were associated with development of flare within 3 years.
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Anandarajah A, Thiele R, Giampoli E, Monu J, Seo GS, Feng C, Ritchlin CT. Patients with rheumatoid arthritis in clinical remission manifest persistent joint inflammation on histology and imaging studies. J Rheumatol 2014; 41:2153-60. [PMID: 25274900 DOI: 10.3899/jrheum.140411] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology. METHODS We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined. RESULTS Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US. CONCLUSION Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.
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Affiliation(s)
- Allen Anandarajah
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester.
| | - Ralf Thiele
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Ellen Giampoli
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Johnny Monu
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Gwy-Suk Seo
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Changyong Feng
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
| | - Christopher T Ritchlin
- From the Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA.A. Anandarajah, MD, MSc, Allergy, Immunology and Rheumatology Division, University of Rochester Medical Center; R. Thiele, MD; E. Giampoli, MD, Department of Pathology and Laboratory Medicine; J. Monu, MD, MSc; G-S. Seo, MD, Department of Musculoskeletal Radiology; C. Feng, Department of Biostatistics, University of Rochester School of Medicine and Dentistry; C.T. Ritchlin, MD, MPH, Allergy, Immunology and Rheumatology Division, University of Rochester
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Ten Cate DF, Luime JJ, Hazes JMW, Kleinrensink GJ, Jacobs JWG. Is the frequent sonographic anechoic area distally in metacarpophalangeal joints a sign of arthritis? ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:2537-2541. [PMID: 25130453 DOI: 10.1016/j.ultrasmedbio.2014.05.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 05/09/2014] [Accepted: 05/16/2014] [Indexed: 06/03/2023]
Abstract
In clinical practice, ultrasonography (US) often reveals, in the dorsal scan, a small anechoic area distally in both inflamed and clinically non-inflamed metacarpophalangeal joints. This "distal anechogenicity in the metacarpophalangeal joint" (DAEM) might thus be scored false positively as arthritis. We aimed to investigate whether the DAEM is a sign of arthritis. We evaluated the prevalence of DAEMs in 24 non-arthritic subjects. We then compared the dimensions of the DAEM in 10 non-arthritic subjects with a DAEM and 7 consecutive rheumatoid arthritis (RA) outpatients, using 2-D and 3-D ultrasound. Furthermore, we dissected two fresh-frozen postmortem hand specimens after US. A DAEM was observed in the metacarpophalangeal 2 (MCP2) joints of 54% of the 24 non-selected non-arthritic individuals; in none of those did the joint exhibit a power Doppler signal. A DAEM was observed in 86% of the 7 RA patients. Dimensions of DAEMs did not statistically significantly differ between these groups. At 3-D imaging and dissection, the DAEM was found to be an extension of the metacarpophalangeal joint capsule. In conclusion, DAEMs occur frequently and are not a sign of arthritis, but are distal joint recesses. This should be taken into account when using current sensitive ultrasonographic scoring systems grading arthritis.
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Affiliation(s)
- David Folkert Ten Cate
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Jolanda Jacoba Luime
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Vordenbäumen S, Schleich C, Lögters T, Sewerin P, Bleck E, Pauly T, Müller-Lutz A, Antoch G, Schneider M, Miese F, Ostendorf B. Dynamic contrast-enhanced magnetic resonance imaging of metacarpophalangeal joints reflects histological signs of synovitis in rheumatoid arthritis. Arthritis Res Ther 2014; 16:452. [PMID: 25270553 PMCID: PMC4201730 DOI: 10.1186/s13075-014-0452-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/04/2014] [Indexed: 12/29/2022] Open
Abstract
Introduction Synovial inflammation and joint destruction in rheumatoid arthritis (RA) may progress despite clinical remission. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is increasingly used to detect synovial inflammation in RA. Although small joints such as metacarpophalangeal (MCP) joints are mainly affected by RA, MRI findings have never been directly compared to histological synovitis in MCP synovial tissue. The objective of the current study was therefore to analyse if DCE-MRI relates to histological signs of synovitis small RA joints. Methods In 9 RA patients, DCE-MRI (3 Tesla, dynamic 2D T1 weighted turbo-flash sequence) of the hand was performed prior to arthroscopically-guided synovial biopsies from the second MCP of the imaged hand. Maximum enhancement (ME), rate of early enhancement, and maximum rate of enhancement were assessed in the MCP. Synovial biopsies were stained for determination of sublining CD68 and the Synovitis Score. Correlations between MRI and histological data were calculated according to Spearman. Results ME of the MCP significantly correlated to sublining CD68 staining (r = 0.750, P = 0.02), the Synovitis Score (r = 0.743, P = 0.02), and the subscores for lining layer hypertrophy (r = 0.789, P = 0.01) and cellular density (r = 0.842; P = 0.004). Conclusions Perfusion imaging of synovial tissue in RA finger joints employing DCE-MRI reflects histological synovial inflammation. According to our study, ME is the most closely associated parameter amongst the measures considered.
