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Trier NH, Houen G. Antibody Cross-Reactivity in Auto-Immune Diseases. Int J Mol Sci 2023; 24:13609. [PMID: 37686415 PMCID: PMC10487534 DOI: 10.3390/ijms241713609] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 08/25/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Autoimmunity is defined by the presence of antibodies and/or T cells directed against self-components. Although of unknown etiology, autoimmunity commonly is associated with environmental factors such as infections, which have been reported to increase the risk of developing autoimmune diseases. Occasionally, similarities between infectious non-self and self-tissue antigens may contribute to immunological cross-reactivity in autoimmune diseases. These reactions may be interpreted as molecular mimicry, which describes cross-reactivity between foreign pathogens and self-antigens that have been reported to cause tissue damage and to contribute to the development of autoimmunity. By focusing on the nature of antibodies, cross-reactivity in general, and antibody-antigen interactions, this review aims to characterize the nature of potential cross-reactive immune reactions between infectious non-self and self-tissue antigens which may be associated with autoimmunity but may not actually be the cause of disease onset.
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Affiliation(s)
- Nicole Hartwig Trier
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
| | - Gunnar Houen
- Department of Neurology, Rigshospitalet Glostrup, Valdemar Hansens Vej 1-23, 2600 Glostrup, Denmark
- Department of Biochemistry and Molecular Biology, University of Southern Denmark, Campusvej 55, 5230 Odense M, Denmark
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2
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Guenoun D, Wirth T, Roche D, Michel CP, Daudé P, Ogier AC, Chagnaud C, Mattei JP, Pini L, Guye M, Ollivier M, Bendahan D, Guis S. Ultra-high field magnetic resonance imaging of the quadriceps tendon enthesis in healthy subjects. Surg Radiol Anat 2023:10.1007/s00276-023-03175-y. [PMID: 37277665 DOI: 10.1007/s00276-023-03175-y] [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: 02/10/2023] [Accepted: 05/24/2023] [Indexed: 06/07/2023]
Abstract
PURPOSE Although enthesitis is a hallmark of several rheumatologic conditions, current imaging methods are still unable to characterize entheses changes because of the corresponding short transverse relaxation times (T2). A growing number of MR studies have used Ultra-High Field (UHF) MRI in order to assess low-T2 tissues e.g., tendon but never in humans. The purpose of the present study was to assess in vivo the enthesis of the quadriceps tendon in healthy subjects using UHF MRI. METHODS Eleven healthy subjects volunteered in an osteoarthritis imaging study. The inclusion criteria were: no knee trauma, Lequesne index = 0, less than 3 h of sport activities per week, and Kellgren and Lawrence grade = 0. 3D MR images were acquired at 7 T using GRE sequences and a T2* mapping. Regions of interest i.e., trabecular bone, subchondral bone, enthesis, and tendon body were identified, and T2* values were quantified and compared. RESULTS Quadriceps tendon enthesis was visible as a hyper-intense signal. The largest and the lowest T2* values were quantified in the subchondral bone region and the tendon body respectively. T2* value within subchondral bone was significantly higher than T2* value within the enthesis. T2* in subchondral bone region was significantly higher than the whole tendon body T2*. CONCLUSION A T2* gradient was observed along the axis from the enthesis toward the tendon body. It illustrates different water biophysical properties. These results provide normative values which could be used in the field of inflammatory rheumatologic diseases and mechanical disorders affecting the tendon.
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Affiliation(s)
- Daphne Guenoun
- Institute for Locomotion, Department of Radiology, APHM, Sainte-Marguerite Hospital, 270 Bd Sainte Marguerite, 13009, Marseille, France.
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France.
| | - Theo Wirth
- Service de Rhumatologie, AP-HM, Marseille, France
- Aix-Marseille Université, Marseille, France
- Inserm UMRs1097, Arthrites Autoimmunes, Marseille, France
| | - Damien Roche
- Service de Rhumatologie, AP-HM, Marseille, France
| | - Constance P Michel
- Aix-Marseille Université, Marseille, France
- CRMBM-CEMEREM, UMR CNRS 7339, Marseille, France
| | - Pierre Daudé
- Aix-Marseille Université, Marseille, France
- CRMBM-CEMEREM, UMR CNRS 7339, Marseille, France
| | - Augustin C Ogier
- CRMBM-CEMEREM, UMR CNRS 7339, Marseille, France
- Service de Radiologie, Hôpital de La Conception, AP-HM, Aix-Marseille Université, Marseille, France
| | - Christophe Chagnaud
- Aix-Marseille Université, Marseille, France
- Service de Radiologie, Hôpital de La Conception, AP-HM, Aix-Marseille Université, Marseille, France
- Aix Marseille Université, Université de Toulon, CNRS, LIS, Marseille, France
| | - Jean Pierre Mattei
- Service de Rhumatologie, AP-HM, Marseille, France
- Aix-Marseille Université, Marseille, France
| | - Lauriane Pini
- Aix-Marseille Université, Marseille, France
- CRMBM-CEMEREM, UMR CNRS 7339, Marseille, France
| | - Maxime Guye
- Aix-Marseille Université, Marseille, France
- CRMBM-CEMEREM, UMR CNRS 7339, Marseille, France
| | - Matthieu Ollivier
- Aix-Marseille Université, Marseille, France
- Department of Orthopedics and Traumatology, Institute of Movement and Locomotion, St. Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - David Bendahan
- Aix-Marseille Université, Marseille, France
- CRMBM-CEMEREM, UMR CNRS 7339, Marseille, France
| | - Sandrine Guis
- Service de Rhumatologie, AP-HM, Marseille, France
- Aix-Marseille Université, Marseille, France
- Inserm UMRs1097, Arthrites Autoimmunes, Marseille, France
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Calcium-Permeable Channels Cooperation for Rheumatoid Arthritis: Therapeutic Opportunities. Biomolecules 2022; 12:biom12101383. [PMID: 36291594 PMCID: PMC9599458 DOI: 10.3390/biom12101383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/18/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
Rheumatoid arthritis is a common autoimmune disease that results from the deposition of antibodies–autoantigens in the joints, leading to long-lasting inflammation. The main features of RA include cartilage damage, synovial invasion and flare-ups of intra-articular inflammation, and these pathological processes significantly reduce patients’ quality of life. To date, there is still no drug target that can act in rheumatoid arthritis. Therefore, the search for novel drug targets has become urgent. Due to their unique physicochemical properties, calcium ions play an important role in all cellular activities and the body has evolved a rigorous calcium signaling system. Calcium-permeable channels, as the main operators of calcium signaling, are widely distributed in cell membranes, endoplasmic reticulum membranes and mitochondrial membranes, and mediate the efflux and entry of Ca2+. Over the last century, more and more calcium-permeable channels have been identified in human cells, and the role of this large family of calcium-permeable channels in rheumatoid arthritis has gradually become clear. In this review, we briefly introduce the major calcium-permeable channels involved in the pathogenesis of RA (e.g., acid-sensitive ion channel (ASIC), transient receptor potential (TRP) channel and P2X receptor) and explain the specific roles and mechanisms of these calcium-permeable channels in the pathogenesis of RA, providing more comprehensive ideas and targets for the treatment of RA.
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Barkaoui A, Ait Oumghar I, Ben Kahla R. Review on the use of medical imaging in orthopedic biomechanics: finite element studies. COMPUTER METHODS IN BIOMECHANICS AND BIOMEDICAL ENGINEERING: IMAGING & VISUALIZATION 2021. [DOI: 10.1080/21681163.2021.1888317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Abdelwahed Barkaoui
- Laboratoire des Énergies Renouvelables et Matériaux Avancés, Université Internationale de Rabat, Sala Al Jadida Morocco
| | - Imane Ait Oumghar
- Laboratoire des Énergies Renouvelables et Matériaux Avancés, Université Internationale de Rabat, Sala Al Jadida Morocco
- Aix Marseille Univ, CNRS, ISM, Inst Movement Sci, Marseille, France
| | - Rabeb Ben Kahla
- Laboratoire de Systémes et de Mécanique Appliquée, Ecole Polytechnique de Tunis, Université de Carthage, Tunis, Tunisia
- Ecole Nationale d’Ingénieurs de Tunis, Université de Tunis el Manar, Campus Universitaire, Tunis, Tunisia
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[Rheumatoid arthritis of the hand : Part 2: Imaging]. Radiologe 2021; 61:362-374. [PMID: 33728480 DOI: 10.1007/s00117-021-00833-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rheumatoid arthritis can cause joint destruction, especially joints of the hands. Diagnosed at an early stage, which often includes imaging methods, can minimize structural joint damage and resulting disabilities as well as avoid systemic manifestations such as cardiovascular damage through rapid and continuous so-called targeted treatment approaches. OBJECTIVE The aim of this work is the systematic description and report of imaging findings in rheumatoid arthritis as the most common autoimmunologic rheumatologic disease, which is characterized by a typical pattern of synovitis of the hands. MATERIALS AND METHODS Narrative review based on the current literature on the subject from the radiological and rheumatological point of view. RESULTS Inflammation of the hands represents the most frequently affected area of the body in rheumatoid arthritis. Taking into consideration the topology and typical synovitis patterns of the hands, differences between early and late stages are described. Knowledge regarding image-based morphological changes associated with this complex disease, especially in the hands, is important in the differential diagnosis, especially in early stages of the disease. CONCLUSIONS For the diagnosis of rheumatoid arthritis of the hands, the radiologist must be familiar with basic knowledge of arthritis in the hands to confidently analyze the typical patterns present in the diagnostic imaging at initial diagnosis and during the course of the disease, which serve as a guide for therapy decisions.
