351
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Ikeda K, Koike T, Wakefield R, Emery P. Is the glass half full or half empty? Comment on the article by Gärtner et Al. Arthritis Rheumatol 2014; 66:1055-6. [PMID: 24757158 DOI: 10.1002/art.38321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kei Ikeda
- Chiba University Hospital, Chiba, Japan
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352
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Rheumatoid arthritis: Is imaging needed to define remission in rheumatoid arthritis? Nat Rev Rheumatol 2014; 10:326-8. [PMID: 24752184 DOI: 10.1038/nrrheum.2014.63] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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353
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Freeston JE, Coates LC, Nam JL, Moverley AR, Hensor EMA, Wakefield RJ, Emery P, Helliwell PS, Conaghan PG. Is there subclinical synovitis in early psoriatic arthritis? A clinical comparison with gray-scale and power Doppler ultrasound. Arthritis Care Res (Hoboken) 2014; 66:432-9. [PMID: 24022986 PMCID: PMC4282111 DOI: 10.1002/acr.22158] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 09/03/2013] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Arthritis activity assessments in psoriatic arthritis (PsA) have traditionally relied on tender and swollen joint counts, but in rheumatoid arthritis, multiple studies have demonstrated subclinical inflammation using modern imaging. The aim of this study was to compare clinical examination and ultrasound (US) findings in an early PsA cohort. METHODS Forty-nine disease-modifying antirheumatic drug-naive patients with recent-onset PsA (median disease duration 10 months) underwent gray-scale (GS) and power Doppler (PD) US of 40 joints plus tender and swollen joint counts of 68/66 joints. GS and PD were scored on a 0-3 semiquantitative scale for each joint. Clinically active joints were defined as tender and/or swollen and US active joints were defined as a GS score ≥2 and/or a PD score ≥1. RESULTS The most common sites for subclinical synovitis were the wrist (30.6%), knee (21.4%), metatarsophalangeal (MTP) joints (26.5-33.7%), and metacarpophalangeal joints (10.2-19.4%). Excluding MTP joints and ankles, 37 (75.5%) of 49 patients had subclinical synovitis with a median of 3 (interquartile range [IQR] 1-4) joints involved. In contrast, clinical overestimation of synovitis occurred most commonly at the shoulder (38%) and ankle (28.6%). Twelve of 49 patients were classified clinically as having oligoarthritis; of these, subclinical synovitis identified 8 (75%) as having polyarthritis with an increase in their median joint count from 3 (IQR 1-4) to 6 (IQR 5-7). CONCLUSION This study has demonstrated that subclinical synovitis, as identified by US, is very common in early PsA and led to the majority of oligoarthritis patients being reclassified as having polyarthritis. Further research is required into the relationship of such subclinical synovitis to structural progression.
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Affiliation(s)
- Jane E Freeston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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Ikeda K, Kambe N, Takei S, Nakano T, Inoue Y, Tomiita M, Oyake N, Satoh T, Yamatou T, Kubota T, Okafuji I, Kanazawa N, Nishikomori R, Shimojo N, Matsue H, Nakajima H. Ultrasonographic assessment reveals detailed distribution of synovial inflammation in Blau syndrome. Arthritis Res Ther 2014; 16:R89. [PMID: 24713464 PMCID: PMC4060485 DOI: 10.1186/ar4533] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 04/02/2014] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Arthritis is the most frequent manifestation of Blau syndrome, an autoinflammatory disorder caused by the genetic mutation of NOD2. However, detailed information on arthritis in Blau syndrome on which the therapeutic strategy should be based on is lacking. This multi-center study aimed to accurately characterize the articular manifestation of Blau syndrome and also to demonstrate the utility of musculoskeletal ultrasound in Blau syndrome. METHODS Patients who had been diagnosed with Blau syndrome by genetic analysis of NOD2 were recruited. A total of 102 synovial sites in 40 joints were assessed semiquantitatively by ultrasound for gray-scale synovitis and synovial power Doppler (PD) signal. RESULTS In total, 10 patients whose age ranged from 10 months to 37 years enrolled in this study. Although only 4 joints (0.8%) were tender on physical examination, 81 joints (16.9%) were clinically swollen. Moreover, 240 (50.0%), and 124 (25.8%) joints showed gray-scale (GS) synovitis and synovial PD signal on ultrasound, respectively. Importantly, GS synovitis was present in 168 out of 399 non-swollen joints, in which 61 also exhibited synovial PD signal. Among 40 joint regions, the ankle, the wrist, and the proximal interphalangeal joints were the most frequently and severely affected joints. Comparisons between different synovial tissues demonstrated a significantly higher proportion of the joints with tenosynovitis as compared with that with intra-articular synovitis (41.5% versus 27.9%, P < 0.0001). In respect of age and treatment, synovial PD signals were minimal in the youngest patient and in the oldest two patients, and were relatively mild in patients receiving treatment with methotrexate plus TNF antagonists. In two patients who underwent the second ultrasound examination, total PD scores markedly decreased after initiating the treatment with a tumor necrosis factor (TNF) antagonist. CONCLUSIONS The detailed information on synovial inflammation obtained by ultrasound confirms the dissociation between pain and inflammation and the frequently involved joint regions and synovial tissue in the arthritis of Blau syndrome. Our data also demonstrate that ultrasonography can be a potent tool in monitoring the activity of synovial inflammation and in investigating the pathophysiology of arthritis in this rare but archetypical autoinflammatory condition.
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355
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Fukae J, Isobe M, Kitano A, Henmi M, Sakamoto F, Narita A, Ito T, Mitsuzaki A, Shimizu M, Tanimura K, Matsuhashi M, Kamishima T, Atsumi T, Koike T. Structural deterioration of finger joints with ultrasonographic synovitis in rheumatoid arthritis patients with clinical low disease activity. Rheumatology (Oxford) 2014; 53:1608-12. [DOI: 10.1093/rheumatology/keu154] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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356
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Sewerin P, Buchbender C, Vordenbäumen S, Scherer A, Miese F, Brinks R, Wittsack HJ, Klein S, Schneider M, Antoch G, Ostendorf B. Advantages of a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and feet: does the RAMRIS of the hand alone underestimate disease activity and progression? BMC Musculoskelet Disord 2014; 15:104. [PMID: 24669889 PMCID: PMC3974414 DOI: 10.1186/1471-2474-15-104] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 03/21/2014] [Indexed: 12/03/2022] Open
Abstract
Background To evaluate a combined rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for hand and foot (HaF-score) in rheumatoid arthritis (RA). Methods Magnetic resonance imaging (MRI, 0.2 Tesla) of the dominant hand and foot of 26 ACPA positive RA patients before and 6 months after initiation of methotrexate was obtained. RAMRIS of the hand was complemented by corresponding scoring of the foot (MTP I-V; HaF-score). Disease Activity Score 28 (DAS28) and a tender and swollen joint count (JC) of the joints scored in MRI were recorded. Changes in these scores (Δ) were assessed. Results ΔHaF-score correlated significantly with ΔDAS28 (r = 0.820, 95%-CI 0.633-0.916). Correlations to ΔDAS28 were best for changes in the synovitis subscore (0.648) and bone marrow edema (0.703). Correlations to ΔDAS28 were significantly better for of the ΔHaF-score than ΔRAMRIS (0.499, 0.139-0.743, p = 0.0368). All patients with at least moderate response (EULAR criteria, n = 11) had continuing disease activity on MRI, including five cases with new erosions, three of them at the feet. Improvements of the hand JC or foot JC were seen in 16 and 15 cases, respectively. However, MRI of the hand or feet improved in only 10 and 9 cases, respectively. No patient fulfilled SDAI remission criteria. Conclusions The HaF-score identifies patients with continuing disease activity despite clinical response that would have been missed by consideration of the traditional RAMRIS or the DAS28 alone. Response as opposed to remission may be an insufficient goal in RA as all patients showed continuing disease activity, especially at the feet.
