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Watanabe K, Chiba K, Shiraishi K, Iida T, Iwamoto N, Yonekura A, Kawakami A, Osaki M. Microarchitectural analysis of the metacarpophalangeal joint using HR-pQCT in patients with rheumatoid arthritis: A comparison with healthy controls. Bone 2024; 189:117250. [PMID: 39237048 DOI: 10.1016/j.bone.2024.117250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 08/06/2024] [Accepted: 09/02/2024] [Indexed: 09/07/2024]
Abstract
OBJECTIVE To investigate which joint microarchitectural parameters measured by high-resolution peripheral quantitative computed tomography (HR-pQCT) serve as imaging markers for rheumatoid arthritis (RA). METHODS The second and third metacarpophalangeal (MCP) joints of 50 patients with RA and 50 healthy controls (HCs) (aged 50-79 years, all females) were scanned using a HR-pQCT. Joint space, trabecular bone microarchitecture, and erosion were measured and compared between RA patients and HCs. RESULTS There were no differences in joint space parameters between RA patients and HCs. For bone microarchitecture, RA patients had lower trabecular bone mineral density (127 vs. 167 mg/cm3), thinner trabecular thickness (0.20 vs. 0.21 mm), fewer trabecular number (1.49 vs. 1.55 /mm), more rod-like structure (1.68 vs. 1.23), and poorer trabecular connectivity (4.51 vs. 5.72 /mm3) than HCs. Regarding erosion, RA patients had a higher number of erosions per joint (36/100 vs. 18/100), larger volume (4.62 vs. 1.89 mm3), and longer width (2.40 vs. 1.82 mm) and longer length (2.34 vs. 1.64 mm) than HCs. Most of the erosions in HCs were <5 mm3 in volume (95 %) and located on the radial side (85 %). When erosions <5 mm3 were compared between RA patients and HCs, there were no differences in their location or morphology. CONCLUSIONS Deterioration of bone microarchitecture and existences of erosions >5 mm3 in the MCP joints are sensitive imaging markers of RA. Erosions <5 mm3 in RA patients may include not only early pathological erosion but also physiological erosion because even HCs can have erosions <5 mm3.
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Affiliation(s)
- Kounosuke Watanabe
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Ko Chiba
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
| | - Kazuteru Shiraishi
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Iida
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Akihiko Yonekura
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Division of Advanced Preventive Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Makoto Osaki
- Department of Orthopedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kenney HM, Chen KL, Schnur L, Fox JI, Wood RW, Xing L, Ritchlin CT, Rahimi H, Schwarz EM, Awad HA. High-throughput micro-CT analysis identifies sex-dependent biomarkers of erosive arthritis in TNF-Tg mice and differential response to anti-TNF therapy. PLoS One 2024; 19:e0305623. [PMID: 38968295 PMCID: PMC11226038 DOI: 10.1371/journal.pone.0305623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 06/03/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Development of reliable disease activity biomarkers is critical for diagnostics, prognostics, and novel drug development. Although computed tomography (CT) is the gold-standard for quantification of bone erosions, there are no consensus approaches or rationales for utilization of specific outcome measures of erosive arthritis in complex joints. In the case of preclinical models, such as sexually dimorphic tumor necrosis factor transgenic (TNF-Tg) mice, disease severity is routinely quantified in the ankle through manual segmentation of the talus or small regions of adjacent bones primarily due to the ease in measurement. Herein, we sought to determine the particular hindpaw bones that represent reliable biomarkers of sex-dependent disease progression to guide future investigation and analysis. METHODS Hindpaw micro-CT was performed on wild-type (n = 4 male, n = 4 female) and TNF-Tg (n = 4 male, n = 7 female) mice at monthly intervals from 2-5 (females) and 2-8-months (males) of age, since female TNF-Tg mice exhibit early mortality from cardiopulmonary disease at approximately 5-6-months. Further, 8-month-old WT (n = 4) and TNF-Tg males treated with anti-TNF monoclonal antibodies (n = 5) or IgG placebo isotype controls (n = 6) for 6-weeks were imaged with micro-CT every 3-weeks. For image analysis, we utilized our recently developed high-throughput and semi-automated segmentation strategy in Amira software. Synovial and osteoclast histology of ankle joints was quantified using Visiopharm. RESULTS First, we demonstrated that the accuracy of automated segmentation, determined through analysis of ~9000 individual bones by a single user, was comparable in wild-type and TNF-Tg hindpaws before correction (79.2±8.9% vs 80.1±5.1%, p = 0.52). Compared to other bone compartments, the tarsal region demonstrated a sudden, specific, and significant bone volume reduction in female TNF-Tg mice, but not in males, by 5-months (4-months 4.3± 0.22 vs 5-months 3.4± 0.62 mm3, p<0.05). Specifically, the cuboid showed significantly reduced bone volumes at early timepoints compared to other tarsals (i.e., 4-months: Cuboid -24.1±7.2% vs Talus -9.0±5.9% of 2-month baseline). Additional bones localized to the anterolateral region of the ankle also exhibited dramatic erosions in the tarsal region of females, coinciding with increased synovitis and osteoclasts. In TNF-Tg male mice with severe arthritis, the talus and calcaneus exhibited the most sensitive response to anti-TNF therapy measured by effect size of bone volume change over treatment period. CONCLUSIONS We demonstrated that sexually dimorphic changes in arthritic hindpaws of TNF-Tg mice are bone-specific, where the cuboid serves as a reliable early biomarker of erosive arthritis in female mice. Adoption of automated segmentation approaches in pre-clinical or clinical models has potential to translate quantitative biomarkers to monitor bone erosions in disease and evaluate therapeutic efficacy.