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Zufferey P, Möller B, Brulhart L, Tamborrini G, Scherer A, Finckh A, Ziswiler HR. Persistence of ultrasound synovitis in patients with rheumatoid arthritis fulfilling the DAS28 and/or the new ACR/EULAR RA remission definitions: Results of an observational cohort study. Joint Bone Spine 2014; 81:426-32. [DOI: 10.1016/j.jbspin.2014.04.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 04/26/2014] [Indexed: 10/25/2022]
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Iwamoto T, Ikeda K, Hosokawa J, Yamagata M, Tanaka S, Norimoto A, Sanayama Y, Nakagomi D, Takahashi K, Hirose K, Sugiyama T, Sueishi M, Nakajima H. Prediction of Relapse After Discontinuation of Biologic Agents by Ultrasonographic Assessment in Patients With Rheumatoid Arthritis in Clinical Remission: High Predictive Values of Total Gray-Scale and Power Doppler Scores That Represent Residual Synovial. Arthritis Care Res (Hoboken) 2014; 66:1576-81. [DOI: 10.1002/acr.22303] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 01/09/2014] [Accepted: 02/04/2014] [Indexed: 12/19/2022]
Affiliation(s)
- Taro Iwamoto
- Chiba University Hospital and National Hospital Organization Shimoshizu Hospital; Yotsukaido, Chiba Japan
| | - Kei Ikeda
- Chiba University Hospital; Chiba Japan
| | | | | | | | | | | | | | | | | | - Takao Sugiyama
- National Hospital Organization Shimoshizu Hospital; Yotsukaido, Chiba Japan
| | - Makoto Sueishi
- National Hospital Organization Shimoshizu Hospital; Yotsukaido, Chiba Japan
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Ben Abdelghani K, Miladi S, Souabni L, Kassab S, Chekili S, Laatar A, Zakraoui L. Role of ultrasound in assessing remission in rheumatoid arthritis. Diagn Interv Imaging 2014; 96:3-10. [PMID: 25220573 DOI: 10.1016/j.diii.2014.07.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Remission is the ultimate goal of the treatment of rheumatoid arthritis (RA). However, the diagnosis of remission might still be vague. Musculoskeletal ultrasound (US) seems to effectively assess synovitis, effusion and bone damage. Thus, its role could be relevant for the diagnosis, monitoring or detection of relapse in the follow-up of RA in remission. The goal of this review of the literature was to clarify the added value of ultrasonography during remission. METHODS A systemic search of the literature was performed on Medline and Scopus. The following key words were used: rheumatoid arthritis, remission, US. Fifty-six papers were collected, then after an in depth analysis, twelve articles were selected for analysis. RESULTS Twelve papers were identified that assessed remission in RA. Remission criteria varied from one author to another. The number of joints assessed by US varied from six to 44 with the wrist and metacarpo-phalangeal joints of the dominant hand scanned at least. Irrespective of remission criteria, all authors demonstrated that US detected Doppler positive synovitis in patients in clinical remission. Also, power Doppler synovitis predicted structural damage and future flares of RA. CONCLUSION US seems to be more effective than a clinical exam. True remission in RA must be defined. Moreover, the inclusion of this technique in the new definition of remission is being validated.