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Affiliation(s)
- Philipp Sewerin
- Department of Rheumatology, Univ Duesseldorf, Medical Faculty, Moorenstrasse 5, Duesseldorf D-40225, Germany.
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357
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Dale J, Purves D, McConnachie A, McInnes I, Porter D. Tightening up? Impact of musculoskeletal ultrasound disease activity assessment on early rheumatoid arthritis patients treated using a treat to target strategy. Arthritis Care Res (Hoboken) 2014; 66:19-26. [PMID: 24376248 DOI: 10.1002/acr.22218] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 10/15/2013] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine the level of agreement and potential impact on disease-modifying antirheumatic drug (DMARD) escalation decisions and of adding musculoskeletal ultrasound (MSUS) assessment of disease activity to the Disease Activity Score in 28 joints (DAS28) in early rheumatoid arthritis (RA). METHODS Data were gathered from 53 early RA patients randomized to the MSUS assessment group of the Targeting Synovitis in Early Rheumatoid Arthritis study. DAS28 scores were calculated every month. MSUS was performed on patients with low disease activity (DAS28 <3.2) and on those with moderate disease activity (3.2 ≤ DAS28 <5.1) without clinically swollen joints (swollen joint count [SJC] ≤1). Fourteen joints (bilateral proximal interphalangeal joints 2 and 3, metacarpophalangeal [MCP] joints 2 and 3, the radiocarpal, and metatarsophalangeal joints 2 and 5) were examined. Active disease was defined as ≥2 joints demonstrating any power Doppler (PD) signal. Data from 414 paired DAS28 and MSUS assessments were pooled to determine the level of agreement between each method. RESULTS A total of 369 MSUS assessments were conducted on patients with DAS28 <3.2; 92 (25%) of these assessments identified active disease. A total of 271 MSUS assessments were performed on those with DAS28 <2.6; 66 (24%) of these identified active disease. Forty-five MSUS assessments were conducted on patients with 3.2 ≤ DAS28 <5.1 and SJC ≤1; 15 (33%) of these assessments confirmed active disease. On 120 occasions (29%), MSUS findings contradicted the DAS28 and led to modified treatment decisions. The joints that most frequently exhibited PD signal were radiocarpal and index and middle MCP joints. CONCLUSION Compared to the DAS28, global RA disease activity assessment using a limited MSUS joint set provided additional disease activity information and led to altered treatment decisions in a significant minority of occasions. This may allow further tailoring of DMARD therapy by supporting DMARD escalation in patients with continuing subclinical synovitis and preventing escalation in symptomatic patients with minimal clinical and/or ultrasonographic synovitis.
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Affiliation(s)
- James Dale
- University of Glasgow, Glasgow, Scotland
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358
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Taniguchi D, Tokunaga D, Oda R, Fujiwara H, Ikeda T, Ikoma K, Kishida A, Yamasaki T, Kawahito Y, Seno T, Ito H, Kubo T. Maximum intensity projection with magnetic resonance imaging for evaluating synovitis of the hand in rheumatoid arthritis: comparison with clinical and ultrasound findings. Clin Rheumatol 2014; 33:911-7. [PMID: 24599675 DOI: 10.1007/s10067-014-2526-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 12/27/2013] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
Abstract
Magnetic resonance imaging (MRI) with maximum intensity projection (MIP) is used to evaluate the hand in rheumatoid arthritis (RA). MIP yields clear visualization of synovitis over the entirety of the bilateral hands with a single image. In this study, we assessed synovitis with MIP images, clinical findings, and power Doppler (PD) findings to examine the clinical usefulness of MIP images for RA in the hand. Thirty RA patients were assessed for swelling and tenderness in the joints included in the DAS28, and both contrast-enhanced MRI for bilateral hands and ultrasonography for bilateral wrist and metacarpophalangeal (MCP) joints were performed. Articular synovitis was scored in MIP images, and the scores were compared with those for PD. The agreement on synovitis between MIP and conventional MR images was excellent. Palpation showed low sensitivity and high specificity compared with both MIP and PD images. There were joints that were positive in MIP images only, but there were no joints that were positive in PD images only. A statistically significant correlation between the scores of MIP and PD images was found. Furthermore, the agreement between grade 2 on MIP images and positive on PD images was 0.87 (κ = 0.73) for the wrist and 0.92 (κ = 0.57) for MCP joints. Using MIP images together with palpation makes detailed evaluation of synovitis of the hand in RA easy. MIP images may predict further joint damage, since they allow semiquantitative estimation of the degree of thickening of the synovial membrane.
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Affiliation(s)
- Daigo Taniguchi
- Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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359
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Ikeda K, Seto Y, Narita A, Kawakami A, Kawahito Y, Ito H, Matsushita I, Ohno S, Nishida K, Suzuki T, Kaneko A, Ogasawara M, Fukae J, Henmi M, Sumida T, Kamishima T, Koike T. Ultrasound Assessment of Synovial Pathologic Features in Rheumatoid Arthritis Using Comprehensive Multiplane Images of the Second Metacarpophalangeal Joint: Identification of the Components That Are Reliable and Influential on the Global Assessment of the. Arthritis Rheumatol 2014; 66:523-32. [DOI: 10.1002/art.38280] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 11/12/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Kei Ikeda
- Chiba University Hospital; Chiba Japan
| | - Yohei Seto
- Tokyo Women's Medical University; Tokyo Japan
| | - Akihiro Narita
- Hokkaido Medical Center for Rheumatic Diseases; Sapporo Japan
| | - Atsushi Kawakami
- Nagasaki University Graduate School of Biomedical Sciences; Nagasaki Japan
| | | | - Hiromu Ito
- Kyoto University Graduate School of Medicine; Kyoto Japan
| | | | - Shigeru Ohno
- Yokohama City University Medical Center; Yokohama Japan
| | | | | | - Atsushi Kaneko
- Nagoya Medical Center, National Hospital Organization; Nagoya Japan
| | | | - Jun Fukae
- Hokkaido Medical Center for Rheumatic Diseases; Sapporo Japan
| | - Mihoko Henmi
- Hokkaido Medical Center for Rheumatic Diseases; Sapporo Japan
| | | | | | - Takao Koike
- NTT Sapporo Medical Center and Hokkaido University Graduate School of Medicine; Sapporo Japan
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Girolomoni G, Griffiths CEM, Krueger J, Nestle FO, Nicolas JF, Prinz JC, Puig L, Ståhle M, van de Kerkhof PCM, Allez M, Emery P, Paul C. Early intervention in psoriasis and immune-mediated inflammatory diseases: A hypothesis paper. J DERMATOL TREAT 2014; 26:103-12. [DOI: 10.3109/09546634.2014.880396] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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361
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Kawashiri SY, Arima K, Suzuki T, Nakashima Y, Horai Y, Okada A, Tamai M, Nakamura H, Kawakami A. Presence of ultrasound subclinical synovitis and increment of serum vascular endothelial growth factor in a patient with rheumatoid arthritis achieved in sustained clinical remission by treatment with adalimumab and methotrexate. Mod Rheumatol 2014; 24:681-4. [PMID: 24533548 DOI: 10.3109/14397595.2013.874736] [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: 11/13/2022]
Abstract
A 63-year-old male Japanese rheumatoid arthritis (RA) patient, in whom treatment with infliximab and methotrexate (MTX) had once led to drug-free remission, experienced a disease flare in July 2010. He was retreated with a combination of adalimumab and MTX, and clinical remission was achieved in 3 months. In contrast, power Doppler signals by ultrasonography with increased serum vascular endothelial growth factor still remained after he achieved sustained clinical remission, whereas no radiographic progression has been found.