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Affiliation(s)
- H. Mark Kenney
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Kiana L. Chen
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Lindsay Schnur
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Jeffrey I. Fox
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Ronald W. Wood
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Urology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Lianping Xing
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Christopher T. Ritchlin
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Medicine, Division of Allergy, Immunology, Rheumatology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Homaira Rahimi
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Pediatrics, Pediatric Rheumatology, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Edward M. Schwarz
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Pathology & Laboratory Medicine, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Urology, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Medicine, Division of Allergy, Immunology, Rheumatology, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, United States of America
| | - Hani A. Awad
- Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Biomedical Engineering, University of Rochester Medical Center, Rochester, NY, United States of America
- Department of Orthopaedics, University of Rochester Medical Center, Rochester, NY, United States of America
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Ribeiro SCCR, Sales LP, Fernandes AL, Perez MO, Takayama L, Caparbo VF, Assad APL, Aiwaka NE, Goldenstein-Schainberg C, Borba EF, Domiciano DS, Figueiredo CP, Pereira RM. Bone erosions associated with systemic bone loss on HR-pQCT in women with longstanding polyarticular juvenile idiopathic arthritis. Semin Arthritis Rheum 2023; 63:152247. [PMID: 37595510 DOI: 10.1016/j.semarthrit.2023.152247] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 07/06/2023] [Accepted: 07/24/2023] [Indexed: 08/20/2023]
Abstract
OBJECTIVES To analyze longstanding polyarticular juvenile idiopathic arthritis (pJIA) for possible associations between localized bone damage (erosions), and systemic bone loss. Besides, to compare the systemic bone mass of pJIA with healthy controls. METHODS Thirty-four pJIA women and 99 healthy controls (HC) were included. Radius and tibia of all subjects were scanned by HR-pQCT. Volumetric bone mineral density (vBMD), bone microarchitecture, and -finite element parameters were analyzed. Patients underwent HR-pQCT of 2nd and 3rd metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of the dominant hand, for bone erosions quantification. RESULTS The mean age of patients was 31.5 ± 7.4yrs with a mean disease duration of 21.7 ± 9.2yrs. Bone erosions were detectable in 79% of patients. The number of bone erosions was positively correlated with cortical porosity (Ct.Po) at tibia (r = 0.575, p = 0.001), and radius (r = 0.423, p = 0.018); and negatively correlated with cortical vBMD at tibia (r=-0.420, p = 0.015). In a logistic regression analysis, adjusted for anti-CCP, the presence of bone erosions was independently associated with Ct.Po at radius (p = 0.018) and cortical vBMD at tibia (p = 0.020). Moreover, cortical and trabecular vBMD, trabecular number, and μ-finite element parameters were decreased in patients compared to HC (p < 0.05). CONCLUSION Bone erosions in longstanding pJIA women were associated with decreased cortical bone parameters, and these patients showed systemic bone impairment at peripheral sites compared with healthy controls.
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Affiliation(s)
- Surian Clarisse C R Ribeiro
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lucas P Sales
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Alan L Fernandes
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Mariana O Perez
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Liliam Takayama
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Valeria F Caparbo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Paula L Assad
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Nadia E Aiwaka
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Cláudia Goldenstein-Schainberg
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Eduardo F Borba
- Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Diogo S Domiciano
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Camille P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil.
| | - Rosa Mr Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, Brazil; Rheumatology Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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Fayed HL, Shahin AA, El-Bohy AEMM, Younis SS. Comparative assessment of hepatitis C virus-related arthritis and rheumatoid arthritis: Relation to clinical, serologic and ultrasonographic characteristics. THE EGYPTIAN RHEUMATOLOGIST 2023. [DOI: 10.1016/j.ejr.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Subhas N, Wu F, Fox MG, Nacey N, Aslam F, Blankenbaker DG, Caracciolo JT, DeJoseph DA, Frick MA, Jawetz ST, Said N, Sandstrom CK, Sharma A, Stensby JD, Walker EA, Chang EY. ACR Appropriateness Criteria® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis, Crystalline Arthritis, or Erosive Osteoarthritis: 2022 Update. J Am Coll Radiol 2023; 20:S20-S32. [PMID: 37236743 DOI: 10.1016/j.jacr.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 05/28/2023]
Abstract
Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity because there is significant overlap of imaging findings among the various types of arthritis. This document provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances in which peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
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Affiliation(s)
| | - Fangbai Wu
- Research Author, Cleveland Clinic Foundation, Cleveland, Ohio.