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Protective effect of Corynoline on the CFA induced Rheumatoid arthritis via attenuation of oxidative and inflammatory mediators. Mol Cell Biochem 2020; 476:831-839. [PMID: 33174074 DOI: 10.1007/s11010-020-03948-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 05/23/2020] [Indexed: 02/05/2023]
Abstract
Rheumatoid arthritis (RA) is a long-standing and growing autoimmune disease. Therefore, the present study was intended to investigate the effect of Corynoline (COR) on CFA induced rheumatoid arthritis in a rat model. Results suggested that COR causes significant reduction in paw swelling, edema, arthritis score, thymus and spleen indexes and neutrophil infiltration (p < 0.01). Moreover, the levels of inflammatory cytokines (interleukin- 1β, -6, and -17, and TNF-α) and anti-collagen II-specific immunoglobulins (IgG1 and IgG2a) were decreased significantly (p < 0.01) together with increase in antioxidant enzymes (SOD, CAT, and GSH) (p < 0.01) in COR-treated group in dose-dependent manner. In western blot analysis, COR-treated group showed concentration-dependent reduction of expression of COX-2, 5-LOX and NF-p65 as compared to CFA rats. Moreover, COR-treated group showed mild inflammation of cartilage with fewer cartilage erosion and synovititis with most significant reversal of arthritic features in the rats treated with 30 mg/kg. It has been concluded that, COR alleviates oxidative stress and inflammation in arthritic rats, thus verifying its anti-rheumatoid arthritis property.
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Blavnsfeldt ABG, Klose-Jensen R, Thygesen J, Therkildsen P, Langdahl BL, Keller KK, Hauge EM. Effect of radiographic disease severity in high-resolution quantitative computed tomography assessment of metacarpophalangeal joint erosion and cysts. Int J Rheum Dis 2020; 24:112-119. [PMID: 33169933 DOI: 10.1111/1756-185x.14020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/24/2020] [Accepted: 10/15/2020] [Indexed: 01/16/2023]
Abstract
AIM Bone erosions are the hallmark of rheumatoid arthritis (RA). High-resolution peripheral quantitative computed tomography (HR-pQCT) enables 3-dimensional visualization of arthritic bone erosions at a high resolution. However, the degree of erosive disease could influence the reliability of HR-pQCT evaluation. We aim to assess the intra- and inter-reader variability of identification of erosions in the metacarpophalangeal (MCP) joints using HR-pQCT in healthy controls and patients with RA, stratified according to van der Heijde-modified Sharp Score (HSS) of radiographic erosions. METHOD We analyzed HR-pQCT images from 78 patients with RA and 25 healthy controls. Patients were allocated to one of three groups of mild, moderate or severe disease according to HSS of MCP joints 2 and 3. Total HR-pQCT scans were analyzed twice in random order by three experienced readers, blinded to group distribution. The number of cortical interruptions and their classification as either erosions or cysts according to predefined criteria were recorded. Intraclass correlation coefficients (ICC) for cortical interruptions, erosions and cysts were calculated for each group using a 2-way random-effects model for inter-reader ICC and a 2-way mixed-effects model for intra-reader ICC. RESULTS The intra- and inter-reader ICC were good to moderate for cortical interruptions and moderate for erosions throughout disease severity groups. The ICCs for the identification of cysts decreased with increasing degree of erosive disease. CONCLUSION The detection of cortical interruptions is only minimally affected by the degree of erosive damage, whereas the distinction between erosions and cysts is more complex in patients with extensive erosive disease.
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Affiliation(s)
- Anne-Birgitte Garm Blavnsfeldt
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Jesper Thygesen
- Department of Procurement and Clinical Engineering, Central Denmark Region, Aarhus C, Denmark
| | - Philip Therkildsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
| | - Bente Lomholdt Langdahl
- Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.,Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus N, Denmark
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Diagnostic Center, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus N, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark
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Shiraishi M, Fukuda T, Igarashi T, Tokashiki T, Kayama R, Ojiri H. Differentiating Rheumatoid and Psoriatic Arthritis of the Hand: Multimodality Imaging Characteristics. Radiographics 2020; 40:1339-1354. [PMID: 32735474 DOI: 10.1148/rg.2020200029] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Accurate diagnosis and therapeutic intervention at an early stage is paramount for the management of rheumatoid arthritis (RA) and psoriatic arthritis (PsA), which are the two major types of inflammatory arthritis that involve the hand joints. As more disease-specific medications are developed, medication selection according to the correct diagnosis becomes more important. A delay in diagnosis and inappropriate medication selection may result in poor functional prognosis. However, clinical differentiation between RA and PsA can be challenging and may become largely dependent on imaging interpretation results. Although there is substantial overlap in the imaging findings of RA and PsA, there are differences in the affected primary target sites, reflected by the various patterns of joint involvement, and different microanatomic localization of abnormalities within a single joint in each disease. Therefore, appropriate use of various imaging modalities and accurate image interpretation add significant value to the diagnosis and treatment process. The synovio-entheseal complex is an important concept for understanding the imaging features of PsA. The authors review the different features of RA and PsA of the hands seen with various imaging modalities, including radiography, US, MRI, and dual-energy CT, with updates on the contemporary role of imaging in diagnosis and treatment. The radiologist should have sufficient knowledge to interpret imaging findings and understand the strengths and weaknesses of each modality to recommend the appropriate imaging method and differentiate both diseases accurately. ©RSNA, 2020.
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Affiliation(s)
- Megumi Shiraishi
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takeshi Fukuda
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takao Igarashi
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Tadashi Tokashiki
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Reina Kayama
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroya Ojiri
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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Imaging evaluation of the cartilage in rheumatoid arthritis patients with an x-ray phase imaging apparatus based on Talbot-Lau interferometry. Sci Rep 2020; 10:6561. [PMID: 32300128 PMCID: PMC7162962 DOI: 10.1038/s41598-020-63155-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 03/20/2020] [Indexed: 12/05/2022] Open
Abstract
X-ray Talbot-Lau interferometry is one of the x-ray phase imaging methods that has high sensitivity in depicting soft tissues. Unlike earlier x-ray phase imaging methods that required particular types of x-ray sources, such as a synchrotron or a micro-focus x-ray tube, x-ray Talbot-Lau interferometry enables to perform clinical x-ray phase imaging using a conventional x-ray source with a relatively compact configuration. We developed an apparatus to depict cartilage in the metacarpophalangeal joints of the hands. In addition, we examined the apparatus performance by applying it to healthy volunteers and patients with rheumatoid arthritis (RA). Cartilage deformation, which is thought to be a precursor of destruction of the joints, was successfully depicted by the apparatus, suggesting a potential early diagnosis of RA.
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Peterfy C, Kremer J, Rigby W, Singer N, Birchwood C, Gill D, Reiss W, Pei J, Michalska M. Magnetic Resonance Imaging (MRI) Results Following Discontinuation of Methotrexate in Rheumatoid Arthritis Treated with Subcutaneous Tocilizumab: The COMP-ACT MRI Substudy. J Rheumatol 2019; 47:325-332. [PMID: 31154414 DOI: 10.3899/jrheum.180953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess differences in joint damage and inflammation using magnetic resonance imaging (MRI) between patients with rheumatoid arthritis (RA) who achieved low disease activity with tocilizumab (TCZ) + methotrexate (MTX) and subsequently continued or discontinued MTX. METHODS In the COMP-ACT trial, US patients with RA received subcutaneous TCZ 162 mg + MTX. Those who achieved 28-joint count Disease Activity Score calculated with erythrocyte sedimentation rate (DAS28-ESR) ≤ 3.2 at Week 24 were randomized 1:1 (double-blind) to discontinue MTX (TCZ monotherapy; mono) or continue TCZ + MTX until Week 52. In a subset of patients, 1.5-Tesla MRI was used to obtain images of bilateral hands and wrists at weeks 24 and 40. Outcomes included changes in MRI-assessed synovitis, osteitis, erosion, and cartilage loss from Week 24 to Week 40, and in the proportion of patients with progression of each score. RESULTS Of 296 patients who achieved DAS28-ESR ≤ 3.2 at Week 24, 79 were enrolled in the pilot MRI substudy and randomized to TCZ mono (n = 38) or TCZ + MTX (n = 41). Treatment with either TCZ mono or TCZ + MTX suppressed erosion progression, synovitis, osteitis, and cartilage loss. The proportion of patients with no progression in each outcome measure was similar between groups (range, TCZ mono: 84.8-97.0%; TCZ + MTX: 92.3-100%). CONCLUSION In a subset of patients who achieved low disease activity with TCZ + MTX, MRI changes were minimal in intraarticular inflammation and damage measures in patients who discontinued MTX versus those who continued TCZ + MTX.