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Affiliation(s)
| | - S Miladi
- Rheumatology department, Mongi Slim hospital, la Marsa, Tunisia.
| | - L Souabni
- Rheumatology department, Mongi Slim hospital, la Marsa, Tunisia
| | - S Kassab
- Rheumatology department, Mongi Slim hospital, la Marsa, Tunisia
| | - S Chekili
- Rheumatology department, Mongi Slim hospital, la Marsa, Tunisia
| | - A Laatar
- Rheumatology department, Mongi Slim hospital, la Marsa, Tunisia
| | - L Zakraoui
- Rheumatology department, Mongi Slim hospital, la Marsa, Tunisia
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Abstract
For decades, diagnostic imaging in rheumatology has used conventional radiography. Over the past 10 years, MRI and ultrasonography have clearly shown their potential in diagnostic imaging in rheumatology and their use is revolutionizing the management of chronic arthritis, revealing subclinical inflammation and predicting progression of joint damage. Although validation processes for these imaging modalities are still ongoing, several investigations have now established the positive correlation between subclinical synovitis and radiographic progression of joint damage. Despite the available evidence and the diagnostic potential, there remains a substantial proportion of rheumatologists for whom MRI and ultrasonography findings do not influence their clinical decision-making. This Perspectives will discuss the key issues related to diagnostic imaging in patients with chronic arthritis, outlining how new imaging techniques have evolved over the past two decades and presenting the most attractive technological advances in this field.
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Dynamic contrast enhanced MRI of wrist as a useful diagnostic tool in early rheumatoid arthritis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Chew LC, Chandra Mohan P, Chan LP, Fong KY, Thumboo J. Use of magnetic resonance imaging in detecting subclinical synovitis in rheumatoid arthritis and correlation of imaging findings with interleukin-18 levels. Int J Rheum Dis 2014; 19:790-8. [DOI: 10.1111/1756-185x.12448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Li-Ching Chew
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore
- Duke-NUS Graduate Medical School; Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - P. Chandra Mohan
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
- Department of Diagnostic Radiology; Singapore General Hospital; Singapore
| | - Lai Peng Chan
- Department of Diagnostic Radiology; Singapore General Hospital; Singapore
| | - Kok Yong Fong
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore
- Duke-NUS Graduate Medical School; Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology; Singapore General Hospital; Singapore
- Duke-NUS Graduate Medical School; Singapore
- Yong Loo Lin School of Medicine; National University of Singapore; Singapore
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Pedersen JK, Lorenzen T, Ejbjerg B, Szkudlarek M, Voss A, Østergaard M, Svendsen AJ, Andersen LS, Hørslev-Petersen K. Low-field magnetic resonance imaging or combined ultrasonography and anti-cyclic citrullinated peptide antibody improve correct classification of individuals as established rheumatoid arthritis: results of a population-based, cross-sectional study. BMC Musculoskelet Disord 2014; 15:268. [PMID: 25103610 PMCID: PMC4132194 DOI: 10.1186/1471-2474-15-268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 07/28/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the present study was to evaluate the accuracy of two approaches using magnetic resonance imaging (MRI) or combined ultrasonography (US) and anti-cyclic citrullinated peptide antibody (ACPA) for diagnosis and classification of individuals with established rheumatoid arthritis (RA). METHODS In 53 individuals from a population-based, cross-sectional study, historic fulfilment of the American College of Rheumatology (ACR) 1987 criteria ("classification") or RA diagnosed by a rheumatologist ("diagnosis") were used as standard references. The sensitivity, specificity and Area under Curve for Receiver Operating Characteristics curves (ROC-area: (sensitivity + specificity)/2) were calculated for "current fulfilment of the ACR 1987 criteria" (list format), "adapted ACR 1987 criteria" (list format, substituting IgM rheumatoid factor with ACPA and clinical joint swelling and erosions on radiography with synovitis and erosions detected by US on a semi-quantitative scale), and RA MRI scoring System (RAMRIS) scores on low-field MRI in the unilateral hand. RESULTS For the ACR 1987 criteria the ROC-area was 75% (sensitivity/specificity = 50%/100%) (with "classification" as standard reference) and 69% (44%/94%) (with "diagnosis" as standard reference), while for the adapted ACR 1987 criteria it was 86% (75%/97%) (classification) and 82% (72%/91%) (diagnosis). For RAMRIS synovitis score in metacarpophalangeal (MCP) joints only (cut-off ≥5), the ROC-area (sensitivity/specificity) was 78% (62%/94%) (classification) and 85% (69%/100%) (diagnosis), while for the total synovitis score of MCP joints plus wrist (cut-off ≥10) it was 78% (62%/94%) (both classification and diagnosis). CONCLUSIONS Compared with the ACR 1987 criteria, low-field MRI alone or adapted criteria incorporating US and ACPA increased the correct classification and diagnosis of RA.