| | - Michael G Fox
- Program Director and Panel Chair, Mayo Clinic Arizona, Phoenix, Arizona
| | - Nicholas Nacey
- Panel Vice-Chair, University of Virginia Health System, Charlottesville, Virginia
| | - Fawad Aslam
- Mayo Clinic, Scottsdale, Arizona, Rheumatologist
| | - Donna G Blankenbaker
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Jamie T Caracciolo
- Section Head, Musculoskeletal Imaging, Moffitt Cancer Center and University of South Florida Morsani College of Medicine, Tampa, Florida; and Chair, MSK-RADS (Bone) Committee
| | | | - Matthew A Frick
- Chair of Education, Department of Radiology, Chair of Musculoskeletal Imaging, Mayo Clinic, Rochester, Minnesota
| | | | - Nicholas Said
- Duke University Medical Center, Durham, North Carolina
| | - Claire K Sandstrom
- University of Washington Medical Center, Seattle, Washington; Committee on Emergency Radiology-GSER
| | - Akash Sharma
- Mayo Clinic, Jacksonville, Florida; Commission on Nuclear Medicine and Molecular Imaging
| | | | - Eric A Walker
- Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania and Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Eric Y Chang
- Specialty Chair, VA San Diego Healthcare System, San Diego, California
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Baksa G, Czeibert K, Sharp V, Handschuh S, Gyebnar J, Barany L, Benis S, Nyiri G, Mandl P, Petnehazy O, Balint PV. Vascular supply of the metacarpophalangeal joint. Front Med (Lausanne) 2022; 9:1015895. [PMID: 36341235 PMCID: PMC9630748 DOI: 10.3389/fmed.2022.1015895] [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: 08/10/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To describe in detail the arterial vasculature of metacarpophalangeal joints 2–5 on cadaver specimens and to compare it to ultrasound imaging of healthy subjects. Methods Eighteen hands of donated human cadavers were arterially injected and investigated with either corrosion casting or cryosectioning. Each layer of cryosectioned specimens was photographed in high-resolution. Images were then segmented for arterial vessels of the metacarpophalangeal (MCP) joints 2–5. The arterial pattern of the joints was reconstructed from the segmented images and from the corrosion cast specimens. Both hands of ten adult healthy volunteers were scanned focusing on the vasculature of the same joints with high-end ultrasound imaging, including color Doppler. Measurements were made on both cryosectioned arteries and Doppler images. Results The arterial supply of MCP joints 2–5 divides into a metacarpal and a phalangeal territory, respectively. The metacarpal half receives arteries from the palmar metacarpal arteries or proper palmar digital arteries, while the phalangeal half is supplied by both proper and common palmar digital arteries. Comparing anatomical and ultrasonographic results, we determined the exact anatomic location of normal vessels using Doppler images acquired of healthy joints. All, except three branches, were found with less than 50% frequency using ultrasound. Doppler signals were identified significantly more frequently in MCP joints 2–3 than on 4–5 (p < 0.0001). Similarly, Doppler signals differed in the number of detectable small, intraarticular vessels (p < 0.009), but not that of the large extraarticular ones (p < 0.1373). When comparing measurements acquired by ultrasound and on cadaver vessels, measurements using the former technique were found to be larger in all joints (p < 0.0001). Conclusion Using morphological and ultrasonographic techniques, our study provides a high-resolution anatomical maps and an essential reference data set on the entire arterial vasculature of healthy human MCP 2–5 joints. We found that Doppler signal could be detected in less than 50% of the vessels of healthy volunteers except three locations. Intraarticular branches were detected with ultrasound imaging significantly more frequently on healthy MCP 2–3 joints, which should be taken into account when inflammatory and normal Doppler signals are evaluated. Our study also provides reference data for future, higher-resolution imaging techniques.
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Affiliation(s)
- Gabor Baksa
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
- *Correspondence: Gabor Baksa,
| | - Kalman Czeibert
- Department of Ethology, Institute of Biology, Eötvös Loránd University, Budapest, Hungary
| | - Veronika Sharp
- Division of Rheumatology, Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA, United States
| | - Stephan Handschuh
- VetCore Facility for Research, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Janos Gyebnar
- Medical Imaging Centre, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Laszlo Barany
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
- Department of Neurosurgery, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Szabolcs Benis
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Gabor Nyiri
- Laboratory of Cerebral Cortex Research, Institute of Experimental Medicine, Budapest, Hungary
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Ors Petnehazy
- Medicopus Non-profit Ltd, Kaposvar, Hungary
- Justanatomy Ltd, Kaposvar, Hungary
| | - Peter Vince Balint
- Károly Rácz Doctoral School of Clinical Medicine, Semmelweis University, Budapest, Hungary
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
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Andreev D, Kachler K, Schett G, Bozec A. Rheumatoid arthritis and osteoimmunology: The adverse impact of a deregulated immune system on bone metabolism. Bone 2022; 162:116468. [PMID: 35688359 DOI: 10.1016/j.bone.2022.116468] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/30/2022] [Accepted: 06/06/2022] [Indexed: 11/20/2022]
Abstract
The term osteoimmunology describes an interdisciplinary research field that links the investigation of osteology (bone cells) with immunology. The crosstalk between innate and adaptive immune cells and cells involved in bone remodeling, mainly bone-resorbing osteoclasts and bone-forming osteoblasts, becomes particularly obvious in the inflammatory autoimmune disease rheumatoid arthritis (RA). Besides striking inflammation of the joints, RA causes bone loss, leading to joint damage and disabilities as well as generalized osteoporosis. Mechanistically, RA-associated immune cells (macrophages, T cells, B cells etc.) produce high levels of pro-inflammatory cytokines, receptor activator of nuclear factor κB ligand (RANKL) and autoantibodies that promote bone degradation and at the same time counteract new bone formation. Today, antirheumatic therapy effectively ceases joint inflammation and arrests bone erosion. However, the repair of established bone lesions still presents a challenging task and requires improved treatment options. In this review, we outline the knowledge gained over the past years about the immunopathogenesis of RA and the impact of a dysregulated immune system on bone metabolism.