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Affiliation(s)
- Charles Peterfy
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA. .,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc.
| | - Joel Kremer
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - William Rigby
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Nora Singer
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Christine Birchwood
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Darcy Gill
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - William Reiss
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Jinglan Pei
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
| | - Margaret Michalska
- From Spire Sciences Inc., Boca Raton, Florida; Albany Medical College and The Center for Rheumatology, Albany, New York; Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire; Case Western Reserve University and MetroHealth System, Cleveland, Ohio; Genentech Inc., South San Francisco, California, USA.,C. Peterfy, MD, Spire Sciences Inc.; J. Kremer, MD, Albany Medical College and The Center for Rheumatology; W. Rigby, MD, Geisel School of Medicine, Dartmouth College; N. Singer, MD, Case Western Reserve University and MetroHealth System; C. Birchwood, PhD, Genentech Inc.; D. Gill, BS, Genentech Inc.; W. Reiss, PharmD, Genentech Inc.; J. Pei, BS, Genentech Inc.; M. Michalska, MD, Genentech Inc
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Shimizu T, Cruz A, Tanaka M, Mamoto K, Pedoia V, Burghardt AJ, Heilmeier U, Link TM, Graf J, Imboden JB, Li X. Structural Changes over a Short Period Are Associated with Functional Assessments in Rheumatoid Arthritis. J Rheumatol 2019; 46:676-684. [DOI: 10.3899/jrheum.180496] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2018] [Indexed: 11/22/2022]
Abstract
Objective.To investigate the correlation between changes in radiological quantitative assessment with changes in clinical and functional assessment from baseline to 3 months in patients with rheumatoid arthritis (RA).Methods.Twenty-eight patients with RA [methotrexate (MTX) and anti-tumor necrosis factor–α (TNF-α) group with high disease activity (n = 18); and MTX group with low disease activity (n = 10)] underwent assessments at baseline and 3 months: clinical [28-joint count Disease Activity Score (DAS28)], functional [Health Assessment Questionnaire (HAQ) and Michigan Hand Outcome Questionnaire (MHQ)], and imaging-based [3 Tesla magnetic resonance imaging (MRI) and high-resolution peripheral quantitative computed tomography (HR-pQCT)]. MR images were evaluated semiquantitatively [RA MRI scoring (RAMRIS)] and quantitatively for the volume of synovitis and bone marrow edema (BME) lesions. Erosion volumes were measured using HR-pQCT.Results.After 3 months, the anti-TNF-α group demonstrated an improvement in disease activity through DAS28, HAQ, and MHQ. MRI showed significant decreases in synovitis and BME volume for the anti-TNF-α group, and significant increases in the MTX group. HR-pQCT showed significant decreases in bone erosion volume for the anti-TNF-α group, and significant increases in the MTX group. No significance was observed using RAMRIS. Changes in synovitis, BME, and erosion volumes, but not RAMRIS, were significantly correlated with changes in DAS28, HAQ, and MHQ.Conclusion.Quantitative measures were more sensitive than semiquantitative grading when evaluating structural and inflammatory changes with treatment, and were associated with patient clinical and functional outcomes. Multimodality imaging with 3T MRI and HR-pQCT may provide promising biomarkers that help determine disease progression and therapy response.
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Kong S, Locrelle H, Amouzougan A, Denarie D, Collet P, Pallot-Prades B, Thomas T, Marotte H. Remaining local subclinical joint inflammation is associated with deteriorated metacarpeal head bone microarchitecture in rheumatoid arthritis patients low disease activity. Joint Bone Spine 2018; 85:569-572. [DOI: 10.1016/j.jbspin.2017.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Accepted: 11/15/2017] [Indexed: 12/22/2022]
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Hunt L, Eugénio G, Grainger AJ. Magnetic resonance imaging in individuals at risk of rheumatoid arthritis. Best Pract Res Clin Rheumatol 2017; 31:80-89. [PMID: 29221601 DOI: 10.1016/j.berh.2017.10.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 07/06/2017] [Accepted: 08/18/2017] [Indexed: 01/07/2023]
Abstract
Individuals with rheumatoid arthritis (RA) benefit from early diagnosis and initiation of therapy. There can be delays in both due to diagnostic uncertainties. Imaging modalities, including magnetic resonance imaging (MRI), can detect inflammation earlier than clinical examination alone in early RA patients. Furthermore, the predictive role of MRI for the future development of RA has recently been explored in 'at-risk' individuals. This review details the use of MRI in early and undifferentiated arthritis and summarises the studies to date in individuals at risk of RA.
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Affiliation(s)
- Laura Hunt
- Leeds Biomedical Research Centre, Chapel Allerton Hospital Leeds, LS7 4SA, UK.
| | - Gisela Eugénio
- Rheumatology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - Andrew J Grainger
- Leeds Biomedical Research Centre, Chapel Allerton Hospital Leeds, LS7 4SA, UK
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Xu H, Zhang Y, Zhang H, Wang C, Mao P. Comparison of the clinical effectiveness of US grading scoring system vs MRI in the diagnosis of early rheumatoid arthritis (RA). J Orthop Surg Res 2017; 12:152. [PMID: 29041980 PMCID: PMC5646118 DOI: 10.1186/s13018-017-0653-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/02/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND As an irreversible disease, a treatment delay can negatively affect treatment response in rheumatoid arthritis (RA). Ultrasound and MRI have played an important role in assessing disease progression and response to treatment in RA for many years. The present study was designed to compare the diagnostic efficacy of ultrasound grading and MRI in early RA. METHODS In this retrospective study, 62 early RA patients within 12 months of symptom onset were included. DAS28, rheumatoid factor (RF), CRP, ESR, and anti-cyclic citrullinated peptide antibody (CCP) of the patients were measured. Bilateral hand joints and wrists were examined by ultrasonography (US) and MRI; diagnosis outcome was compared. Relationship between DAS28 scores, laboratory parameters, and ultrasound findings were analyzed. RESULTS Ultrasound and MRI had an equivalent diagnosis value in synovitis, joint effusion, and tenosynovitis. The detection rate of synovitis, arthroedema, and tenosynovitis on ultrasound and MRI was very close (P > 0.05). The detection rate of bone erosion was lower in ultrasonography than that in MRI (P < 0.05). There were significant differences between power Doppler ultrasonography (PDUS) and gray-scale ultrasonography (GSUS) in the diagnosis of synovitis (χ 2 = 3.92, P < 0.05); the sensitivity of GSUS was better than that of PDUS (P < 0.05). PDUS was positively correlated with DAS28, ESR, CRP, and CCP (P < 0.01), but not correlated with RF and disease duration (P > 0.05). GSUS was positively correlated with RF and CRP (P < 0.01), but not correlated with DAS28, CCP, ESR, and disease duration (P > 0.05). Bone erosion was positively correlated with disease duration, CCP, and RF (P < 0.01) and was not correlated with DAS28, ESR, and CRP (P > 0.05). CONCLUSION Ultrasonography has a high reliability in the diagnosis of early RA in synovitis, joint effusion, tenosynovitis, and bone erosion. Ultrasonography and clinical and laboratory parameters had a great correlativity. Both ultrasound and MRI are effective techniques. In view of the advantages of low cost and convenience, ultrasound may be a better choice during early RA diagnosis.
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Affiliation(s)
- Huajun Xu
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, San Xiang Road 1055, Suzhou, 215004 China
- Department of Ultrasound, Huzhou Central Hospital, Hong Qi Road 198, Huzhou, 313000 China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, San Xiang Road 1055, Suzhou, 215004 China
| | - Huimei Zhang
- Department of Radiology, Huzhou Central Hospital, Hong Qi Road 198, Huzhou, 313000 China
| | - Caishan Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, San Xiang Road 1055, Suzhou, 215004 China
| | - Pan Mao
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, San Xiang Road 1055, Suzhou, 215004 China
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Efficacy of double inversion recovery magnetic resonance imaging for the evaluation of the synovium in the femoro-patellar joint without contrast enhancement. Eur Radiol 2017; 28:459-467. [PMID: 28828623 DOI: 10.1007/s00330-017-5017-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 07/25/2017] [Accepted: 08/02/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the efficacy of double inversion recovery (DIR) sequence for evaluating the synovium of the femoro-patellar joint without contrast enhancement (CE). METHODS Two radiologists independently evaluated the axial DIR and CE T1-weighted fat-saturated (CET1FS) images of 33 knees for agreement; the visualisation and distribution of the synovium were evaluated using a four-point visual scaling system at each of the five levels of the femoro-patellar joint and the location of the thickest synovium. The maximal synovial thickness at each sequence was measured by consensus. RESULTS The interobserver agreement was good (κ = 0.736) for the four-point scale, and was excellent for the location of the thickest synovium on DIR and CET1FS (κ = 0.955 and 0.954). The intersequential agreement for the area with the thickest synovium was also excellent (κ = 0.845 and κ = 0.828). The synovial thickness on each sequence showed excellent correlation (r = 0.872). CONCLUSION The DIR showed as good a correlation as CET1FS for the evaluation of the synovium at the femoro-patellar joint. DIR may be a useful MR technique for evaluating the synovium without CE. KEY POINTS • DIR can be useful for evaluating the synovium of the femoro-patellar joint. • Interobserver and intersequential agreements between DIR and CET1FS were good. • Mean thickness of the synovium was significantly different between two sequences.