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Affiliation(s)
- Jens K Pedersen
- King Christian 10th Hospital for Rheumatic Diseases, South Jutland Hospital, Toldbodgade 3, 6300 Graasten, Denmark.
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Teruel JR, Burghardt AJ, Rivoire J, Srikhum W, Noworolski SM, Link TM, Imboden JB, Li X. Bone structure and perfusion quantification of bone marrow edema pattern in the wrist of patients with rheumatoid arthritis: a multimodality study. J Rheumatol 2014; 41:1766-73. [PMID: 25086074 DOI: 10.3899/jrheum.131564] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To quantify bone structure and perfusion parameters in regions of bone marrow edema pattern (BMEP), non-edematous bone marrow (NBM), and pannus tissue areas in the wrists of patients with rheumatoid arthritis (RA) using 3-Tesla (3T) magnetic resonance imaging (MRI), and high resolution peripheral quantitative computed tomography (HR-pQCT). METHODS Sixteen subjects fulfilling American College of Rheumatology classification were imaged using a HR-pQCT system and a 3T MRI scanner with an 8-channel wrist coil. Coronal T2-weighted and dynamic contrast-enhanced (DCE-MRI) images were acquired. BMEP and pannus tissue areas were segmented semiautomatically in T2-weighted images. NBM areas were placed at a similar distance from the joint space as BMEP regions. MR and HR-pQCT images were registered, and bone variables were calculated within the BMEP and NBM regions. Perfusion parameters in BMEP, pannus tissue, and NBM regions were calculated based on the signal-time curve obtained from DCE-MRI. RESULTS Eighteen BMEP areas were segmented, 15 of them presented proximal to pannus-filled erosions. Significant increases in bone density and trabecular thickness and number were observed in all BMEP regions compared to NMB (p < 0.05). Significantly elevated perfusion measures were observed in both BMEP and pannus tissue regions compared to NBM (p < 0.05). CONCLUSION BMEP regions showed significantly increased bone density and structures as well as perfusion measures, suggesting bone remodeling and active inflammation. Combining MRI and HR-pQCT provides a powerful multimodality approach for understanding BMEP and erosions, and for potentially identifying novel imaging markers for disease progression in RA.
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Affiliation(s)
- Jose R Teruel
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Andrew J Burghardt
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Julien Rivoire
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Waraporn Srikhum
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Susan M Noworolski
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Thomas M Link
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - John B Imboden
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF
| | - Xiaojuan Li
- From the Musculoskeletal Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, California, USA.J.R. Teruel, MSc, Research Fellow, Department of Radiology and Biomedical Imaging, University of California, San Francisco (UCSF); PhD Candidate, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; A.J. Burghardt, Researcher, Department of Radiology and Biomedical Imaging, UCSF; J. Rivoire, PhD, Postdoctoral Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; W. Srikhum, MD, Research Fellow, Department of Radiology and Biomedical Imaging, UCSF; Lecturer in Radiology, Department of Radiology, Thammasat University, Pathum Thani, Thailand; S.M. Noworolski, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF; T.M. Link, MD, PhD, Professor of Radiology, Chief, Musculoskeletal Imaging and Clinical Director, Musculoskeletal and Quantitative Imaging Research Group, Department of Radiology and Biomedical Imaging, UCSF; J.B. Imboden, MD, Professor of Rheumatology, Department of Medicine, UCSF; X. Li, PhD, Associate Professor, Department of Radiology and Biomedical Imaging, UCSF.