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Affiliation(s)
- Darja Andreev
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany
| | - Katerina Kachler
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany.
| | - Georg Schett
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany
| | - Aline Bozec
- Department of Internal Medicine 3 - Rheumatology and Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany; Deutsches Zentrum für Immuntherapie (DZI), Erlangen, Germany.
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Naredo E, Rodriguez-Garcia SC, Terslev L, Martinoli C, Klauser A, Hartung W, Hammer HB, Cantisani V, Zaottini F, Vlad V, Uson J, Todorov P, Tesch C, Sudoł-Szopińska I, Simoni P, Serban O, Sconfienza LM, Sala-Blanch X, Plagou A, Picasso R, Özçakar L, Najm A, Möller I, Micu M, Mendoza-Cembranos D, Mandl P, Malattia C, Lenghel M, Kessler J, Iohom G, de la Fuente J, DʼAgostino MA, Collado P, Bueno A, Bong D, Alfageme F, Bilous D, Gutiu R, Marian A, Pelea M, Fodor D. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:252-273. [PMID: 34734404 DOI: 10.1055/a-1640-9183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | | | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Maria Antonietta DʼAgostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Wang X, Shen Y, Zhuang X, Wang N, Zhang Q, Zhu L, Liu Y, Lu X, Qin L, Zhang Q. Jintiange Capsule Alleviates Rheumatoid Arthritis and Reverses Changes of Serum Metabolic Profile in Collagen-Induced Arthritic Rats. J Inflamm Res 2021; 14:6685-6706. [PMID: 34949931 PMCID: PMC8688834 DOI: 10.2147/jir.s338107] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Purpose Jintiange capsule (JTG), an approved drug developed as a substitute for tiger bone (TB), has been clinically applied for osteoporosis therapy since 2003. The drug is composed of bionic TB powder, in which peptides and proteins are primarily enriched from other bone extracts. However, as a precious material of traditional Chinese medicine (TCM), TB has been mainly understood and used in TCM to relieve osteoporosis, rheumatoid arthritis and bone injury. Inspired by those, the purpose of this study was to investigate whether JTG also had an effect on relieving rheumatoid arthritis in collagen-induced arthritic (CIA) rats and explore potential mechanism from the perspective of serum metabolic profile changes. Methods JTG was analyzed using Nano LC-MS/MS and orally administered in CIA rats for 6 weeks. After administration, intervention effects of JTG on synovial inflammation, bone micro-architecture and bone metabolism were studied, and the impact of JTG on serum metabolic profiles in CIA rats was investigated by metabolomics. Results Nine bioactive peptides were identified in JTG. In animal treatments, JTG alleviated paw swelling (P < 0.01), arthritic severity (P < 0.01) and synovial tissue proliferation, as well as inflammatory cell infiltration of ankle joint, decreased bone loss, improved microstructure of bone in CIA rats by regulating bone absorption and formation, specifically increasing bone mineral density (BMD) (P < 0.05), bone volume fraction (BVF) (P < 0.05), trabecular number (Tb.N) (P < 0.05) and decreasing trabecular separation (Tb.Sp) (P < 0.05). Besides, serum IL-6 was down-regulated remarkably in CIA rats (P < 0.05). Furthermore, metabolomics analysis revealed that 32 metabolites were regulated significantly (P < 0.05) by comparison between CIA model and JTG in 360 mg/kg dose. The pathway analysis implied that JTG was involved in regulation of biosynthesis of phenylalanine. Conclusion JTG alleviates rheumatoid arthritis and reverses changes in serum metabolic profile in CIA rats. ![]()
Point your SmartPhone at the code above. If you have a QR code reader, the video abstract will appear. Or use: https://youtu.be/fgIlcSWmw_Y
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Affiliation(s)
- Xiaoyan Wang
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Yi Shen
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Xinying Zhuang
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Na Wang
- Ginwa Enterprise (Group) INC, Xi'an, 710069, People's Republic of China
| | - Qi Zhang
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Lulin Zhu
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Yuling Liu
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Xinyu Lu
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Luping Qin
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
| | - Qiaoyan Zhang
- School of Pharmaceutical Sciences, Zhejiang Chinese Medical University, Hangzhou, 310053, People's Republic of China
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10
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Wen J, Liu J, Xin L, Wan L, Jiang H, Sun Y, Sun Y, Wang X, Wang J. Effective factors on Sharp Score in patients with rheumatoid arthritis: a retrospective study. BMC Musculoskelet Disord 2021; 22:865. [PMID: 34627206 PMCID: PMC8502366 DOI: 10.1186/s12891-021-04742-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 09/27/2021] [Indexed: 02/07/2023] Open
Abstract
Background This study aims to describe the association between sharp score and clinical indexes, bone metabolism indexes, Disease Activity Score (DAS28) and sociodemographic factors in rheumatoid arthritis (RA). Methods Data were collected from the HIS (hospital information system), a national inpatient database in China, with information on the patients hospitalized during the period from 2012 to 2019. The association between sharp score and effective factors were identified using multinomial logistic regression and association rule mining (ARM). Results Three thousand eight hundred and forty patients were included: 82.66% males, 17.34% females, mean (SD) age 56.95 (12.68) years and symptom duration 3.45 (1.09) years. Spearman correlation analysis and Association rules analysis showed that there were significant positive correlations between sharp score and effective factors. Logistic regression analysis presented that erythrocyte sedimentation rate (ESR), high-sensitivity C-reactive protein (CRP), rheumatoid factor (RF) were risk factors of sharp score. In the analysis of individual outcomes, sex, age, symptom duration, DSA28 score, RF, ever drinker, and radiographic grading of hands were influence factors of sharp score. Conclusion Sharp score should be taken into consideration in formulating treatment strategies in RA.