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Affiliation(s)
- Shin-Ya Kawashiri
- Department of Immunology and Rheumatology, Unit of Translational Medicine, Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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362
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Kay J, Morgacheva O, Messing SP, Kremer JM, Greenberg JD, Reed GW, Gravallese EM, Furst DE. Clinical disease activity and acute phase reactant levels are discordant among patients with active rheumatoid arthritis: acute phase reactant levels contribute separately to predicting outcome at one year. Arthritis Res Ther 2014; 16:R40. [PMID: 24485007 PMCID: PMC3978994 DOI: 10.1186/ar4469] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Accepted: 01/24/2014] [Indexed: 11/25/2022] Open
Abstract
Introduction Clinical trials of new treatments for rheumatoid arthritis (RA) typically require subjects to have an elevated acute phase reactant (APR), in addition to tender and swollen joints. However, despite the elevation of individual components of the Clinical Disease Activity Index (CDAI) (tender and swollen joint counts and patient and physician global assessment), some patients with active RA may have normal erythrocyte sedimentation rate (ESR) and/or C-reactive protein (CRP) levels and thus fail to meet entry criteria for clinical trials. We assessed the relationship between CDAI and APRs in the Consortium of Rheumatology Researchers of North America (CORRONA) registry by comparing baseline characteristics and one-year clinical outcomes of patients with active RA, grouped by baseline APR levels. Methods This was an observational study of 9,135 RA patients who had both ESR and CRP drawn and a visit at which CDAI was >2.8 (not in remission). Results Of 9,135 patients with active RA, 58% had neither elevated ESR nor CRP; only 16% had both elevated ESR and CRP and 26% had either ESR or CRP elevated. Among the 4,228 patients who had a one-year follow-up visit, both baseline and one-year follow-up modified Health Assessment Questionnaire (mHAQ) and CDAI scores were lowest for patients with active RA but with neither APR elevated; both mHAQ and CDAI scores increased sequentially with the increase in number of elevated APR levels at baseline. Each individual component of the CDAI followed the same trend, both at baseline and at one-year follow-up. The magnitude of improvement in both CDAI and mHAQ scores at one year was associated positively with the number of APRs elevated at baseline. Conclusions In a large United States registry of RA patients, APR levels often do not correlate with disease activity as measured by joint counts and global assessments. These data strongly suggest that it is appropriate to obtain both ESR and CRP from RA patients at the initial visit. Requiring an elevation in APR levels as a criterion for inclusion of RA patients in studies of experimental agents may exclude some patients with active disease.
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363
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Epis O, Paoletti F, d'Errico T, Favalli E, Garau P, Mancarella L, Pomponio G, Sandri G, Scioscia C, Selvi E, Tirri E. Ultrasonography in the diagnosis and management of patients with inflammatory arthritides. Eur J Intern Med 2014; 25:103-11. [PMID: 24041708 DOI: 10.1016/j.ejim.2013.08.700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/04/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
In primary care and internal medicine settings clinicians are often reluctant to take advantage of the resources that ultrasonography (US) offers as a diagnostic tool in the initial management of patients with inflammatory arthritis, despite the recognised importance of an accurate and timely diagnosis of rheumatoid arthritis (RA) and of early referral to ensure optimal patient management. Both grey-scale (GS) and power Doppler (PD) imaging have been extensively used in early detection of synovitis and bone erosions in patients with inflammatory arthritides. We reviewed the main data on the clinical use of US in the initial management of patients with inflammatory arthritis, focusing on RA diagnosis in patients with undifferentiated arthritis, prediction of disease severity, differential diagnoses and assessment of synovitis in children with juvenile idiopathic arthritis (JIA). The role of US in assessing treatment response and monitoring disease activity in clinical remission was also briefly evaluated. The reliability of US as a diagnostic tool in rheumatological diseases has greatly advanced in the last years and the use of this imaging technique, in association with conventional assessments such as physical examination and serological tests, should be considered more often also in primary care settings.
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Affiliation(s)
- Oscar Epis
- S.C. Reumatologia, A.O. Ospedale Niguarda Ca' Granda, Milano, Italy.
| | - Franco Paoletti
- U.O. Reumatologia, Ospedale 'S. Francesco Caracciolo', Agnone, Italy
| | - Tito d'Errico
- Ambulatiorio di Reumatologia, P.O. 'S.M.d.P degli Incurabili', Napoli, Italy
| | - Ennio Favalli
- Divisione di Reumatologia, Istituto Ortopedico G. Pini, Milano, Italy
| | - Pietro Garau
- Struttura Complessa di Reumatologia, A.O.U. Cagliari, Italy
| | | | | | - Gilda Sandri
- Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università degli Studi di Modena e Reggio Emilia, Italy
| | | | - Enrico Selvi
- Sezione di Reumatologia, A.O.U. Senese, Siena, Italy
| | - Enrico Tirri
- U.O. Reumatologia, Ospedale 'S. Giovanni Bosco', Napoli, Italy
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Pereira DF, Natour J, Buosi ALPD, Ferreira FBMD, Fernandes ADRC, Furtado RNV. Is painless synovitis different from painful synovitis? A controlled, ultrasound, radiographic, clinical trial. Clinics (Sao Paulo) 2014; 69:93-100. [PMID: 24519199 PMCID: PMC3912334 DOI: 10.6061/clinics/2014(02)04] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 07/23/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE This study compares the clinical, ultrasonography, radiography, and laboratory outcomes of painless and painful chronic synovitis in patients with established rheumatoid arthritis. METHODS This cross-sectional study involved 60 patients with rheumatoid arthritis and synovitis in the metacarpophalangeal joints; 30 of the patients did not experience pain, and 30 had experienced pain for at least 6 months prior to the study. The radiocarpal, distal radioulnar, and metacarpophalangeal joints were evaluated using the ultrasound gray scale, power Doppler, and radiography. Past and present clinical and laboratory findings were also evaluated. RESULTS There were no statistically significant differences between the groups for most of the outcomes. The group with pain scored worse on the disease activity indices (e.g., DAS 28 and SDAI), function questionnaires (HAQ and Cochin), and pinch strength test. A logistic regression analysis revealed that the use of an immunobiological agent was associated with a 3-fold greater chance of belonging to the group that experienced pain. The painless group had worse erosion scores in the second and fifth metacarpophalangeal with odd ratios (ORs) of 6.5 and 3.5, respectively. The painless group had more cartilage with grade 4 damage in the third metacarpophalangeal. CONCLUSIONS The rheumatoid arthritis patients with both painless and painful synovitis exhibited similar disease histories and radiographic and ultrasound findings. However, the ultrasonography evaluation revealed worse scores in the second and fifth metacarpophalangeal of the synovitis patients who did not experience pain.