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Ogishima H, Tsuboi H, Umeda N, Horikoshi M, Kondo Y, Sugihara M, Suzuki T, Matsumoto I, Sumida T. Analysis of subclinical synovitis detected by ultrasonography and low-field magnetic resonance imaging in patients with rheumatoid arthritis. Mod Rheumatol 2014; 24:60-8. [PMID: 24261760 DOI: 10.3109/14397595.2013.854050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the utilities of ultrasonography (US) and low-field magnetic resonance imaging (compacTscan, cMRI) in the diagnosis of subclinical synovitis of hand joints of patients with rheumatoid arthritis (RA). METHODS A total of 1,540 joints of 77 RA patients were examined clinically, using US, using cMRI, and the baseline X-ray examination was performed. Clinical synovitis was defined as joint tenderness or swelling. Subclinical synovitis was diagnosed by US and by cMRI. The incidence of bone erosion and joint space narrowing was assessed by X-ray examination performed at approximately 40 weeks of follow-up. RESULTS Of the hand joints examined, 294 (19.1 %) were diagnosed with clinical synovitis, and 218 joints (14.1 %) were diagnosed with subclinical synovitis. The remaining 1,028 joints (66.8 %) were synovitis-free on clinical examination and imaging. For the diagnosis of subclinical synovitis, cMRI (11.4 %) was significantly more sensitive than power Doppler signals detected by US (US-PD; 6.8 %) (P < 0.01), and the combination of US-PD and cMRI was more useful (14.1 %) than US-PD or cMRI alone (P < 0.05). Follow-up X-ray examination of 600 joints showed a significantly higher incidence of bone erosion in joints with subclinical synovitis than in synovitis-free joints (P < 0.05). CONCLUSION US-PD and cMRI are useful for detecting subclinical synovitis in patients with RA. Subclinical synovitis of the small joints of the hand can progress to bone destruction.
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Affiliation(s)
- Hiroshi Ogishima
- Department of Internal Medicine, University of Tsukuba , 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575 , Japan
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Krabben A, Stomp W, van Nies JAB, Huizinga TWJ, van der Heijde D, Bloem JL, Reijnierse M, van der Helm-van Mil AHM. MRI-detected subclinical joint inflammation is associated with radiographic progression. Ann Rheum Dis 2014; 73:2034-7. [DOI: 10.1136/annrheumdis-2014-205208] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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344
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Darawankul B, Chaiamnuay S, Pakchotanon R, Asavatanabodee P, Narongroeknawin P. The good EULAR response at the first year is strongly predictive of clinical remission in rheumatoid arthritis: results from the TARAC cohort. Clin Rheumatol 2014; 34:43-9. [DOI: 10.1007/s10067-014-2749-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/14/2014] [Accepted: 07/14/2014] [Indexed: 01/30/2023]
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Ciubotariu E, Gabay C, Finckh A. Joint damage progression in patients with rheumatoid arthritis in clinical remission: do biologics perform better than synthetic antirheumatic drugs? J Rheumatol 2014; 41:1576-82. [PMID: 25028383 DOI: 10.3899/jrheum.130767] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Randomized controlled studies have demonstrated protective advantages of biologic therapies over the synthetic disease-modifying antirheumatic drugs (DMARD) in slowing joint damage progression in patients with rheumatoid arthritis (RA). This effect appears to be largely independent of the clinical disease control. We measured the rate of radiographic progression in patients with RA in clinical remission treated with synthetic versus biologic DMARD. METHODS This is an observational cohort study of patients with RA in clinical remission, nested within the Swiss Clinical Quality Management in Rheumatoid Arthritis (SCQM-RA) Registry. The primary study outcome was the rate of radiographic progression (Ratingen erosion score), and a secondary outcome was functional disability [Health Assessment Questionnaire-Disability Index (HAQ-DI)] progression. We compared the rate of progression between synthetic and biologic DMARD using a multivariate regression model for longitudinal data, adjusting for potential confounders. RESULTS A total of 2055 patients in the SCQM-RA registry were in remission at least once from 1999 to 2012 and met the study inclusion criteria. Baseline characteristics of patients in remission receiving synthetic and biologic DMARD were not significantly different in terms of prognostic factors for joint damage progression. During followup, erosion progression differed significantly between the 2 groups [1.4% (95% CI: 1.1-1.6) vs 0.9% (95% CI: 0.5-1.2) of progression over 3 years, respectively, p < 0.001], with less damage progression in patients treated with biologic DMARD than with synthetic DMARD. This difference remained significant after adjusting for confounding factors. The evolution of the HAQ-DI score was also statistically better in the biologic group (p < 0.001). CONCLUSION This observational study confirms that the rate of structural damage progression in clinical remission is decreased taking biologics compared to synthetic DMARD. However, while the difference is statistically significant it is probably not relevant from a clinical perspective.