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Affiliation(s)
- Jianting Wen
- Anhui University of Traditional Chinese Medicine, Hefei, 230031, Anhui Province, China.,Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China.,Institute of Rheumatology, Anhui College of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China.,Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, Anhui, 230038, P. R. China.,Anhui Province Key Laboratory of Modern Chinese Medicine Department of Internal Medicine Application Foundation Research and Development, Hefei, 230031, Anhui, China
| | - Jian Liu
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China. .,Institute of Rheumatology, Anhui College of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China. .,Key Laboratory of Xin'an Medicine of the Ministry of Education, Anhui University of Chinese Medicine, Hefei, Anhui, 230038, P. R. China. .,Anhui Province Key Laboratory of Modern Chinese Medicine Department of Internal Medicine Application Foundation Research and Development, Hefei, 230031, Anhui, China.
| | - Ling Xin
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China.,Institute of Rheumatology, Anhui College of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China.,Anhui Province Key Laboratory of Modern Chinese Medicine Department of Internal Medicine Application Foundation Research and Development, Hefei, 230031, Anhui, China
| | - Lei Wan
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China.,Institute of Rheumatology, Anhui College of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China.,Anhui Province Key Laboratory of Modern Chinese Medicine Department of Internal Medicine Application Foundation Research and Development, Hefei, 230031, Anhui, China
| | - Hui Jiang
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China.,Institute of Rheumatology, Anhui College of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China.,Anhui Province Key Laboratory of Modern Chinese Medicine Department of Internal Medicine Application Foundation Research and Development, Hefei, 230031, Anhui, China
| | - Yue Sun
- Department of Rheumatology and Immunology, First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China.,Institute of Rheumatology, Anhui College of Traditional Chinese Medicine, Hefei, 230038, Anhui Province, China.,Anhui Province Key Laboratory of Modern Chinese Medicine Department of Internal Medicine Application Foundation Research and Development, Hefei, 230031, Anhui, China
| | - Yanqiu Sun
- Anhui University of Traditional Chinese Medicine, Hefei, 230031, Anhui Province, China.,Anhui Province Key Laboratory of Modern Chinese Medicine Department of Internal Medicine Application Foundation Research and Development, Hefei, 230031, Anhui, China
| | - Xin Wang
- Anhui University of Traditional Chinese Medicine, Hefei, 230031, Anhui Province, China.,Anhui Province Key Laboratory of Modern Chinese Medicine Department of Internal Medicine Application Foundation Research and Development, Hefei, 230031, Anhui, China
| | - Jie Wang
- Anhui University of Traditional Chinese Medicine, Hefei, 230031, Anhui Province, China.,Anhui Province Key Laboratory of Modern Chinese Medicine Department of Internal Medicine Application Foundation Research and Development, Hefei, 230031, Anhui, China
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11
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Perez MO, Figueiredo CP, Sales LP, Medeiros-Ribeiro AC, Takayama L, Domiciano DS, Bonfiglioli K, Caparbo VF, Pereira RM. Bone erosions and osteophytes in premenopausal women with long-standing rheumatoid arthritis: association with systemic bone involvement by HR-Pqct. Arthritis Rheumatol 2021; 74:407-417. [PMID: 34463054 DOI: 10.1002/art.41961] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/13/2021] [Accepted: 08/26/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate premenopausal women with long-standing RA and to explore the relationship between parameters of systemic and localized bone involvement. METHODS Eighty consecutive RA premenopausal women were evaluated. Volumetric bone mineral density (vBMD), microarchitecture and finite element analysis were performed using high-resolution peripheral quantitative computed tomography (HR-pQCT) at the distal radius (DR) and tibia (DT) and compared with parameters from 160 female healthy controls matched by age and body mass index. Localized bone involvement was also analyzed using HR-pQCT in the metacarpophalangeal and proximal interphalangeal joints to identify erosions and osteophytes. RESULTS The mean age of RA patients was 39.4±6.7years and disease duration 9.8±5.3years. RA patients had impaired trabecular, cortical and bone strength parameters, at DR and DT, compared with healthy controls (p<0.05). Bone erosions and osteophytes were found in 75% and 41.3% of patients, respectively. Comparing patients with and without erosions, at DR and DT, a lower cortical vBMD (DR: 980±72 versus 1021±47mgHA/cm3 , p=0.03; DT:979±47 versus 1003±34 mgHA/cm3 , p=0.04) and higher cortical porosity (DR:2.8±2.5 versus 1.8±1.6%, p=0.04; and DT:3.7±1.6 versus 2.7±1.6%, p=0.01) were observed in patients with erosions. At the DR, osteophyte volume was positively correlated with trabecular vBMD (0.392, p=0.02), trabecular number (0.381, p=0.03) and stiffness (0.411, p=0.02), and negatively with trabecular separation (-0.364, p=0.04). CONCLUSION Our findings showed that premenopausal women with long-standing RA had systemic bone fragility at peripheral sites. Moreover, erosions were associated mainly with cortical bone fragility at the DR and DT, and osteophytes correlated with repair of trabecular bone at the radius.