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Humby F, Mahto A, Ahmed M, Barr A, Kelly S, Buch M, Pitzalis C, Conaghan PG. The Relationship Between Synovial Pathobiology and Magnetic Resonance Imaging Abnormalities in Rheumatoid Arthritis: A Systematic Review. J Rheumatol 2017; 44:1311-1324. [DOI: 10.3899/jrheum.161314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2017] [Indexed: 01/16/2023]
Abstract
Objective.Magnetic resonance imaging (MRI) has been increasingly recognized as a critical tool for the assessment of patients with rheumatoid arthritis (RA) and is able to reliably identify synovitis, bone marrow edema, bone erosion, and joint space narrowing (JSN)/cartilage loss. Understanding the exact relationship between each MRI feature and local synovial pathobiology is critical to dissect disease pathogenesis as well as develop future predictive models.Methods.A systematic review was performed of the current published literature examining the relationship between MRI abnormalities and synovial pathobiology in patients with RA.Results.Eighteen studies were identified; most focused on validation of MRI as a tool to detect and quantify synovitis, with a significant relationship demonstrated. Additionally, from the limited data available, a critical role seems likely for synovial pathways, at least in driving joint damage. However, there was a lack of data examining the relationship between synovial pathobiology and bone marrow abnormalities and JSN.Conclusion.Although understanding the interrelationship of these disease biomarkers offers the potential to enhance the predictive validity of modern imaging with concomitant synovial pathobiological analysis, further studies integrating MRI with synovial tissue analysis in well-controlled cohorts at distinct disease stages before and after therapeutic intervention are required to achieve this.
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Fluorescence optical imaging and 3T-MRI for detection of synovitis in patients with rheumatoid arthritis in comparison to a composite standard of reference. Eur J Radiol 2017; 90:6-13. [DOI: 10.1016/j.ejrad.2017.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/16/2017] [Accepted: 02/12/2017] [Indexed: 11/22/2022]
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Assessing Synovitis and Bone Erosion With Apparent Diffusion Coefficient in Early Stage of Rheumatoid Arthritis. J Comput Assist Tomogr 2017; 41:833-838. [DOI: 10.1097/rct.0000000000000609] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Taljanovic MS, Melville DM, Gimber LH, Scalcione LR, Miller MD, Kwoh CK, Klauser AS. High-Resolution US of Rheumatologic Diseases. Radiographics 2016; 35:2026-48. [PMID: 26562235 DOI: 10.1148/rg.2015140250] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For the past 15 years, high-resolution ultrasonography (US) is being routinely and increasingly used for initial evaluation and treatment follow-up of rheumatologic diseases. This imaging technique is performed by using high-frequency linear transducers and has proved to be a powerful diagnostic tool in evaluation of articular erosions, simple and complex joint and bursal effusions, tendon sheath effusions, and synovitis, with results comparable to those of magnetic resonance imaging, excluding detection of bone marrow edema. Crystal deposition diseases including gouty arthropathy and calcium pyrophosphate deposition disease (CPPD) have characteristic appearances at US, enabling differentiation between these two diseases and from inflammatory arthropathies. Enthesopathy, which frequently accompanies psoriatic and reactive arthritis, also has a characteristic appearance at high-resolution US, distinguishing these two entities from other inflammatory and metabolic arthropathies. The presence of Doppler signal in examined joints, bursae, and tendon sheaths indicates active synovitis. Microbubble echo contrast agents augment detection of tissue vascularity and may act in the future as a drug delivery vehicle. Frequently, joint, tendon sheath, and bursal fluid aspirations and therapeutic injections are performed under US guidance. The authors describe the high-resolution US technique including gray-scale, color or power Doppler, and contrast agent-enhanced US that is used in evaluation of rheumatologic diseases of the wrist and hand and the ankle and foot in their routine clinical practice. This article demonstrates imaging findings of normal joints, rheumatoid arthritis, gouty arthritis, CPPD, psoriatic and reactive arthritis, and osteoarthritis.
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Affiliation(s)
- Mihra S Taljanovic
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - David M Melville
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Lana H Gimber
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Luke R Scalcione
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Margaret D Miller
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - C Kent Kwoh
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Andrea S Klauser
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
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Wang J, Zhao Q, Wang G, Yang C, Xu Y, Li Y, Yang P. Circulating levels of Th1 and Th2 chemokines in patients with ankylosing spondylitis. Cytokine 2016; 81:10-4. [PMID: 26827189 DOI: 10.1016/j.cyto.2016.01.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/21/2016] [Accepted: 01/21/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Although chemokines are critical elements for the selective attraction and activation of various leukocyte subsets in the inflammatory process, there are few findings concerning T helper (Th) 1 or Th2 chemokines in ankylosing spondylitis (AS). This study was designed to determine whether serum levels of chemokines that are preferentially chemotactic for Th1 (IFN-gamma-inducible protein-10, IP-10/CXCL10) and Th2 (thymus and activation regulated chemokine, TARC/CCL17) and (macrophage derived chemokine, MDC/CCL22) cells were elevated and whether they correlated with the clinical features in patients with AS. METHODS Forty-two patients with axial AS and 25 healthy controls were enrolled into the study. Serum levels of chemokines (IP-10, TARC and MDC) and cytokines (IFN-γ, TNF-α and IL-4) were examined using ELISA. The disease activity was evaluated by Ankylosing Spondylitis Disease Activity Score (ASDAS). Serum levels of IgG, IgA, IgM, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were measured. RESULTS Serum chemokine levels of IP-10, TARC and MDC were significantly higher in patients with AS than those in healthy controls. Serum cytokine levels of IFN-γ, TNF-α were also significantly increased, but the levels of IL-4 were not. Furthermore, IP-10 levels in AS patients correlated with ESP, CRP and ASDAS, while the levels of TARC and MDC did not correlate with these clinic indexes. Correlation analysis between the levels of chemokines and cytokines revealed a positive correlation between IP-10 and TNF-α. The levels of both Th1 and Th2 chemokines decreased under blockade of TNF-α. CONCLUSION Our results suggest that both a Th1 chemoattractant IP-10 and Th2 chemoattractants, TARC and MDC, cooperatively play a role in the development of AS.
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Affiliation(s)
- Jianing Wang
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Qi Zhao
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Gaoya Wang
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Chunshu Yang
- Department of 1st Cancer Institute, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Yong Xu
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Yujia Li
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China
| | - Pingting Yang
- Department of Rheumatology and Immunology, First Affiliated Hospital, China Medical University, Shenyang 110001, People's Republic of China.
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Song HP, Li X, Yu R, Zeng G, Yuan ZY, Wang W, Huang HY, Cai X. Phenotypic characterization of type II collagen-induced arthritis in Wistar rats. Exp Ther Med 2015; 10:1483-1488. [PMID: 26622511 PMCID: PMC4578065 DOI: 10.3892/etm.2015.2667] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2014] [Accepted: 05/01/2015] [Indexed: 11/06/2022] Open
Abstract
The aim of the present study was to determine a more specific, efficient and simple method for the induction of collagen-induced arthritis (CIA) in rats. Different strains of rats were injected at the base of the tail with bovine type II collagen (CII) emulsified in incomplete Freund's adjuvant (IFA). The onset and severity of arthritis were evaluated by clinical assessment. The established CIA model was analyzed using a comprehensive examination of clinical, hematological, histological and radiological parameters. The results demonstrated that Wistar rats were the most susceptible strain to CIA followed by Wistar Furth rats, with Sprague Dawley rats being the least susceptible. Following primary and booster immunization, female Wistar rats developed severe arthritis, with an incidence of >83% and low variability in clinical signs. The development of arthritis was accompanied by a significantly elevated erythrocyte sedimentation rate compared with that in the control rats. The radiographic examination revealed bone matrix resorption, considerable soft tissue swelling, periosteal new bone formation and bone erosion in the arthritic joints of the CIA rats. Histopathologically, the synovial joints of CIA rats were characterized by synovial hyperplasia, pannus formation, marked cellular infiltration, bone and cartilage erosion and narrowing of the joint space. The administration of an intradermal injection of only 200 µg bovine CII emulsified in IFA at the base of the tail therefore leads to the successful development of a CIA rat model. This well-characterized CIA rat model could be specifically used to study the pathophysiology of human rheumatoid arthritis as well as to test and develop anti-arthritic agents for humans.