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Affiliation(s)
- Daniele Freitas Pereira
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São Paulo/SP, Brazil
| | - Jamil Natour
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São Paulo/SP, Brazil
| | - Ana Leticia Pirozzi de Buosi
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São Paulo/SP, Brazil
| | - Fernando Bernardes Maia Diniz Ferreira
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Diagnóstico por Imagem, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Diagnóstico por Imagem, São Paulo/SP, Brazil
| | - Artur da Rocha Corrêa Fernandes
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Diagnóstico por Imagem, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Diagnóstico por Imagem, São Paulo/SP, Brazil
| | - Rita Nely Vilar Furtado
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São PauloSP, Brazil, Universidade Federal de São Paulo, Escola Paulista de Medicina, Disciplina de Reumatologia, São Paulo/SP, Brazil
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365
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van Nies JAB, van Steenbergen HW, Krabben A, Stomp W, Huizinga TWJ, Reijnierse M, van der Helm-van Mil AHM. Evaluating processes underlying the predictive value of baseline erosions for future radiological damage in early rheumatoid arthritis. Ann Rheum Dis 2014; 74:883-9. [PMID: 24431393 DOI: 10.1136/annrheumdis-2013-204659] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2013] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Baseline erosions are characteristic for rheumatoid arthritis (RA) and predictive for a severe disease course. The mechanisms leading to baseline erosions being a strong predictor for radiological progression are unknown. We aimed to increase this understanding by mediation analyses in an observational cohort and a cross-sectional MRI study. METHODS 3256 hands and feet radiographs of 653 early RA patients assessed during 7 years of disease were scored using the Sharp-van der Heijde method. Mediation models and multivariate regression analyses were used to explore the association between baseline erosions, other predictors and radiological damage over time. 603 joints (MCP2-5 and MTP1-5) of 67 RA patients underwent 1.5 T MRI at baseline. Data on MRI inflammation were compared with clinical inflammation and baseline radiological erosions. RESULTS Patients with baseline erosions had, at any point in time during 7 years, 3.45 times more joint damage than patients without erosions (p<0.001, 95% CI 3.00 to 3.98). Baseline erosions were an independent predictor and not a mediator between symptom duration, systemic or local clinical inflammation (erythrocyte sedimentation rate (ESR), swollen joint count (SJC)) or autoantibodies (anti-citrullinated-peptide antibodies, rheumatoid factor) and radiological damage. Subclinical MRI inflammation was studied in relation to erosions, revealing that 83% of the non-swollen joints with baseline erosions had subclinical MRI inflammation compared with 25% of the non-swollen joints without baseline erosions (OR 15.2 95% CI 3.1 to 102.1). The association between MRI inflammation and baseline erosions was independent of symptom duration, ESR, SJC and autoantibodies. CONCLUSIONS Baseline erosions are a predictor for future joint damage, independent of known predictors as time, autoantibodies or clinical measurable inflammation. Subclinical inflammation is suggested as an underlying mechanism.
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Affiliation(s)
- Jessica A B van Nies
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Annemarie Krabben
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter Stomp
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Ramírez J, Ruíz-Esquide V, Pomés I, Celis R, Cuervo A, Hernández MV, Pomés J, Pablos JL, Sanmartí R, Cañete JD. Patients with rheumatoid arthritis in clinical remission and ultrasound-defined active synovitis exhibit higher disease activity and increased serum levels of angiogenic biomarkers. Arthritis Res Ther 2014; 16:R5. [PMID: 24398122 PMCID: PMC3978423 DOI: 10.1186/ar4431] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 12/30/2013] [Indexed: 12/23/2022] Open
Abstract
Introduction The aim of this study was to identify and characterize subclinical synovitis in patients with rheumatoid arthritis (RA) in clinical remission using power Doppler ultrasound (PDUS) and serum levels of biomarkers of inflammation and/or angiogenesis. Methods We selected patients with RA in clinical remission defined as a Disease activity score of 28 joints (DAS28)-erythrocyte sedimentation rate (ESR) <2.6 for more than six months tested by two independent rheumatologists. Clinical, epidemiological, demographic and serological data were analyzed. PDUS of knees and hands was performed by a sonographer. Synovial hypertrophy (SH) and PDUS signal were scored (grades 0 to 3). SH ≥2 and a PDUS signal was classified as active synovitis. Serum levels of biomarkers of inflammation/angiogenesis were determined by Quantibody® Human Array. Results This study included 55 patients, of whom 25 (45.4%) met criteria for ultrasound-defined active synovitis. Patients with active synovitis had higher DAS28-C reactive protein (P = 0.023), DAS28-ESR (P = 0.06), simplified disease activity score, SDAI (P = 0.064), and only 12% were taking oral glucocorticoids (≤5 mg/day) compared with 40% of patients without active synovitis (P = 0.044). Patients with synovitis also had significantly higher serum levels of the angiogenic biomarkers angiopoietin-2 (P = 0.038), vascular endothelial growth factor-D (P = 0.018), placental growth factor (P = 0.043), stromal cell-derived factor-1 (P = 0.035), matrix metallopeptidase-2 (P = 0.027) and basic fibroblast growth factor (bFGF) (P = 0.007), but not of pro-inflammatory cytokines. In the multivariate logistic regression model used to explore prognostic biomarkers for active synovitis, serum levels of bFGF, DAS28-ESR and not receiving glucocorticoids were the best predictors of active synovitis. The predictive indexes provided by the model were specificity 73.3%, sensitivity 72%, and area under the curve in receiver operating characteristic 81.5% (95% CI: 70.1% to 92.8%). Conclusions Nearly half of the patients with RA in clinical remission had ultrasound-defined active synovitis, higher disease activity and less frequent oral glucocorticoid consumption than patients without active synovitis. This clinical situation was associated with a specific biological profile characterized by an excess of angiogenic mediators rather than persistent proinflammatory cytokine responses.
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367
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Fukae J, Shimizu M, Kon Y, Tanimura K, Matsuhashi M, Kamishima T, Koike T. Screening for rheumatoid arthritis with finger joint power Doppler ultrasonography: quantification of conventional power Doppler ultrasonographic scoring. Mod Rheumatol 2014. [DOI: 10.3109/s10165-009-0190-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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368
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Suzuki T, Ito S, Handa S, Kose K, Okamoto Y, Minami M, Sugihara M, Horikoshi M, Tsuboi H, Hayashi T, Goto D, Matsumoto I, Sumida T. New low-field extremity MRI, compacTscan: comparison with whole-body 1.5 T conventional MRI. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0282-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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369
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Yoshimi R, Hama M, Takase K, Ihata A, Kishimoto D, Terauchi K, Watanabe R, Uehara T, Samukawa S, Ueda A, Takeno M, Ishigatsubo Y. Ultrasonography is a potent tool for the prediction of progressive joint destruction during clinical remission of rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0690-1] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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370
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Takeuchi T, Miyasaka N, Zang C, Alvarez D, Fletcher T, Wajdula J, Yuasa H, Vlahos B. A phase 3 randomized, double-blind, multicenter comparative study evaluating the effect of etanercept versus methotrexate on radiographic outcomes, disease activity, and safety in Japanese subjects with active rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0742-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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371
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Hama M, Takase K, Ihata A, Ohno S, Ueda A, Takeno M, Ishigatsubo Y. Challenges to expanding the clinical application of musculoskeletal ultrasonography (MSUS) among rheumatologists: from a second survey in Japan. Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0512-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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372
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Fujiwara M, Kita Y. Reexamination of the assessment criteria for rheumatoid arthritis disease activity based on comparison of the Disease Activity Score 28 with other simpler assessment methods. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0652-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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de Miguel E, Andreu JL, Naredo E, Möller I. La ecografía en reumatología: dónde estamos y hacia dónde nos dirigimos. ACTA ACUST UNITED AC 2014; 10:6-9. [DOI: 10.1016/j.reuma.2013.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 03/29/2013] [Accepted: 04/03/2013] [Indexed: 11/26/2022]
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Feehan L, Buie H, Li L, McKay H. A customized protocol to assess bone quality in the metacarpal head, metacarpal shaft and distal radius: a high resolution peripheral quantitative computed tomography precision study. BMC Musculoskelet Disord 2013; 14:367. [PMID: 24364867 PMCID: PMC3877978 DOI: 10.1186/1471-2474-14-367] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 12/18/2013] [Indexed: 12/17/2022] Open
Abstract
Background High Resolution-Peripheral Quantitative Computed Tomography (HR-pQCT) is an emerging technology for evaluation of bone quality in Rheumatoid Arthritis (RA). However, there are limitations with standard HR-pQCT imaging protocols for examination of regions of bone commonly affected in RA. We developed a customized protocol for evaluation of volumetric bone mineral density (vBMD) and microstructure at the metacarpal head (MH), metacarpal shaft (MS) and ultra-ultra-distal (UUD) radius; three sites commonly affected in RA. The purpose was to evaluate short-term measurement precision for bone density and microstructure at these sites. Methods 12 non-RA participants, individuals likely to have no pre-existing bone damage, consented to participate [8 females, aged 23 to 71 y [median (IQR): 44 (28) y]. The custom protocol includes more comfortable/stable positioning and adapted cortical segmentation and direct transformation analysis methods. Dominant arm MH, MS and UUD radius scans were completed on day one; repeated twice (with repositioning) three to seven days later. Short-term precision for repeated measures was explored using intraclass correlational coefficient (ICC), mean coefficient of variation (CV%), root mean square coefficient of variation (RMSCV%) and least significant change (LSC%95). Results Bone density and microstructure precision was excellent: ICCs varied from 0.88 (MH2 trabecular number) to .99 (MS3 polar moment of inertia); CV% varied from < 1 (MS2 vBMD) to 6 (MS3 marrow space diameter); RMSCV% varied from < 1 (MH2 full bone vBMD) to 7 (MS3 marrow space diameter); and LSC% 95varied from 2 (MS2 full bone vBMD to 21 (MS3 marrow space diameter). Cortical porosity measures were the exception; RMSCV% varying from 19 (MS3) to 42 (UUD). No scans were stopped for discomfort. 5% (5/104) were repeated due to motion during imaging. 8% (8/104) of final images had motion artifact graded > 3 on 5 point scale. Conclusion In our facility, this custom protocol extends the potential for in vivo HR-pQCT imaging to assess, with high precision, regional differences in bone quality at three sites commonly affected in RA. Our methods are easy to adopt and we recommend other users of HR-pQCT consider this protocol for further evaluations of its precision and feasibility in their imaging facilities.