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Affiliation(s)
- Elena Ciubotariu
- From the Division of Rheumatology, University Hospital Sacré Coeur de Montréal, Montréal, Canada; Division of Rheumatology, University Hospital of Geneva; and Division of Clinical Epidemiology, University Hospital of Geneva, Geneva, Switzerland.E. Ciubotariu, MD, MSc, Division of Rheumatology, University Hospital Sacré Coeur of Montréal; C. Gabay, MD, PhD, Professor, Division of Rheumatology, University Hospital of Geneva; A. Finckh, MD, PhD, Adjoint Professor Division of Rheumatology; Division of Clinical Epidemiology, University Hospital of Geneva.
| | - Cem Gabay
- From the Division of Rheumatology, University Hospital Sacré Coeur de Montréal, Montréal, Canada; Division of Rheumatology, University Hospital of Geneva; and Division of Clinical Epidemiology, University Hospital of Geneva, Geneva, Switzerland.E. Ciubotariu, MD, MSc, Division of Rheumatology, University Hospital Sacré Coeur of Montréal; C. Gabay, MD, PhD, Professor, Division of Rheumatology, University Hospital of Geneva; A. Finckh, MD, PhD, Adjoint Professor Division of Rheumatology; Division of Clinical Epidemiology, University Hospital of Geneva
| | - Axel Finckh
- From the Division of Rheumatology, University Hospital Sacré Coeur de Montréal, Montréal, Canada; Division of Rheumatology, University Hospital of Geneva; and Division of Clinical Epidemiology, University Hospital of Geneva, Geneva, Switzerland.E. Ciubotariu, MD, MSc, Division of Rheumatology, University Hospital Sacré Coeur of Montréal; C. Gabay, MD, PhD, Professor, Division of Rheumatology, University Hospital of Geneva; A. Finckh, MD, PhD, Adjoint Professor Division of Rheumatology; Division of Clinical Epidemiology, University Hospital of Geneva.
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346
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Tavares R, Beattie KA, Bensen WG, Bobba RS, Cividino AA, Finlay K, Goeree R, Hart LE, Jurriaans E, Larche MJ, Parasu N, Tarride JE, Webber CE, Adachi JD. A double-blind, randomized controlled trial to compare the effect of biannual peripheral magnetic resonance imaging, radiography and standard of care disease progression monitoring on pharmacotherapeutic escalation in rheumatoid and undifferentiated inflammatory arthritis: study protocol for a randomized controlled trial. Trials 2014; 15:268. [PMID: 24997587 PMCID: PMC4227117 DOI: 10.1186/1745-6215-15-268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 06/05/2014] [Indexed: 11/28/2022] Open
Abstract
Background Permanent joint damage is a major consequence of rheumatoid arthritis (RA), the most common and destructive form of inflammatory arthritis. In aggressive disease, joint damage can occur within 6 months from symptom onset. Early, intensive treatment with conventional and biologic disease-modifying anti-rheumatic drugs (DMARDs) can delay the onset and progression of joint damage. The primary objective of the study is to investigate the value of magnetic resonance imaging (MRI) or radiography (X-ray) over standard of care as tools to guide DMARD treatment decision-making by rheumatologists for the care of RA. Methods A double-blind, randomized controlled trial has been designed. Rheumatoid and undifferentiated inflammatory arthritis patients will undergo an MRI and X-ray assessment every 6 months. Baseline adaptive randomization will be used to allocate participants to MRI, X-ray, or sham-intervention groups on a background of standard of care. Prognostic markers, treating physician, and baseline DMARD therapy will be used as intervention allocation parameters. The outcome measures in rheumatology RA MRI score and the van der Heijde-modified Sharp score will