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Affiliation(s)
- Hou-Pan Song
- Hunan Provincial Key Laboratory of Diagnostics in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Xin Li
- Hunan Provincial Key Laboratory of Diagnostics in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Rong Yu
- Hunan Department of Education's Key Laboratory of Translational Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Guang Zeng
- Hunan Provincial Key Laboratory of Diagnostics in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Zhen-Yi Yuan
- Hunan Department of Education's Key Laboratory of Translational Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Wei Wang
- School of Pharmaceutical Sciences, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Hui-Yong Huang
- Hunan Provincial Key Laboratory of Diagnostics in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China
| | - Xiong Cai
- Hunan Provincial Key Laboratory of Diagnostics in Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410007, P.R. China ; Hunan Department of Education's Key Laboratory of Translational Chinese Medicine, Changsha, Hunan 410007, P.R. China
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Miller A, Nightingale AL, Sammon CJ, Mahtani KR, Holt TA, McHugh NJ, Luqmani RA. Estimating the diagnostic accuracy of rheumatoid factor in UK primary care: a study using the Clinical Practice Research Datalink. Rheumatology (Oxford) 2015; 54:1882-9. [DOI: 10.1093/rheumatology/kev131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Indexed: 11/13/2022] Open
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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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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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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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Gramoun A, Crowe LA, Maurizi L, Wirth W, Tobalem F, Grosdemange K, Coullerez G, Eckstein F, Koenders MI, Van den Berg WB, Hofmann H, Vallée JP. Monitoring the effects of dexamethasone treatment by MRI using in vivo iron oxide nanoparticle-labeled macrophages. Arthritis Res Ther 2014; 16:R131. [PMID: 24957862 PMCID: PMC4095600 DOI: 10.1186/ar4588] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 06/09/2014] [Indexed: 12/14/2022] Open
Abstract
Introduction Rheumatoid arthritis (RA) is a chronic disease causing recurring inflammatory joint attacks. These attacks are characterized by macrophage infiltration contributing to joint destruction. Studies have shown that RA treatment efficacy is correlated to synovial macrophage number. The aim of this study was to experimentally validate the use of in vivo superparamagnetic iron oxide nanoparticle (SPION) labeled macrophages to evaluate RA treatment by MRI. Methods The evolution of macrophages was monitored with and without dexamethasone (Dexa) treatment in rats. Two doses of 3 and 1 mg/kg Dexa were administered two and five days following induction of antigen induced arthritis. SPIONs (7 mg Fe/rat) were injected intravenously and the knees were imaged in vivo on days 6, 10 and 13. The MR images were scored for three parameters: SPION signal intensity, SPION distribution pattern and synovial oedema. Using 3D semi-automated software, the MR SPION signal was quantified. The efficacy of SPIONs and gadolinium chelate (Gd), an MR contrast agent, in illustrating treatment effects were compared. Those results were confirmed through histological measurements of number and area of macrophages and nanoparticle clusters using CD68 immunostaining and Prussian blue staining respectively. Results Results show that the pattern and the intensity of SPION-labeled macrophages on MRI were altered by Dexa treatment. While the Dexa group had a uniform elliptical line surrounding an oedema pocket, the untreated group showed a diffused SPION distribution on day 6 post-induction. Dexa reduced the intensity of SPION signal 50-60% on days 10 and 13 compared to controls (P = 0.00008 and 0.002 respectively). Similar results were found when the signal was measured by the 3D tool. On day 13, the persisting low grade arthritis progression could not be demonstrated by Gd. Analysis of knee samples by Prussian blue and CD68 immunostaining confirmed in vivo SPION uptake by macrophages. Furthermore, CD68 immunostaining revealed that Dexa treatment significantly decreased the area and number of synovial macrophages. Prussian blue quantification corresponded to the macrophage measurements and both were in agreement with the MRI findings. Conclusions We have demonstrated the feasibility of MRI tracking of in vivo SPION-labeled macrophages to assess RA treatment effects.
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Ball EMA, Tan AL, Fukuba E, McGonagle D, Grey A, Steiner G, Bell AL, Rooney MR. A study of erosive phenotypes in lupus arthritis using magnetic resonance imaging and anti-citrullinated protein antibody, anti-RA33 and RF autoantibody status. Rheumatology (Oxford) 2014; 53:1835-43. [PMID: 24850876 DOI: 10.1093/rheumatology/keu215] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The aims of this study were to investigate the extent of MRI-determined joint disease (erosion and synovitis) in SLE and to link this to autoantibody profiles known to be relevant to SLE, including ACPA, RF and anti-RA33 antibodies. METHODS Contrast-enhanced MRI of the hand and wrist was performed in 34 symptomatic SLE patients and in 15 RA patients with similar disease duration. Images were scored by two observers using the OMERACT rheumatoid arthritis MRI scoring (RAMRIS) system. Findings were correlated with clinical examination and autoantibody status. RESULTS Erosions were present at the wrist in 93% of SLE patients and at the MCP joints in 61% of SLE patients. Despite the high prevalence of MRI-determined erosion, only 8.8% of SLE patients were ACPA positive, although these patients had a higher burden of erosive disease. There was no positive correlation with anti-RA33 titres and erosion scores in the SLE patients, but there was a negative correlation with anti-RA33 titres and total bone oedema scores in the SLE patients. Ninety-three per cent of SLE patients had at least grade 1 synovitis at one or more MCP joints, and wrist joint synovitis was present in all the SLE patients. CONCLUSION An MRI-determined joint erosive phenotype is common in SLE, even in ACPA-negative cases. The conventional radiographic observation that anti-RA33 is not positively associated with erosion in patients with RA was also found to be the case in SLE patients.
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Affiliation(s)
- Elisabeth M A Ball
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK. Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
| | - Ai Lyn Tan
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Eiji Fukuba
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Dennis McGonagle
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Arthur Grey
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Günter Steiner
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Aubrey L Bell
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Madeleine R Rooney
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
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Conaghan PG, Peterfy C, Olech E, Kaine J, Ridley D, Dicarlo J, Friedman J, Devenport J, Troum O. The effects of tocilizumab on osteitis, synovitis and erosion progression in rheumatoid arthritis: results from the ACT-RAY MRI substudy. Ann Rheum Dis 2014; 73:810-6. [PMID: 24525910 PMCID: PMC3995246 DOI: 10.1136/annrheumdis-2013-204762] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objective To examine the imaging-detected mechanism of reduction of structural joint damage progression by tocilizumab (TCZ) in patients with rheumatoid arthritis (RA) using MRI. Methods In a substudy of a randomised, double-blind, phase 3b study (ACT-RAY) of biologic-naïve patients with RA who were methotrexate (MTX)-inadequate responders, 63 patients were randomised to continue MTX or receive placebo (PBO), both in combination with TCZ 8 mg/kg every 4 weeks, with optional additional disease-modifying antirheumatic drugs at week 24 if Disease Activity Score of 28 joints < 3.2. The most symptomatic hand was imaged with 0.2 Tesla extremity MRI at weeks 0, 2, 12 and 52. MR images were scored using Outcome Measures in Rheumatology–Rheumatoid Arthritis Magnetic Resonance Imaging Score. Predictors of week 52 erosion progression were determined by logistic regression analysis. Results TCZ + PBO (n=32) demonstrated mean improvements in synovitis from baseline to weeks 2 (−0.92; p=0.0011), 12 (−1.86; p<0.0001) and 52 (−3.35; p<0.0001), while TCZ + MTX (n=31) had mean improvements in synovitis at week 12 (−0.88; p=0.0074), but not week 52 (−1.00; p=0.0711). TCZ+PBO demonstrated mean reductions in osteitis at weeks 12 (−5.10; p=0.0022) and 52 (−8.56; p=0.0006), while TCZ+MTX had mean reductions at weeks 2 (−0.21; p<0.05) and 12 (−3.63; p=0.0008), but not week 52 (−2.31; p=0.9749). Mean erosion scores did not worsen in either group. MRI erosion scores at weeks 12 and 52 correlated strongly with radiography erosion scores at week 52 (r>0.80). Baseline synovitis and worsening of osteitis predicted erosion progression. Conclusions Rapid suppression of synovitis and osteitis with reduction in structural joint damage progression occurred with TCZ, as monotherapy or in combination with MTX, through week 52.