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Affiliation(s)
- Lynne Feehan
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia (UBC), Vancouver, BC, Canada.
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376
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Gandjbakhch F, Haavardsholm EA, Conaghan PG, Ejbjerg B, Foltz V, Brown AK, Døhn UM, Lassere M, Freeston JE, Olsen IC, Bøyesen P, Bird P, Fautrel B, Hetland ML, Emery P, Bourgeois P, Hørslev-Petersen K, Kvien TK, McQueen FM, Østergaard M. Determining a Magnetic Resonance Imaging Inflammatory Activity Acceptable State Without Subsequent Radiographic Progression in Rheumatoid Arthritis: Results from a Followup MRI Study of 254 Patients in Clinical Remission or Low Disease Activity. J Rheumatol 2013; 41:398-406. [DOI: 10.3899/jrheum.131088] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective.To assess the predictive value of magnetic resonance imaging (MRI)-detected subclinical inflammation for subsequent radiographic progression in a longitudinal study of patients with rheumatoid arthritis (RA) in clinical remission or low disease activity (LDA), and to determine cutoffs for an MRI inflammatory activity acceptable state in RA in which radiographic progression rarely occurs.Methods.Patients with RA in clinical remission [28-joint Disease Activity Score-C-reactive protein (DAS28-CRP) < 2.6, n = 185] or LDA state (2.6 ≤ DAS28-CRP < 3.2, n = 69) with longitudinal MRI and radiographic data were included from 5 cohorts (4 international centers). MRI were assessed according to the Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system (RAMRIS). Statistical analyses included an underlying conditional logistic regression model stratified per cohort, with radiographic progression as dependent variable.Results.A total of 254 patients were included in the multivariate analyses. At baseline, synovitis was observed in 95% and osteitis in 49% of patients. Radiographic progression was observed in 60 patients (24%). RAMRIS synovitis was the only independent predictive factor in multivariate analysis. ROC analysis identified a cutoff value for baseline RAMRIS synovitis score of 5 (maximum possible score 21). Rheumatoid factor (RF) status yielded a significant interaction with synovitis (p value = 0.044). RF-positive patients with a RAMRIS synovitis score of > 5 vs ≤ 5, had an OR of 4.4 (95% CI 1.72–11.4) for radiographic progression.Conclusion.High MRI synovitis score predicts radiographic progression in patients in clinical remission/LDA. A cutoff point for determining an MRI inflammatory activity acceptable state based on the RAMRIS synovitis score was established. Incorporating MRI in future remission criteria should be considered.
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Do patients with juvenile idiopathic arthritis in remission exhibit active synovitis on joint ultrasound? Rheumatol Int 2013; 34:937-45. [DOI: 10.1007/s00296-013-2909-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 11/22/2013] [Indexed: 10/25/2022]
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378
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Kawashiri SY, Suzuki T, Nakashima Y, Horai Y, Okada A, Iwamoto N, Ichinose K, Tamai M, Arima K, Nakamura H, Origuchi T, Uetani M, Aoyagi K, Eguchi K, Kawakami A. Ultrasonographic examination of rheumatoid arthritis patients who are free of physical synovitis: power Doppler subclinical synovitis is associated with bone erosion. Rheumatology (Oxford) 2013; 53:562-9. [PMID: 24319104 DOI: 10.1093/rheumatology/ket405] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to investigate the characteristics of power Doppler (PD) subclinical synovitis in patients with RA who achieve clinical remission free from physical synovitis. METHODS Twenty-nine RA patients were consecutively enrolled. All of the patients had achieved clinical remission [simplified disease activity index (SDAI) 3.3] for at least 6 months at the musculoskeletal ultrasound (MSKUS) examination. Additionally, none of the patients exhibited tender joints at 68 sites or swollen joints at 66 sites. MSKUS of bilateral wrist and finger joints, including the first to fifth MCP joints, the first IP joint and the second to fifth PIP joints, was performed and the findings obtained by grey scale (GS) and PD were graded on a semi-quantitative scale from 0 to 3. RESULTS The median disease duration upon the introduction of DMARDs was 3 months and that at MSKUS examination was 21 months. The percentages of patients with PD synovitis in at least one joint were PD grade 1, 58.6%; PD grade 2, 31.0% and PD grade 3, 6.9%. The use of biological agents was low in patients with PD synovitis grade 2 (P < 0.05). The presence of US bone erosion was high by patient (P < 0.05) and by joint (P < 0.0001) with PD synovitis as compared with those without PD synovitis. However, no correlations were found between PD synovitis measures and serum biomarkers, including angiogenesis factors. CONCLUSION PD subclinical synovitis correlates with several clinical characteristics, whereas conventional serum biomarkers are not useful for indicating the presence of subclinical PD synovitis.
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Affiliation(s)
- Shin-ya Kawashiri
- Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan.