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Affiliation(s)
- Mariana O Perez
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Camille P Figueiredo
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Lucas P Sales
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Ana Cristina Medeiros-Ribeiro
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Liliam Takayama
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Diogo S Domiciano
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Karina Bonfiglioli
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Valeria F Caparbo
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Rosa Mr Pereira
- Division of Rheumatology, Hospital das Clinicas HCFMUSP Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
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12
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Kumar V, Leekha A, Kaul A, Mishra AK, Verma AK. Role of folate-conjugated glycol-chitosan nanoparticles in modulating the activated macrophages to ameliorate inflammatory arthritis: in vitro and in vivo activities. Drug Deliv Transl Res 2021; 10:1057-1075. [PMID: 32363539 DOI: 10.1007/s13346-020-00765-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Activated macrophages are the primary targets in rheumatoid arthritis (RA) management. So, we report efficacious, dual-functional Methotrexate (MTX) loaded folate-conjugated pH-responsive glycol-chitosan nanoparticles (MFGCN) prepared by nano-precipitation and zero-order cross-linking reaction for targeting inflamed arthritic tissue. Physical characterization by DLS, SEM and TEM indicated a spherical, smooth morphology with a diameter ~ 300 nm. 1H NMR and FTIR indicated folic acid conjugation to GC by zero-order cross-linkers. In vitro release kinetics in PBS showed pH-responsive and sustained release behaviour of MFGCN. Enhanced cellular uptake and cytotoxicity of MFGCN in LPS(+)RAW and activated peritoneal macrophages (Mϕ) were observed when compared to LPS(-)RAW cells. MFGCN-induced mitochondrial membrane potential (MMP) perturbations indicated apoptosis. Oxidative stress was evident by significant increase in ROS and RNS, 4 h post incubation with MFGCN. Negligible hemolysis by FGCN and MFGCN on rat RBC's indicated biocompatibility. In vivo biodistribution of MFGCN in adjuvant-induced arthritis (AIA) rats indicated RA targetability. Prolonged blood circulation coupled with higher concentrations of 99mTc-MFGCN at the arthritic site was observed post 24 h of injection. The gamma scintigraphic image confirmed accumulation of radiolabelled MFGCN in arthritic paw when compared to the non-inflamed paw, confirming the selective uptake of 99mTc-MFGCN by folate-overexpressing macrophages in the arthritic synovium thereby proving its targeted efficacy and theranostic potential. In AIA rats, MFGCN lowers arthritic signs, improves antioxidant response and decreases pro-inflammatory cytokines, suggesting its potential in targeting activated macrophages of synovium. Graphical abstract.
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Affiliation(s)
- Vijay Kumar
- NanoBiotech Lab, Department of Zoology, Kirori Mal College, University of Delhi, Delhi, 110007, India
| | - Ankita Leekha
- NanoBiotech Lab, Department of Zoology, Kirori Mal College, University of Delhi, Delhi, 110007, India
| | - Ankur Kaul
- Division of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, Delhi, 110054, India
| | - Anil Kumar Mishra
- Division of Cyclotron and Radiopharmaceutical Sciences, Institute of Nuclear Medicine and Allied Sciences, Delhi, 110054, India
| | - Anita Kamra Verma
- NanoBiotech Lab, Department of Zoology, Kirori Mal College, University of Delhi, Delhi, 110007, India.
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13
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Husic R, Finzel S, Stradner MH, Dreu M, Hofmeister A, Beham-Schmid C, Graninger WB, Fessler J, Dejaco C. Ultrasound in Osteoarthritis of the Hand; a Comparison to Computed Tomography and Histology. Rheumatology (Oxford) 2021; 61:SI73-SI80. [PMID: 34244721 DOI: 10.1093/rheumatology/keab526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To compare structural findings between ultrasound (US), micro-computed tomography (µCT) and histology in people with osteoarthritis of the hands (HOA). METHODS We analyzed distal and proximal interphalangeal (DIP and PIP) joints of 31 fingers from 15 dissecting-room cadavers with HOA. The occurrence of bone erosions and osteophytes were recorded by US, µCT and histology at 16 regions for each joint and compared for each method. RESULTS In total, US (n = 558, 56.2% of 992 examined regions) and µCT (n = 493, 49.7%) detected a higher frequency of osteophytes at PIP and DIP joints than histology (n = 161, 23.4% of 689 histological examined regions; p= 0.01). We found a comparable number of erosions with each method [US, n = 52 (5.2%); µCT, n = 43 (4.3%); histology, n = 35 (5.2%)]. Both imaging techniques correlated moderately with each other regarding the detection of osteophytes (r = 0.54, p= 0.002) and erosions (r = 0.43, p= 0.017). Neither US nor µCT correlated with histology regarding erosions or osteophytes. With histology as the reference, US had a sensitivity of 80% and a specificity of 32% to detect osteophytes, whereas µCT had a sensitivity of 73% and a specificity of 27%. For erosions, sensitivities (US 10% and µCT 6% respectively) were much lower. Microscopically, erosions contained fibrous myxoid tissue extending from subcortical cavities through the breach of cortical bone. CONCLUSIONS The ability of US to identify osteophytes was comparable to that of µCT, yielding a good sensitivity when histology was used as the gold standard. The sensitivity of US and µCT to detecting erosions was low compared with histology.