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Affiliation(s)
- Philip G Conaghan
- University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, , Leeds, UK
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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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Bouta EM, Ju Y, Rahimi H, de Mesy-Bentley KL, Wood RW, Xing L, Schwarz EM. Power Doppler ultrasound phenotyping of expanding versus collapsed popliteal lymph nodes in murine inflammatory arthritis. PLoS One 2013; 8:e73766. [PMID: 24040061 PMCID: PMC3767819 DOI: 10.1371/journal.pone.0073766] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 07/30/2013] [Indexed: 11/28/2022] Open
Abstract
Rheumatoid arthritis is a chronic inflammatory disease manifested by episodic flares in affected joints that are challenging to predict and treat. Longitudinal contrast enhanced-MRI (CE-MRI) of inflammatory arthritis in tumor necrosis factor-transgenic (TNF-Tg) mice has demonstrated that popliteal lymph nodes (PLN) increase in volume and contrast enhancement during the pre-arthritic “expanding” phase of the disease, and then suddenly “collapse” during knee flare. Given the potential of this biomarker of arthritic flare, we aimed to develop a more cost-effective means of phenotyping PLN using ultrasound (US) imaging. Initially we attempted to recapitulate CE-MRI of PLN with subcutaneous footpad injection of US microbubbles (DEFINITY®). While this approach allowed for phenotyping via quantification of lymphatic sinuses in PLN, which showed a dramatic decrease in collapsed PLN versus expanding or wild-type (WT) PLN, electron microscopy demonstrated that DEFINITY® injection also resulted in destruction of the lymphatic vessels afferent to the PLN. In contrast, Power Doppler (PD) US is innocuous to and efficiently quantifies blood flow within PLN of WT and TNF-Tg mice. PD-US demonstrated that expanding PLN have a significantly higher normalized PD volume (NPDV) versus collapsed PLN (0.553±0.007 vs. 0.008±0.003; p<0.05). Moreover, we define the upper (>0.030) and lower (<0.016) quartile NPDVs in this cohort of mice, which serve as conservative thresholds to phenotype PLN as expanding and collapsed, respectively. Interestingly, of the 12 PLN phenotyped by the two methods, there was disagreement in 4 cases in which they were determined to be expanding by CE-MRI and collapsed by PD-US. Since the adjacent knee had evidence of synovitis in all 4 cases, we concluded that the PD-US phenotyping was correct, and that this approach is currently the safest and most cost-effective in vivo approach to phenotype murine PLN as a biomarker of arthritic flare.
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Affiliation(s)
- Echoe M. Bouta
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Yawen Ju
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Homaira Rahimi
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Karen L. de Mesy-Bentley
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Ronald W. Wood
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Lianping Xing
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
| | - Edward M. Schwarz
- Center for Musculoskeletal Research, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Biomedical Engineering, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- Department of Urology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- * E-mail:
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Rodríguez-Henríquez P, Solano C, Peña A, León-Hernández S, Hernández-Díaz C, Gutiérrez M, Pineda C. Sternoclavicular Joint Involvement in Rheumatoid Arthritis: Clinical and Ultrasound Findings of a Neglected Joint. Arthritis Care Res (Hoboken) 2013; 65:1177-82. [DOI: 10.1002/acr.21958] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 01/08/2013] [Indexed: 12/18/2022]
Affiliation(s)
| | - Carla Solano
- Hospital Nacional Rosales and Instituto Salvadoreño del Seguro Social; San Salvador; El Salvador
| | - Angélica Peña
- Instituto Nacional de Rehabilitación, Col. Arenal de Guadalupe, Tlalpan; 14389; México; DF; Mexico
| | - Saúl León-Hernández
- Instituto Nacional de Rehabilitación, Col. Arenal de Guadalupe, Tlalpan; 14389; México; DF; Mexico
| | - Cristina Hernández-Díaz
- Instituto Nacional de Rehabilitación, Col. Arenal de Guadalupe, Tlalpan; 14389; México; DF; Mexico
| | | | - Carlos Pineda
- Instituto Nacional de Rehabilitación, Col. Arenal de Guadalupe, Tlalpan; 14389; México; DF; Mexico
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Orguc S, Tikiz C, Aslanalp Z, Erbay PD. Comparison of OMERACT-RAMRIS scores and computer-aided dynamic magnetic resonance imaging findings of hand and wrist as a measure of activity in rheumatoid arthritis. Rheumatol Int 2013; 33:1837-44. [PMID: 23328931 DOI: 10.1007/s00296-012-2658-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 12/28/2012] [Indexed: 01/02/2023]
Abstract
The purpose of this study was to compare the value of conventional magnetic resonance imaging (MRI) finding of rheumatoid arthritis (RA) and computer-aided dynamic MRI measurements in predicting the activity of disease. The activity of the disease in 40 RA patients was evaluated by the disease activity score in 28 joints (DAS28). The conventional MRI of the wrists of all patients were scored for bone edema, synovitis and erosions, according to the criteria of RA-MRI scoring system (RAMRIS) developed by Outcome measures in rheumatology clinical trials (OMERACT) MR Imaging Group. Synovitis was also quantified by dynamic postcontrast MRI imaging using color coded maximum slope of increase maps and measurements of early enhancement rate (EER) and relative enhancement (RE). Twenty-two (55 %) patients with a score higher than 5.1 constituted the high disease activity group, 18 (45 %) patients with a score of 5.1 or less constituted moderate disease activity group. The dynamic MRI-EER score was the most significant parameter to differentiate between the groups (p = 0.001). Among OMERACT scores, only bone edema [p = 0.020 for wrist and p = 0.037 for metacarpophalangeal joints (MCP)] had a significant difference between the two groups. Dynamic MRI RE score and OMERACT scores for erosions and synovitis for both the wrist and MCP joints did not differ significantly between the two groups. Computer-aided dynamic MRI is a reliable, noninvasive method of evaluating the RA patients, which correlates with the DAS28 scores, at a higher significance than the OMERACT-RAMRIS scores.
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Affiliation(s)
- Sebnem Orguc
- Celal Bayar University Hospital, Manisa, Turkey.
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Characterisation of hand small joints arthropathy using high-resolution MRI—Limited discrimination between osteoarthritis and psoriatic arthritis. Eur Radiol 2013; 23:1686-93. [DOI: 10.1007/s00330-012-2739-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 11/20/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022]
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Albrecht A, Finzel S, Englbrecht M, Rech J, Hueber A, Schlechtweg P, Uder M, Schett G. The structural basis of MRI bone erosions: an assessment by microCT. Ann Rheum Dis 2012; 72:1351-7. [PMID: 22993229 DOI: 10.1136/annrheumdis-2012-201982] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine whether erosions appearing in MRI in patients with rheumatoid arthritis (RA) represent true erosions. METHODS 50 RA patients received 1.5 T MRI and microCT (μCT) of the dominant hand. Erosion counts were assessed in coronal T1 weighted MRI sections and in coronal as well as axial μCT sections of the metacarpophalangeal (MCP) joints II-IV. Extent of erosions was assessed by RA MRI Score (RAMRIS) erosion score (MRI) and by three-dimensional assessment of erosion volume (μCT). RESULTS 111 of the 600 evaluated joint regions showed erosions in the MRI and 137 in the μCT. In only 28 regions false negative lesions (μCT positive, MRI negative) were found, all of which were very small lesions with a volume of less than 10 mm(3). Only two results were false-positive (μCT negative, MRI positive). RAMRIS erosion scores were strongly correlated to erosion volumes in the μCT (Pearson's r=0.514, p<0.001). Mean RAMRIS erosion scores were below 1 with erosion volumes up to 1.5 mm(3), below 2 with erosion volumes up to 20 mm(3) and over 2 with volumes of more than 20 mm(3). DISCUSSION MRI erosions are generally based on true cortical breaks as shown by μCT. MRI is sensitive to detect bone erosions and only very small lesions escape detection. Moreover, RAMRIS erosion scores are closely linked to the absolute size of bone erosions in the μCT.
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Affiliation(s)
- Andreas Albrecht
- Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
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Conaghan PG, Durez P, Alten RE, Burmester GR, Tak PP, Klareskog L, Catrina AI, DiCarlo J, Gaillez C, Le Bars M, Zhou X, Peterfy C. Impact of intravenous abatacept on synovitis, osteitis and structural damage in patients with rheumatoid arthritis and an inadequate response to methotrexate: the ASSET randomised controlled trial. Ann Rheum Dis 2012; 72:1287-94. [PMID: 22915624 PMCID: PMC3711370 DOI: 10.1136/annrheumdis-2012-201611] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objectives This randomised, double-blind, placebo-controlled phase IIIb study evaluated the impact of abatacept on MRI pathology as a primary outcome in methotrexate (MTX)-refractory patients with rheumatoid arthritis. Methods Patients received intravenous abatacept (∼10 mg/kg) or placebo, on background MTX, for 4 months, followed by an 8-month open-label extension (OLE; all patients received abatacept plus MTX). Patients had 1.5T MRI with intravenous contrast at baseline, Months 4 and 12; wrist synovitis (three locations assessed), and wrist and hand (15 and eight locations assessed, respectively) osteitis and erosion were scored using OMERACT-RAMRIS. Results 26/27 abatacept- and 23/23 placebo-randomised patients completed Month 4 and entered the OLE; 26 and 21 completed Month 12. The primary endpoint was not achieved; mean change (SD) from baseline in synovitis was −0.44 (1.47) for abatacept versus 0.52 (1.38) for placebo (p=0.103) at Month 4. For mean change in synovitis adjusted for baseline score (sensitivity analysis), the difference between groups was −0.69, p=0.078. Adjusted mean changes (SE) in osteitis and erosion were −1.94 (0.86) and 0.45 (0.43) for abatacept, and 1.54 (0.90) and 0.95 (0.45) for placebo. Further MRI improvements were observed up to Month 12 for abatacept and from Months 4 to 12 for placebo-treated patients switched to abatacept at Month 4. Clinical efficacy was shown with abatacept and sustained to Month 12. Conclusions Despite small patient numbers, MRI detected structural and synovial benefit, sustained to Month 12 in abatacept+MTX-treated patients, and improvements in structural and inflammatory outcomes for placebo+MTX-treated patients following addition of abatacept. Clinical trial registration Clinicaltrials.gov NCT00420199.