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379
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Yoshimi R, Hama M, Minegishi K, Kishimoto D, Watanabe T, Kamiyama R, Kirino Y, Asami Y, Ihata A, Tsunoda S, Ueda A, Takeno M, Ishigatsubo Y. Ultrasonography predicts achievement of Boolean remission after DAS28-based clinical remission of rheumatoid arthritis. Mod Rheumatol 2013; 24:590-8. [DOI: 10.3109/14397595.2013.857800] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ryusuke Yoshimi
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Maasa Hama
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Kaoru Minegishi
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Daiga Kishimoto
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Toshiyuki Watanabe
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Reikou Kamiyama
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Yohei Kirino
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Yukiko Asami
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Atsushi Ihata
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Shinichiro Tsunoda
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
- Division of Rheumatology, Department of Internal Medicine, Hyogo College of Medicine,
Nishinomiya, Japan
| | - Atsuhisa Ueda
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Mitsuhiro Takeno
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
| | - Yoshiaki Ishigatsubo
- Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine,
Yokohama, Japan
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380
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Garrigues F, Jousse-Joulin S, Bouttier R, Nonent M, Bressollette L, Saraux A. Concordance between clinical and ultrasound findings in rheumatoid arthritis. Joint Bone Spine 2013; 80:597-603. [DOI: 10.1016/j.jbspin.2013.03.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 03/11/2013] [Indexed: 01/17/2023]
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381
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Werner SG, Langer HE, Schott P, Bahner M, Schwenke C, Lind-Albrecht G, Spiecker F, Kurtz B, Burmester GR, Backhaus M. Indocyanine Green-Enhanced Fluorescence Optical Imaging in Patients With Early and Very Early Arthritis: A Comparative Study With Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2013; 65:3036-44. [DOI: 10.1002/art.38175] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 08/22/2013] [Indexed: 01/18/2023]
Affiliation(s)
- Stephanie G. Werner
- Charité University Medicine Berlin; Berlin Germany
- RHIO Center Dusseldorf and RHIO Research Institute; Dusseldorf Germany
| | | | - Peter Schott
- Evangelisches Krankenhaus Dusseldorf; Dusseldorf Germany
| | | | | | | | | | - Bernward Kurtz
- Evangelisches Krankenhaus Dusseldorf; Dusseldorf Germany
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382
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Ball EMA, Gibson DS, Bell AL, Rooney MR. Plasma IL-6 levels correlate with clinical and ultrasound measures of arthritis in patients with systemic lupus erythematosus. Lupus 2013; 23:46-56. [PMID: 24243775 DOI: 10.1177/0961203313512882] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this paper is to elucidate the role of specific cytokines in lupus (SLE) arthritis. METHODS Fifty SLE and 40 RA patients had an ultrasound (US) scan of their hand as per standardized protocols. US scores were expressed per joint and as a total 'US activity' score, (sum of power Doppler (PD) and grey-scale synovial hypertrophy scores in all joints) and a total erosion score. SLE disease activity was assessed (BILAG and SELENA-SLEDAI). Plasma levels of IL-6, TNF-alpha and BLyS were measured using sandwich ELISA kits (Quantikine kits, R & D). RESULTS On the basis of the US results SLE patients were divided into three groups: erosive arthritis (n = 20), non-erosive arthritis (n = 18) and those with a normal US scan (n = 12). Across the SLE groups plasma IL-6 levels correlated with CRP (p < 0.001), hand deformity scores (p = 0.005), BILAG musculoskeletal score (p = 0.009), wrist PD score (p = 0.01), the presence of tenosynovitis (p = 0.008) and total US activity score (p < 0.001) (which remained constant when corrected for total BILAG score). Neither TNF-alpha nor BLyS levels correlated with US or clinical measures of lupus arthritis; however, TNF-alpha correlated with total BILAG score (p < 0.001). CONCLUSION This is the first study to examine levels of specific cytokines in a cohort of SLE patients stratified in terms of joint disease by US, where the most significant finding is that IL-6 levels correlated both with clinical and US measures of arthritis disease activity.
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Affiliation(s)
- E M A Ball
- 1Centre for Infection & Immunity, Queen's University, Belfast, UK
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383
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Kawashiri SY, Suzuki T, Nakashima Y, Horai Y, Okada A, Iwamoto N, Ichinose K, Tamai M, Arima K, Nakamura H, Origuchi T, Uetani M, Aoyagi K, Kawakami A. Confirmation of effectiveness of tocilizumab by ultrasonography and magnetic resonance imaging in biologic agent-naïve early-stage rheumatoid arthritis patients. Mod Rheumatol 2013; 25:948-53. [PMID: 24252054 DOI: 10.3109/14397595.2013.844394] [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: 01/05/2023]
Abstract
Efficacy of tocilizumab in active early-stage RA patients despite methotrexate was evaluated for 12 months. One out of 5 patients was quitted by infusion reaction whereas tocilizumab continued for 12 months in the remaining 4 patients. Power Doppler articular synovitis was reduced in every patient and disappeared in 2 patients. Marked MRI osteitis, found in 1 patient, had disappeared at 12 months. Present results confirm the efficacy of tocilizumab by ultrasonography and MRI.
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Affiliation(s)
- Shin-Ya Kawashiri
- a Department 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 Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Yoshikazu Nakashima
- a Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Yoshiro Horai
- a Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Akitomo Okada
- a Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Naoki Iwamoto
- a Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Kunihiro Ichinose
- a Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Mami Tamai
- c Center for Health & Community Medicine, Nagasaki University , Nagasaki , Japan
| | - Kazuhiko Arima
- b Department of Public Health , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Hideki Nakamura
- a Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Tomoki Origuchi
- d Department of Health Sciences , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
| | - Masataka Uetani
- e Department of 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 Department of Immunology and Rheumatology , Nagasaki University Graduate School of Biomedical Sciences , Nagasaki , Japan
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384
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Axelsen MB, Ejbjerg BJ, Hetland ML, Skjødt H, Majgaard O, Lauridsen UB, Hørslev-Petersen K, Boesen M, Kubassova O, Bliddal H, Østergaard M. Differentiation between early rheumatoid arthritis patients and healthy persons by conventional and dynamic contrast-enhanced magnetic resonance imaging. Scand J Rheumatol 2013; 43:109-18. [DOI: 10.3109/03009742.2013.824022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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385
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Ikeda K, Seto Y, Ohno S, Sakamoto F, Henmi M, Fukae J, Narita A, Nakagomi D, Nakajima H, Tanimura K, Koike T. Analysis of the factors which influence the measurement of synovial power Doppler signals with semi-quantitative and quantitative measures – a pilot multicenter exercise in Japan. Mod Rheumatol 2013; 24:419-25. [DOI: 10.3109/14397595.2013.843763] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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386
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Ikeda K, Nakagomi D, Sanayama Y, Yamagata M, Okubo A, Iwamoto T, Kawashima H, Takahashi K, Nakajima H. Correlation of Radiographic Progression with the Cumulative Activity of Synovitis Estimated by Power Doppler Ultrasound in Rheumatoid Arthritis: Difference Between Patients Treated with Methotrexate and Those Treated with Biological Agents. J Rheumatol 2013; 40:1967-76. [DOI: 10.3899/jrheum.130556] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective.Our prospective study aimed to demonstrate that the cumulative synovial power Doppler (PD) ultrasound scores correlate with radiographic progression better than conventional measures in patients with rheumatoid arthritis (RA). We also investigated the difference between antirheumatic agents.Methods.Sixty-nine patients with RA who had recently received either methotrexate (MTX; n = 23), tumor necrosis factor (TNF) antagonists (n = 28), or tocilizumab (TCZ; n = 18) were enrolled. Patients underwent clinical, laboratory, and ultrasonographic assessment at baseline, 12 weeks, and 24 weeks. Radiographic damage was evaluated using van der Heijde modified total Sharp score (TSS) at baseline and 24 weeks.Results.Fifty-seven patients continued the same treatment regimen for 24 weeks and completed the study, and 21 patients (36.8%) showed radiographic progression during the study period. In all patients, ΔTSS significantly correlated both with cumulative 28-joint Disease Activity Score–C-reactive protein (DAS28-CRP; ρ = 0.342, p = 0.009) and cumulative total PD scores (ρ = 0.357, p = 0.006). In MTX-treated patients, cumulative total PD scores significantly correlated with ΔTSS (ρ = 0.679, p = 0.004), whereas cumulative DAS28-CRP did not (ρ = 0.487, p = 0.056). However, cumulative total PD scores did not correlate with ΔTSS in TNF antagonist–treated or TCZ-treated patients.Conclusion.Our data confirm the evidence that synovial PD activity more accurately reflects active synovial inflammation (which actually causes joint destruction) than do conventional measures in patients treated with MTX. Our data also indicate that TNF antagonists can inhibit short-term radiographic progression in the presence of active synovitis.