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Affiliation(s)
- Rusmir Husic
- Division of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Martin H Stradner
- Division of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Manuel Dreu
- Department of Anatomy, Medical University of Graz, Graz, Austria
| | - Alexander Hofmeister
- Core Facility Alternative Biomodels & Preclinical Imaging, Medical University of Graz, Graz, Austria
| | | | - Winfried B Graninger
- Division of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Johannes Fessler
- Division of Rheumatology and Immunology, Medical University of Graz, Graz, Austria.,Division of Immunology and Pathophysiology, Medical University of Graz
| | - Christian Dejaco
- Division of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
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14
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Cipolletta E, Smerilli G, Di Matteo A, Di Battista J, Di Carlo M, Grassi W, Filippucci E. The sonographic identification of cortical bone interruptions in rheumatoid arthritis: a morphological approach. Ther Adv Musculoskelet Dis 2021; 13:1759720X211004326. [PMID: 33948124 PMCID: PMC8053750 DOI: 10.1177/1759720x211004326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 03/03/2021] [Indexed: 12/25/2022] Open
Abstract
Bone erosions are the hallmark of structural damage in rheumatoid arthritis (RA). Among imaging techniques, ultrasonography (US) has emerged as an accurate, reliable, repeatable, low-cost and non-invasive imaging modality to detect erosive changes in RA. However, small interruptions of the cortical bone detectable by last generation US equipment do not necessarily represent bone erosions. According to the available data, in addition to cortical bone interruption itself, only a few morphological US findings have been proposed to define RA bone erosions. However, other additional features may be considered to facilitate the interpretation of US cortical bone interruptions in RA. These could be summarised using the following four domains: size, site, shape and scenery. This hypothesis article provides a critical literature review of US features characteristic of RA bone erosions and pictorial evidence supporting the potential role of a morphological analysis in the US identification of bone erosions in RA patients. Plain language summary The ultrasonographic morphology of cortical interruptions is helpful for the identification of bone erosions in rheumatoid arthritis: the "four Ss" approach Bone erosions are characteristic features of rheumatoid arthritis. They are associated with a more aggressive disease and with irreversible physical disability. In recent years, ultrasonography has emerged as an accurate and reliable technique for the detection of bone erosions, that appear as interruptions of the cortical bone with variable size. However, cortical bone interruptions do not necessarily represent bone erosions. Since bone erosions represent the earliest evidence of the destructive behaviour of RA, their identification is crucial.Besides the cortical interruption itself, only a few morphological ultrasonographic features were proposed to characterise bone erosions in rheumatoid arthritis.We believe that a morphological approach, including size, site, shape and scenery, may be considered to facilitate the interpretation of ultrasonographic cortical bone interruptions in rheumatoid arthritis.In this hypothesis article we carried out a critical review of the scientific literature and provided extensive pictorial evidence of the ultrasonographic spectrum of cortical interruptions supporting the potential role of considering the "four Ss" for the ultrasonographic identification of bone erosions in rheumatoid arthritis.
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Affiliation(s)
| | | | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi (Ancona), Italy
| | - Jacopo Di Battista
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi (Ancona), Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi (Ancona), Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi (Ancona), Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, ‘Carlo Urbani’ Hospital, Jesi (Ancona), Italy
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15
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Brunet SC, Tse JJ, Kuczynski MT, Engelke K, Boyd SK, Barnabe C, Manske SL. Heterogenous bone response to biologic DMARD therapies in rheumatoid arthritis patients and their relationship to functional indices. Scand J Rheumatol 2021; 50:417-426. [PMID: 33775211 DOI: 10.1080/03009742.2020.1869303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: Previous studies of high-resolution peripheral quantitative computed tomography (HR-pQCT) imaging of hand joints in patients with rheumatoid arthritis (RA) have suggested that erosion healing may occur. Our objective was to examine changes in erosion volume, joint space width (JSW), bone mineral density (BMD), and bone remodelling, and their association with clinical outcomes and measures of patient hand function.Method: We examined 48 patients who achieved a good response to a newly initiated biologic therapy. HR-pQCT images of the dominant hands' second and third metacarpophalangeal joints were obtained 3 and 12 months after therapy initiation. Bone erosion volume, JSW, BMD, and bone remodelling were quantified from HR-pQCT images, with improvement, no change (unchanged), or progression in these measures determined by least significant change. Disease activity and hand function measures were collected.Results: There were no significant group changes in HR-pQCT outcomes over the 9 month period. Twenty-two patients had total erosion volumes that remained unchanged, nine showed improvement, and two progressed. The majority of JSW and BMD measures remained unchanged. There was a significant association between the baseline Health Assessment Questionnaire score and the change in minimum JSW, but no other significant associations between HR-pQCT outcomes and function were observed.Conclusions: The vast majority of patients maintained unchanged JSW and BMD over the course of follow-up. Significant improvements in total erosion volume occurred in 27% of patients, suggesting that biologic therapies may lead to erosion healing in some patients, although this did not have an impact on self-reported and demonstrated hand function.