be used to evaluate the MRI and X-ray images, respectively. Radiologists will score anonymized images for all patients regardless of intervention allocation. Disease progression will be determined based on the study-specific, inter-rater smallest detectable difference. Allocation-dependent, intervention-concealed reports of positive or negative disease progression will be reported to the treating rheumatologist. Negative reports will be delivered for the sham-intervention group. Study-based radiology clinical reports will be provided to the treating rheumatologists for extra-study X-ray requisitions to limit patient radiation exposure as part of diagnostic imaging standard of care. DMARD treatment dose escalation and therapy changes will be measured to evaluate the primary objective. A sample size of 186 (62 per group) patients will be required to determine a 36% difference in pharmacological treatment escalation between the three groups with intermediate dispersion of data with 90% power at a 5% level of significance. Discussion This study will determine if monitoring RA and undifferentiated inflammatory arthritis patients using MRI and X-ray every 6 months over 2 years provides incremental evidence over standard of care to influence pharmacotherapeutic decision-making and ultimately hinder disease progression. Trial registration This trial has been registered at ClinicalTrials.gov: NCT00808496 (registered on 12 December 2008).
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Affiliation(s)
- Ruben Tavares
- UNCOVER Clinical Research Company, Milton, ON, Canada.
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Lisbona MP, Pàmies A, Ares J, Almirall M, Navallas M, Solano A, Maymó J. Association of Bone Edema with the Progression of Bone Erosions Quantified by Hand Magnetic Resonance Imaging in Patients with Rheumatoid Arthritis in Remission. J Rheumatol 2014; 41:1623-9. [DOI: 10.3899/jrheum.130902] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To evaluate the association of synovitis, bone marrow edema (BME), and tenosynovitis in the progression of erosions quantified by hand magnetic resonance imaging (MRI) at 1 year in patients with early rheumatoid arthritis (RA) in remission.Methods.A total of 56 of 196 patients with early RA in remission at 1 year and with available MRI data at baseline and at 12 months were included. MRI images were assessed according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) system. Persistent remission was defined as 28-joint Disease Activity Score-erythrocyte sedimentation rate ≤ 2.6 and/or Simplified Disease Activity Index ≤ 3.3 and/or the new boolean American College of Rheumatology/European League Against Rheumatism remission criteria for a continuous period of at least 6 months. Progression of bone erosions was defined as an increase of 1 or more units in annual RAMRIS score for erosions compared to baseline.Results.At 1 year, the majority of patients with RA in sustained remission showed some inflammatory activity on MRI (94.6% synovitis, 46.4% BME, and 58.9% tenosynovitis) and 19 of the 56 patients (33.9%) showed MRI progression of bone erosions. A significant difference was observed in MRI BME at 1 year, with higher mean score in patients with progression compared to nonprogression of erosions (4.8 ± 5.6 and 1.4 ± 2.6, p = 0.03).Conclusion.Subclinical inflammation was identified by MRI in 96.4% of patients with RA in sustained clinical remission. Significantly higher scores of BME after sustained remission were observed in patients with progression of erosions compared to patients with no progression. The persistence of higher scores of BME may explain the progression of bone erosions in patients with persistent clinical remission.