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387
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Ten Cate DF, Luime JJ, van der Ven M, Hazes JMW, Kooiman K, de Jong N, Bosch JG. Very different performance of the power Doppler modalities of several ultrasound machines ascertained by a microvessel flow phantom. Arthritis Res Ther 2013; 15:R162. [PMID: 24286540 PMCID: PMC3978434 DOI: 10.1186/ar4345] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/02/2013] [Indexed: 11/12/2022] Open
Abstract
Introduction In many patients with rheumatoid arthritis (RA) subclinical disease activity can be detected with ultrasound (US), especially using power Doppler US (PDUS). However, PDUS may be highly dependent on the type of machine. This could create problems both in clinical trials and in daily clinical practice. To clarify how the PDUS signal differs between machines we created a microvessel flow phantom. Methods The flow phantom contained three microvessels (150, 1000, 2000 microns). A syringe pump was used to generate flows. Five US machines were used. Settings were optimised to assess the lowest detectable flow for each US machine. Results The minimal detectable flow velocities showed very large differences between the machines. Only two of the machines may be able to detect the very low flows in the capillaries of inflamed joints. There was no clear relation with price. One of the lower-end machines actually performed best in all three vessel sizes. Conclusions We created a flow phantom to test the sensitivity of US machines to very low flows in small vessels. The sensitivity of the power Doppler modalities of 5 different machines was very different. The differences found between the machines are probably caused by fundamental differences in processing of the PD signal or internal settings inaccessible to users. Machines considered for PDUS assessment of RA patients should be tested using a flow phantom similar to ours. Within studies, only a single machine type should be used.
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388
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Contrast-enhanced MRI compared with the physical examination in the evaluation of disease activity in juvenile idiopathic arthritis. Eur Radiol 2013; 24:327-34. [DOI: 10.1007/s00330-013-3036-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Revised: 09/16/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
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389
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Seeliger B, Foerster M, Neumann T, Moeser A, Happe J, Kehler N, Kroegel C. Interferon-α induced remission in three patients with eosinophilic granulomatosis and polyangiitis. A case study. Respir Med Case Rep 2013; 10:60-3. [PMID: 26029516 PMCID: PMC3920446 DOI: 10.1016/j.rmcr.2013.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 08/21/2013] [Accepted: 09/10/2013] [Indexed: 11/17/2022] Open
Abstract
Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic small vessel vasculitis associated with asthma and eosinophilia. Optimal therapy for maintenance of remission is yet to be defined. We present a case-series of three patients with EGPA in whom IFN-α, an immunomodulatory cytokine induced remission, which was maintained even after discontinuation of the drug. In all patients (ages 60, 51, and 50 years), remission was associated with normalisation of eosinophil counts and IgE-levels. Moreover, the patients remained in remission for one to four years. Two patients did not need further immunosuppression, one patient required low dose maintenance therapy. Although reversible side effects occur, IFN-α-therapy induces long-term remission of EGPA even after discontinuation of treatment.
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Affiliation(s)
- B. Seeliger
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
- Corresponding author. Pneumology & Allergology, Friedrich-Schiller-University Jena, Erlanger Allee 101, 07749 Jena, Thuringia, Germany.
| | - M. Foerster
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
| | - T. Neumann
- Rheumatology/Osteology, Internal Medicine III, Jena University Hospital, Germany
| | - A. Moeser
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
| | - J. Happe
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
| | - N. Kehler
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
| | - C. Kroegel
- Pneumology & Allergology/Immunology, Internal Medicine I, Jena University Hospital, Germany
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390
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Fukae J, Tanimura K, Atsumi T, Koike T. Sonographic synovial vascularity of synovitis in rheumatoid arthritis. Rheumatology (Oxford) 2013; 53:586-91. [DOI: 10.1093/rheumatology/ket311] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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391
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Janta I, Naredo E, Martinez-Estupinan L, Nieto JC, De la Torre I, Valor L, Estopinan L, Bello N, Hinojosa M, Gonzalez CM, Lopez-Longo J, Monteagudo I, Montoro M, Carreno L. Patient self-assessment and physician's assessment of rheumatoid arthritis activity: which is more realistic in remission status? A comparison with ultrasonography. Rheumatology (Oxford) 2013; 52:2243-50. [DOI: 10.1093/rheumatology/ket297] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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392
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Svensson B, Andersson MLE, Bala SV, Forslind K, Hafström I. Long-term sustained remission in a cohort study of patients with rheumatoid arthritis: choice of remission criteria. BMJ Open 2013; 3:e003554. [PMID: 24022393 PMCID: PMC3773654 DOI: 10.1136/bmjopen-2013-003554] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVES Remission is a widely accepted goal for treatment of rheumatoid arthritis (RA) but has to be sustained to arrest joint damage and disability. However, appropriate criteria for the assessment of sustained remission in long-term studies are not established. Therefore, we have compared the disease activity score calculated on 28 joints (DAS28) remission criterion, the Simplified Disease Activity Index less than 3.3 remission criterion (SDAI Cr) and the new Boolean-based set of criteria (Boolean Cr), and assessed the association of these criteria with radiographic and functional outcome. DESIGN Prospective, long-term observational study of patients with early RA. SETTING Secondary level of care; six participating centres from southern Sweden; both urban and rural populations. PARTICIPANTS 698 patients were consecutively included in the study and 527 remained at the 8-year follow-up visit. Almost all patients were Caucasians, of which 64% were women. To be included, a patient, 18 years or older, had to fulfil the 1987 American College of Rheumatology criteria for RA and have a disease duration of no more than 1 year. RESULTS Sustained remission was most common by the DAS28 Cr (14%), while 3% met the Boolean Cr and 5% the SDAI Cr, the latter figures increasing to 9% and 8%, respectively, when the patient's global assessment was excluded. Radiographic joint damage was common but least pronounced in patients in sustained remission by all criteria. Sustained remission was associated with rapid and lasting improvement in function assessed by the Health Assessment questionnaire, irrespective of criteria. CONCLUSIONS The DAS28 Cr acquired more patients in sustained remission compared with the other criteria. In spite of that, radiographic damage and disability were not worse than that seen by other criteria and the patients' perspective was preserved. The DAS28 Cr may therefore still be used in long-term observational studies until more accurate criteria are available.