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Affiliation(s)
- Philip G Conaghan
- Section of Musculoskeletal Disease, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK.
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Martínez-Calatrava MJ, Prieto-Potín I, Roman-Blas JA, Tardio L, Largo R, Herrero-Beaumont G. RANKL synthesized by articular chondrocytes contributes to juxta-articular bone loss in chronic arthritis. Arthritis Res Ther 2012; 14:R149. [PMID: 22709525 PMCID: PMC3446534 DOI: 10.1186/ar3884] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 05/13/2012] [Accepted: 06/18/2012] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION The receptor activator nuclear factor-kappaB ligand (RANKL) diffuses from articular cartilage to subchondral bone. However, the role of chondrocyte-synthesized RANKL in rheumatoid arthritis-associated juxta-articular bone loss has not yet been explored. This study aimed to determine whether RANKL produced by chondrocytes induces osteoclastogenesis and juxta-articular bone loss associated with chronic arthritis. METHODS Chronic antigen-induced arthritis (AIA) was induced in New Zealand (NZ) rabbits. Osteoarthritis (OA) and control groups were simultaneously studied. Dual X-ray absorptiometry of subchondral knee bone was performed before sacrifice. Histological analysis and protein expression of RANKL and osteoprotegerin (OPG) were evaluated in joint tissues. Co-cultures of human OA articular chondrocytes with peripheral blood mononuclear cells (PBMCs) from healthy donors were stimulated with macrophage-colony stimulating factor (M-CSF) and prostaglandin E2 (PGE2), then further stained with tartrate-resistant acid phosphatase. RESULTS Subchondral bone loss was confirmed in AIA rabbits when compared with controls. The expression of RANKL, OPG and RANKL/OPG ratio in cartilage were increased in AIA compared to control animals, although this pattern was not seen in synovium. Furthermore, RANKL expression and RANKL/OPG ratio were inversely related to subchondral bone mineral density. RANKL expression was observed throughout all cartilage zones of rabbits and was specially increased in the calcified cartilage of AIA animals. Co-cultures demonstrated that PGE2-stimulated human chondrocytes, which produce RANKL, also induce osteoclasts differentiation from PBMCs. CONCLUSIONS Chondrocyte-synthesized RANKL may contribute to the development of juxta-articular osteoporosis associated with chronic arthritis, by enhancing osteoclastogenesis. These results point out a new mechanism of bone loss in patients with rheumatoid arthritis.
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Affiliation(s)
- Maria J Martínez-Calatrava
- Bone and Joint Research Unit, Service of Rheumatology, IIS Fundación Jiménez D237;az, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - Ivan Prieto-Potín
- Bone and Joint Research Unit, Service of Rheumatology, IIS Fundación Jiménez D237;az, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - Jorge A Roman-Blas
- Bone and Joint Research Unit, Service of Rheumatology, IIS Fundación Jiménez D237;az, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - Lidia Tardio
- Bone and Joint Research Unit, Service of Rheumatology, IIS Fundación Jiménez D237;az, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - Raquel Largo
- Bone and Joint Research Unit, Service of Rheumatology, IIS Fundación Jiménez D237;az, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain
| | - Gabriel Herrero-Beaumont
- Bone and Joint Research Unit, Service of Rheumatology, IIS Fundación Jiménez D237;az, Universidad Autónoma, Av. Reyes Católicos 2, 28040, Madrid, Spain
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Kosta PE, Voulgari PV, Zikou AK, Tsampoulas K, Drosos AA, Argyropoulou MI. Effect of very early treatment in rheumatoid arthritis on bone oedema and synovitis, using magnetic resonance imaging. Scand J Rheumatol 2012; 41:339-44. [PMID: 22646866 DOI: 10.3109/03009742.2012.666263] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To evaluate the magnetic resonance imaging (MRI) findings of hand involvement before and 1 year after treatment in patients with early rheumatoid arthritis (RA). METHOD MRI of the dominant hand was performed in 22 patients fulfilling the new criteria for early RA. The patients were divided into three groups. Nine had very early RA (VERA; disease duration < 3 months), seven had early RA (ERA; disease duration < 6 months), and six had established RA (ESTRA; disease duration > 12 months). The MRI protocol consisted of fat-suppressed T2, and plain and contrast-enhanced T1-weighted sequences. Assessment of bone marrow oedema, synovitis, and bone erosions was performed by the OMERACT RA MRI scoring system. Patients were treated with methotrexate (MTX) 0.2 mg/kg/body weight/week and prednisone 7.5 mg/day. Clinical assessment was evaluated using the Disease Activity Score for 28 joint indices (DAS28). RESULTS After treatment, a significant decrease was observed: (a) in DAS28 of VERA (6.2 ± 0.9 vs. 2.4 ± 1.2), ERA (5.3 ± 0.8 vs. 2.8 ± 1.0), and ESTRA patients (5.7 ± 8.0 vs. 2.7 ± 0.7; p < 0.05); (b) in bone oedema (16.77 ± 13.78 vs. 5.88 ± 6.31) and synovitis (12.44 ± 6.44 vs. 2.88 ± 3.25) of VERA patients; and (c) in synovitis (7.57 ± 6.32 vs. 1.42 ± 1.81) of ERA patients (p < 0.05). No significant difference was found in erosions in any group. CONCLUSION Bone marrow oedema and synovitis decrease significantly when RA is diagnosed and treated early. MRI is useful in the early detection of these changes. MTX treatment resulted in a significant decrease in DAS28 score and significant improvement in bone oedema and synovitis.
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Affiliation(s)
- P E Kosta
- Department of Clinical Imaging and Radiology, Medical School, University of Ioannina, Greece
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Contrast-Enhanced Magnetic Resonance Imaging Positively Impacts the Management of Some Patients With Rheumatoid Arthritis or Suspected RA. J Clin Rheumatol 2012; 18:15-22. [DOI: 10.1097/rhu.0b013e31823e5ab3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Olivieri M, Gerardi MC, Spinelli FR, Di Franco M. A Focus on the Diagnosis of Early Rheumatoid Arthritis. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/ijcm.2012.37116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Demertzis JL, Rubin DA. MR imaging assessment of inflammatory, crystalline-induced, and infectious arthritides. Magn Reson Imaging Clin N Am 2011; 19:339-63. [PMID: 21665094 DOI: 10.1016/j.mric.2011.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The role of magnetic resonance imaging in evaluating patients with inflammatory arthritides has evolved with the recent introduction of drugs capable of modifying disease activity and natural history. In conditions like rheumatoid arthritis, active synovitis and bone marrow inflammation precede and predict bone and cartilage erosion. These imaging findings identify patients who can be treated early and aggressively to prevent future morbidity. Similarly, in gout and other crystalline disorders, specific diagnosis aided by imaging may lead to earlier medical and surgical management. Infected joints need the most rapid identification to institute immediate therapy and prevent irreversible cartilage destruction.
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Affiliation(s)
- Jennifer L Demertzis
- Division of Musculoskeletal Radiology, Mallinckrodt Institute of Radiology, 510 South Kingshighway Boulevard, Campus Box 8131, St Louis, MO 63110, USA.
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Kosta PE, Voulgari PV, Zikou AK, Drosos AA, Argyropoulou MI. The usefulness of magnetic resonance imaging of the hand and wrist in very early rheumatoid arthritis. Arthritis Res Ther 2011; 13:R84. [PMID: 21658223 PMCID: PMC3218898 DOI: 10.1186/ar3355] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/18/2011] [Accepted: 06/09/2011] [Indexed: 11/25/2022] Open
Abstract
Introduction Magnetic resonance imaging (MRI) was used to study the hand and wrist in very early rheumatoid arthritis (RA), and the results were compared with early and established disease. Methods Fifty-seven patients fulfilling the new American College of Rheumatology criteria for RA, 26 with very early RA (VERA), 18 with early RA (ERA), and 13 with established RA (ESTRA), (disease duration < 3 months, < 12 months, and > 12 months, respectively) were enrolled in the study. MRI of the dominant hand and wrist was performed by using fat-suppressed T2-weighted and plain and contrast-enhanced T1-weighted sequences. Evaluation of bone marrow edema, synovitis, and bone erosions was performed with the OMERACT RA MRI scoring system. Results Edema, erosions, and synovitis were present in VERA, and the prevalence was 100%, 96.15%, and 92.3%, respectively. Significant differences in edema and erosions were found between VERA and ESTRA (P < 0.05). No significant difference was found in synovitis. Conclusions Edema, erosions, and synovitis are findings of very early RA. MRI, by detecting these lesions, may play an important role in the management of these patients.