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348
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Naredo E, Hinojosa M, Valor L, Hernández-Flórez D, Mata-Martínez C, Serrano-Benavente B, Del Río T, Bello N, Montoro M, Nieto-González JC, González CM, López-Longo FJ, Monteagudo I, Carreño L. Does ultrasound-scored synovitis depend on the pharmacokinetics of subcutaneous anti-TNF agents in patients with rheumatoid arthritis? Rheumatology (Oxford) 2014; 53:2088-94. [PMID: 24939676 DOI: 10.1093/rheumatology/keu248] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the influence of the pharmacokinetics of s.c. anti-TNF agents on the grade of US-detected synovitis in RA patients. METHODS Fifty RA patients were prospectively recruited from the Biologic Therapy Unit of our hospital. Inclusion criteria were being in treatment with s.c. anti-TNF agents and having had neither changes in therapy nor local corticosteroid injections in the previous 3 months. Patients underwent clinical, laboratory [28-joint DAS (DAS28) and Simplified Disease Activity Index (SDAI)] and US assessment at two time points, i.e. at peak plasma drug concentration and at trough plasma drug concentration. US assessments were performed blindly to the anti-TNF agent, the administration time and the clinical and laboratory data. Twenty-eight joints were investigated for the presence and grade (0-3) of B-mode synovitis and synovial power Doppler signal. Global indices for B-mode synovitis (BSI) and Doppler synovitis (DSI) were calculated for 12 joints and for wrist-hand-ankle-foot joints. B-mode US remission was defined as a BSI <1 and Doppler US remission as a DSI <1. RESULTS There were no significant differences between the clinical, laboratory and B-mode and Doppler US parameters at peak time and trough time (P = 0.132-0.986). There were no significant differences between the proportion of patients with active disease and those in remission according to DAS28, SDAI, B-mode US and Doppler US at peak time and trough time assessments (P = 0.070-1). CONCLUSION Our results suggested that s.c. anti-TNF pharmacokinetics do not significantly influence US-scored synovitis in RA patients.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain.
| | - Michelle Hinojosa
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Lara Valor
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Diana Hernández-Flórez
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Carmen Mata-Martínez
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Belén Serrano-Benavente
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Tamara Del Río
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Natalia Bello
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - María Montoro
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Juan Carlos Nieto-González
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Carlos M González
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Francisco Javier López-Longo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Indalecio Monteagudo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Luis Carreño
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Faculty of Medicine, Complutense University, Madrid, Spain
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Nguyen H, Ruyssen-Witrand A, Gandjbakhch F, Constantin A, Foltz V, Cantagrel A. Prevalence of ultrasound-detected residual synovitis and risk of relapse and structural progression in rheumatoid arthritis patients in clinical remission: a systematic review and meta-analysis. Rheumatology (Oxford) 2014; 53:2110-8. [DOI: 10.1093/rheumatology/keu217] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Responsiveness to therapy change of a global ultrasound assessment in spondyloarthritis patients. Clin Rheumatol 2014; 34:125-32. [PMID: 24838482 DOI: 10.1007/s10067-014-2673-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2013] [Revised: 04/30/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
Abstract
The objective of this study is to evaluate the responsiveness to therapy change of a global ultrasound (US) assessment in the short-term monitoring of spondyloarthritis (SpA) patients with peripheral involvement. Consecutive SpA patients with both clinical peripheral involvement and active disease (initiating or changing therapy) were included. All patients underwent both clinical and US assessment in day entering the study and after 3 months of follow-up. Peripheral global US assessment included the recognition of abnormal inflammatory findings at joint, tendon, and entheseal level according to standardized scanning methods. A total of 34 patients completed both basal and 3-month follow-up assessments. Acute phase reactants, both erythrocyte sedimentation rate and C-reactive protein, tenderness (68) and swollen (66) joint counts, Bath Ankylosing Spondylitis Disease Activity Index and Health Assessment Questionnaire decreased significantly at 3-month follow-up. Total score for the global US assessment also decreased significantly between basal and 3-month follow-up assessment [mean difference, 12.33 (IC 95 %, 9.23-15.42); p < 0.0001]. All individual component, joint, tendon, and enthesis scores, also showed a significant decrease during the follow-up period. A high degree of intra-observer reliability was found for the global US assessment (ICC [95 % CI]: 0.977 [0.961-0.993]). This global US assessment, including joints, tendons, and entheses, showed a good responsiveness to clinical changes and might be useful for monitoring SpA patients with peripheral involvement.
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