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Affiliation(s)
- Björn Svensson
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
| | | | - Sidona-Valentina Bala
- Department of Internal Medicine, Section of Rheumatology, Helsingborgs Lasarett, Helsingborg, Sweden
| | - Kristina Forslind
- Department of Clinical Sciences, Section of Rheumatology, Lund University, Lund, Sweden
- Department of Internal Medicine, Section of Rheumatology, Helsingborgs Lasarett, Helsingborg, Sweden
| | - Ingiäld Hafström
- Department of Rheumatology, Karolinska Institutet at Karolinska University Hospital, Huddinge, Sweden
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393
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Goodman SM. Invited commentary. Radiographics 2013; 33:956-8; discussion 959-61. [PMID: 24006534 DOI: 10.1148/radiographics.33.4.125100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Susan M Goodman
- Hospital for Special Surgery, Weill Cornell College of Medicine New York, New York, USA
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394
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Nam JL, Villeneuve E, Hensor EMA, Conaghan PG, Keen HI, Buch MH, Gough AK, Green MJ, Helliwell PS, Keenan AM, Morgan AW, Quinn M, Reece R, van der Heijde DM, Wakefield RJ, Emery P. Remission induction comparing infliximab and high-dose intravenous steroid, followed by treat-to-target: a double-blind, randomised, controlled trial in new-onset, treatment-naive, rheumatoid arthritis (the IDEA study). Ann Rheum Dis 2013; 73:75-85. [PMID: 23912798 DOI: 10.1136/annrheumdis-2013-203440] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES In disease modifying antirheumatic drug (DMARD)-naive early rheumatoid arthritis (RA), to compare the efficacy of methotrexate (MTX) and infliximab (IFX) with MTX and intravenous corticosteroid for remission induction. METHODS In a 78-week multicentre randomised controlled trial, double-blinded to week 26, 112 treatment-naive RA patients (1987 American College of Rheumatology classification criteria) with disease activity score 44 (DAS44)>2.4 were randomised to MTX + IFX or MTX + single dose intravenous methylprednisolone 250 mg. A treat-to-target approach was used with treatment escalation if DAS44>2.4. In the IFX group, IFX was discontinued for sustained remission (DAS44<1.6 for 6 months). The primary outcome was change in modified total Sharp-van der Heijde score (mTSS) at week 50. RESULTS The mean changes in mTSS score at week 50 in the IFX and intravenous steroid groups were 1.20 units and 2.81 units, respectively (adjusted difference (95% CI) -1.45 (-3.35 to 0.45); p=0.132). Radiographic non-progression (mTSS<2.0) occurred in 81% vs 71% (OR 1.77 (0.56 to 5.61); p=0.328). DAS44 remission was achieved at week 50 in 49% and 36% (OR 2.13 (0.91 to 5.00); p=0.082), and at week 78 in 48% and 50% (OR 1.12 (0.47 to 2.68); p=0.792). Exploratory analyses suggested higher DAS28 remission at week 6 and less ultrasound synovitis at week 50 in the IFX group. Of the IFX group, 25% (14/55) achieved sustained remission and stopped IFX. No substantive differences in adverse events were seen. CONCLUSIONS In DMARD-naive early RA patients, initial therapy with MTX+high-dose intravenous steroid resulted in good disease control with little structural damage. MTX+IFX was not statistically superior to MTX+intravenous steroid when combined with a treat-to-target approach.
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Affiliation(s)
- J L Nam
- Institute Rheumatic and Musculoskeletal Medicine, Leeds Institute of Molecular Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit, LTHT, , Leeds, UK
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395
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Abstract
Over the last decade, increasing numbers of rheumatologists have incorporated musculoskeletal ultrasound (MSUS) as a valuable diagnostic tool into their clinical practice. Some countries have established training programmes for MSUS. The European League Against Rheumatism has developed education guidelines for the content and conductance of MSUS courses and it would be useful to standardise rheumatology MSUS training worldwide. A thorough knowledge of anatomy, US physics and technology, US scanning methods, US pattern of normal and pathological musculoskeletal tissues, definitions for US pathology, artefacts and pitfalls in both greyscale and Doppler modalities is necessary to perform efficient MSUS. MSUS training includes attending theoretical-practical and online courses, as well as studying textbooks and using digital video discs (DVDs). Having access to US equipment and performing supervised normal and pathological MSUS examinations for a training period are mandatory for consolidating MSUS learning. A proposal to accredit and certificate competence in MSUS is now being discussed.
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Affiliation(s)
- Annamaria Iagnocco
- Rheumatology Unit, Sapienza Università di Roma, Viale del Policlinico 155, Rome 00161, Italy.
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396
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397
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Dalvi SR, Moser DW, Samuels J. Ultrasound and Treatment Algorithms of RA and JIA. Rheum Dis Clin North Am 2013; 39:669-88. [DOI: 10.1016/j.rdc.2013.02.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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398
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Gärtner M, Mandl P, Radner H, Supp G, Machold KP, Aletaha D, Smolen JS. Sonographic Joint Assessment in Rheumatoid Arthritis: Associations With Clinical Joint Assessment During a State of Remission. ACTA ACUST UNITED AC 2013; 65:2005-14. [DOI: 10.1002/art.38016] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 05/07/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | - Peter Mandl
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary, and Medical University of Vienna; Vienna Austria
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399
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Miotto e Silva VB, Faquin G, Nicácio A, Regacini R, Lederman H, Esteves Hilário MO, Lemos Ramos Ascensão Terreri MTDSE. Associação entre achados ultrassonográficos e clínicos do quadril de pacientes com artrite idiopática juvenil. REVISTA BRASILEIRA DE REUMATOLOGIA 2013. [DOI: 10.1590/s0482-50042013000400002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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400
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Zampeli E, Raftakis I, Michelongona A, Nikolaou C, Elezoglou A, Toutouzas K, Siores E, Sfikakis PP. Detection of subclinical synovial inflammation by microwave radiometry. PLoS One 2013; 8:e64606. [PMID: 23741349 PMCID: PMC3669424 DOI: 10.1371/journal.pone.0064606] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 04/16/2013] [Indexed: 01/15/2023] Open
Abstract
Objective Microwave Radiometry is a non-invasive method which determines within seconds the in vivo temperature of internal tissues at a depth of 3–7 cm with an accuracy of ±0.2°C. In this proof-of-concept study, we tested the hypothesis that, in absence of relevant clinical signs, increased local temperature detected by microwave radiometry reflects subclinical synovial inflammation, using ultrasound as reference method. Methods Knees of healthy controls, subjects with recent knee trauma and symptom-free patients with rheumatoid arthritis (RA) or osteoarthritis were examined by placing the microwave radiometry sensor, a) at the upper one third of the anterior surface of the thigh (control-point), and b) over the suprapatellar recess. Ultrasound was performed immediately after and the possible presence of fluid and/or synovitis was correlated with microwave radiometry findings. Results In 30 healthy and 10 injured knees the temperature was always lower than thigh (32.3±1.1 and 31.8±1.4 versus 34.1±0.9 and 33.6±1.2°C with a difference (ΔΤ) of −1.8±0.2 and −1.9±0.4°C respectively). Of 40 RA and 20 osteoarthritis knees examined, ultrasound findings indicative of subclinical inflammation (fluid effusion and/or Doppler signal) were found in 24 and 12, respectively, in which the temperature was higher than healthy knees and ΔΤ was lower (−0.9±0.7 in RA and −1.0±0.5 in osteoarthritis versus −1.8±0.2°C, p<0.001). The 5 RA knees with power Doppler findings indicative of grade 2 inflammation had a ΔΤ 3 times lower compared to healthy (−0.6±0.6, p = 0.007), whereas the 9 RA and the 7 osteoarthritis knees with additionally fluid effusion, had even lower ΔΤ (−0.4±0.7, p<0.001). Conclusion Using a safe, rapid and easy-to-perform method, such as microwave radiometry, thermal changes within the knee joint may reflect non-clinically apparent joint inflammation. Refinement of this method, including production of sensors for small joints, could result to the development of the ideal objective tool to detect subclinical synovitis in clinical practice.
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Affiliation(s)
- Evangelia Zampeli
- First Department of Propedeutic and Internal Medicine, Athens University Medical School, Athens, Greece
| | - Ioannis Raftakis
- Rheumatology Department, Asklepion General Hospital, Athens, Greece
| | | | - Chara Nikolaou
- First Department of Cardiology, Athens University Medical School, Athens, Greece
| | | | | | - Elias Siores
- Institute for Materials Research and Innovation, University of Bolton, Bolton, United Kingdom
| | - Petros P. Sfikakis
- First Department of Propedeutic and Internal Medicine, Athens University Medical School, Athens, Greece
- * E-mail:
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