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Affiliation(s)
- Paraskevi E Kosta
- Department of Clinical Imaging and Radiology Medical School, University of Ioannina, 45110, Ioannina, Greece
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Okochi K, Kretapirom K, Sumi Y, Kurabayashi T. Longitudinal MRI follow-up of rheumatoid arthritis in the temporomandibular joint: importance of synovial proliferation as an early-stage sign. Oral Radiol 2011; 27:83-86. [PMID: 21836772 PMCID: PMC3150820 DOI: 10.1007/s11282-011-0063-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 02/21/2011] [Indexed: 10/27/2022]
Abstract
This article describes longitudinal magnetic resonance imaging (MRI) observations in a patient with rheumatoid arthritis of the temporomandibular joint. The characteristic findings included marked synovial proliferation, which was observed before the onset of severe bone destruction. MRI is considered to provide valuable information for the early detection of rheumatoid arthritis of the temporomandibular joint.
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Bird P, Joshua F. New applications of imaging techniques for monitoring progression of rheumatoid arthritis and predicting outcome. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.10.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dale J, Porter D. Pharmacotherapy: concepts of pathogenesis and emerging treatments. Optimising the strategy of care in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 2010; 24:443-55. [PMID: 20732643 DOI: 10.1016/j.berh.2009.11.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
In rheumatoid arthritis (RA), early use of disease-modifying anti-rheumatic drugs (DMARDs), intensive follow-up and 'treating to target' to achieve low disease activity produce significant improvements in measures of disease activity, functional impairment and retard erosive radiographic progression. Step-up, parallel and step-down regimens are all significantly more effective than sequential monotherapy; although the most effective regimen has not been established. Minimising the period of exposure to synovitis, by including a rapidly acting agent (e.g., corticosteroids or tumour necrosis factor alpha (TNFalpha) inhibitor), may slow radiographic progression further. Biologic therapies, especially TNFalpha inhibitors, are effective in early RA; however, their exact role is unclear. Current measures may overestimate the number of patients in clinical remission; therefore, musculoskeletal ultrasound and/or novel biomarkers may also have a role. Pre-clinical immunological markers could possibly be used to trigger pre-emptive treatment in asymptomatic, 'at risk' individuals. Potential treatment developments include combining biologic agents or targeting alternative immunological pathways.
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Affiliation(s)
- James Dale
- Division of Immunology, Infection and Inflammation, University of Glasgow, Glasgow, Scotland, UK.
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McGonagle D, Ash ZR, Hodgson RJ, Emery P, Radjenovic A. MRI for the assessment and monitoring of RA--what can it tell us? Nat Rev Rheumatol 2010; 7:185-9. [PMID: 20956990 DOI: 10.1038/nrrheum.2010.172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The past 15 years has seen an exponential rise in the use of MRI for the assessment of rheumatoid arthritis (RA). In this Perspectives article, we review the current and potential future role of MRI in the diagnosis, prognosis and monitoring of RA. We also review the impact of MRI research on the understanding of disease mechanisms. In our view, the pivotal role of synovitis in RA and its predilection for sonographically accessible joints makes it likely that MRI will be used diagnostically in joints that are inaccessible to ultrasonography or where the differential diagnosis is unclear. Additionally, MRI will probably assume an even more prominent role in clinical trials where the aim of therapy is the complete ablation of synovitis. Given the ever-increasing sophistication of MRI, we anticipate that it will continue to be a key research tool in the coming years.
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Affiliation(s)
- Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Academic Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Chapeltown Road, Leeds, UK.
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Temporomandibular joint bone tissue resorption in patients with early rheumatoid arthritis can be predicted by joint crepitus and plasma glutamate level. Mediators Inflamm 2010; 2010:627803. [PMID: 20671920 PMCID: PMC2910501 DOI: 10.1155/2010/627803] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 04/20/2010] [Accepted: 05/21/2010] [Indexed: 11/18/2022] Open
Abstract
The aim was to investigate whether bone tissue resorption in early RA is related to crepitus of the temporomandibular joint (TMJ) and systemic levels of inflammatory mediators and markers and sex steroid hormones.
Twentynine women and 18 men with recently diagnosed RA were examined for TMJ bone erosions with computerized tomography and TMJ crepitus was assessed. Blood samples were analyzed for glutamate, 5-HT, TNF, IL-1β, IL-6, VEGF, inflammatory markers, and estradiol, progesterone and testosterone.
The TMJ erosion score was positively correlated to glutamate, and TMJ crepitus where crepitus, glutamate and ESR explained 40% of the variation in the bone erosion score. In the patients without crepitus, bone erosion score was positively correlated to glutamate, which was not the case in the patients with crepitus.
In conclusion, the results of this study show that TMJ bone tissue resorption can be predicted by TMJ crepitus and glutamate in early RA.
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Cheung PP, Dougados M, Gossec L. Reliability of ultrasonography to detect synovitis in rheumatoid arthritis: a systematic literature review of 35 studies (1,415 patients). Arthritis Care Res (Hoboken) 2010; 62:323-34. [PMID: 20391478 DOI: 10.1002/acr.20102] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To perform a systematic review on the reliability of ultrasonographic (US) synovitis detection in rheumatoid arthritis (RA) by B-mode and power Doppler (PD) in image acquisition and still-image interpretation. US is a sensitive method for synovitis detection. However, reliability is still a key concern. METHODS Articles reporting any US reliability results for synovitis in RA in PubMed, EMBase, the Cochrane Library, and meeting abstracts were selected. Data were extracted from the collection of data on US synovitis detection (either qualitatively [binary] or semiquantitatively [0-3 scale], for intraobserver and interobserver reliability in B-mode and PD, and for image acquisition and still-image interpretation). The type of joints tested, the experience of the ultrasonographer, and the quality of the studies were assessed. Data analysis involved descriptive and graphic interpretation of reliability and its potential determinants. RESULTS Thirty-five studies (12 for B-mode, 11 for PD, or 12 for both) with a total of 1,415 patients were analyzed. Intraobserver and interobserver reliability for still images in B-mode and PD was high (kappa = 0.5-1.0 [14,991 joints] for intraobserver reliability for B-mode, kappa = 0.59-1.0 [14,934 joints] for PD, kappa = 0.49-1.0 [3,138 joints] for interobserver for B-mode, and kappa = 0.66-1.0 [3,325 joints] for PD). Interobserver reliability for image acquisition in both US modes was lower than still-image interpretation (kappa = 0.22-0.95). Few studies reported intraobserver image acquisition reliability. CONCLUSION Intraobserver and interobserver reliability of still-image interpretation was high, especially for PD, in published studies involving highly trained observers. However, reliability of acquisition of US should be further assessed.
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Affiliation(s)
- Peter P Cheung
- Paris Descartes University, Cochin Hospital, Paris, France.
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Narváez JA, Narváez J, De Lama E, De Albert M. MR imaging of early rheumatoid arthritis. Radiographics 2010; 30:143-63; discussion 163-5. [PMID: 20083591 DOI: 10.1148/rg.301095089] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Early diagnosis and treatment have been recognized as essential for improving clinical outcomes in patients with early rheumatoid arthritis. However, diagnosis is somewhat difficult in the early stages of the disease because the diagnostic criteria were developed from data obtained in patients with established rheumatoid arthritis and therefore are not readily applicable. Magnetic resonance (MR) imaging is increasingly being used in the assessment of rheumatoid arthritis due to its capacity to help identify the key pathologic features of this disease entity at presentation. MR imaging has demonstrated greater sensitivity for the detection of synovitis and erosions than either clinical examination or conventional radiography and can help establish an early diagnosis of rheumatoid arthritis. It also allows the detection of bone marrow edema, which is thought to be a precursor for the development of erosions in early rheumatoid arthritis as well as a marker of active inflammation. In addition, MR imaging can help differentiate rheumatoid arthritis from some clinical subsets of peripheral spondyloarthropathies by allowing identification of inflammation at the insertions of ligaments and tendons (enthesitis).
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Affiliation(s)
- José A Narváez
- Departments of Radiology and Rheumatology, Hospital Universitario de Bellvitge, Feixa Llarga s/n, L'Hospitalet de Llobregat, Spain.
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McGonagle D. The history of erosions in rheumatoid arthritis: are erosions history? ACTA ACUST UNITED AC 2010; 62:312-5. [PMID: 20112356 DOI: 10.1002/art.27199] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Detection of bone erosion in early rheumatoid arthritis: ultrasonography and conventional radiography versus non-contrast magnetic resonance imaging. Clin Rheumatol 2010; 29:883-91. [DOI: 10.1007/s10067-010-1423-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2009] [Revised: 02/06/2010] [Accepted: 02/22/2010] [Indexed: 10/19/2022]
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