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Affiliation(s)
- S C Brunet
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - J J Tse
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - M T Kuczynski
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - K Engelke
- Department of Medicine, FAU University Erlangen-Nürnberg and University Clinic Erlangen, Erlangen, Germany
| | - S K Boyd
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - C Barnabe
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - S L Manske
- McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Biomedical Engineering Graduate Program, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Canada
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16
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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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17
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Applying precision medicine to unmet clinical needs in psoriatic disease. Nat Rev Rheumatol 2020; 16:609-627. [PMID: 33024296 DOI: 10.1038/s41584-020-00507-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2020] [Indexed: 02/08/2023]
Abstract
Psoriatic disease (PsD) is a heterogeneous condition that can affect peripheral and axial joints (arthritis), entheses, skin (psoriasis) and other structures. Over the past decade, considerable advances have been made both in our understanding of the pathogenesis of PsD and in the treatment of its diverse manifestations. However, several major areas of continued unmet need in the care of patients with PsD have been identified. One of these areas is the prediction of poor outcome, notably radiographic outcome in patients with psoriatic arthritis, so that stratified medicine approaches can be taken; another is predicting response to the numerous current and emerging therapies for PsD, so that precision medicine can be applied to rapidly improve clinical outcome and reduce the risk of toxicity. In order to address these needs, novel approaches, including imaging, tissue analysis and the application of proteogenomic technologies, are proposed as methodological solutions that will assist the dissection of the critical immune-metabolic pathways in this complex disease. Learning from advances made in other inflammatory diseases, it is time to address these unmet needs in a multi-centre partnership aimed at improving short-term and long-term outcomes for patients with PsD.
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18
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Finzel S, Manske SL, Barnabe CCM, Burghardt AJ, Marotte H, Scharmga A, Hauge EM, Chapurlat R, Engelke K, Li X, van Teeffelen BCJ, Conaghan PG, Stok KS. Reliability and Change in Erosion Measurements by High-resolution Peripheral Quantitative Computed Tomography in a Longitudinal Dataset of Rheumatoid Arthritis Patients. J Rheumatol 2020; 48:348-351. [PMID: 32934121 DOI: 10.3899/jrheum.191391] [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] [Accepted: 09/05/2020] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The aim of this multireader exercise was to assess the reliability and change over time of erosion measurements in patients with rheumatoid arthritis (RA) using high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS HR-pQCT scans of 23 patients with RA were assessed at baseline and 12 months. Four experienced readers examined the dorsal, palmar, radial, and ulnar surfaces of the metacarpal head (MH) and phalangeal base (PB) of the second and third digits, blinded to time order. In total, 368 surfaces (23 patients´ 16 surfaces) were evaluated per timepoint to characterize cortical breaks as pathological (erosion) or physiological, and to quantify erosion width and depth. Reliability was evaluated by intraclass correlation coefficients (ICC), percentage agreement, and Light k; change over time was defined by means ± SD of erosion numbers and dimensions. RESULTS ICC for the mean measurements of width and depth of the pathological breaks ranged between 0.819-0.883, and 0.771-0.907, respectively. Most physiological cortical breaks were found at the palmar PB, whereas most pathological cortical breaks were located at the radial MH. There was a significant increase in both the numbers and the dimensions of erosions between baseline and follow-up (P = 0.0001 for erosion numbers, width, and depth in axial plane; P = 0.001 for depth in perpendicular plane). CONCLUSION This exercise confirmed good reliability of HR-pQCT erosion measurements and their ability to detect change over time.
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Affiliation(s)
- Stephanie Finzel
- S. Finzel, MD, Senior Attending Physician, Department of Rheumatology and Clinical Immunology, Medical Center - University of Freiburg, Medical Faculty, University of Freiburg, Freiburg, Germany;
| | - Sarah L Manske
- S.L. Manske, PhD, Assistant Professor, Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl C M Barnabe
- C.C. Barnabe, MD, MSc, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
| | - Andrew J Burghardt
- A.J. Burghardt, BS, Research Specialist, Department of Radiology and Biomedical Imaging, University of California San Francisco, California, USA
| | - Hubert Marotte
- H. Marotte, MD, PhD, Professor, INSERM 1059, Université de Lyon, and Service de Rhumatologie, CHU de Saint-Etienne, Saint-Etienne, France
| | - Andrea Scharmga
- A. Scharmga, PhD, Maastricht University, Maastricht, the Netherlands
| | - Ellen-Margrethe Hauge
- E.M. Hauge, MD, PhD, Professor, Department of Rheumatology, Aarhus University Hospital and Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Roland Chapurlat
- R. Chapurlat, MD, PhD, Professor, INSERM 1033, Hôpital Edouard Herriot, Lyon, France
| | - Klaus Engelke
- K. Engelke, PhD, Professor, Department of Medicine 3, FAU University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Xiaojuan Li
- X. Li, PhD, Professor, Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bente C J van Teeffelen
- B.C. van Teeffelen, Department of Biomedical Engineering, Melbourne School of Engineering, The University of Melbourne, Melbourne, Australia
| | - Philip G Conaghan
- P.G. Conaghan, MD, PhD, Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Kathryn S Stok
- K.S. Stok, PhD, Senior Lecturer, Institute for Biomechanics, ETH Zurich, Zurich, Switzerland, and Department of Biomedical Engineering, University of Melbourne, Melbourne, Australia
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19
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Figueiredo CP, Perez MO, Sales LP, Schett G, Pereira RMR. HR-pQCT in vivo imaging of periarticular bone changes in chronic inflammatory diseases: Data from acquisition to impact on treatment indications. Mod Rheumatol 2020; 31:294-302. [PMID: 32735144 DOI: 10.1080/14397595.2020.1804669] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Imaging is essential for the assessment of bone and inflammatory joint diseases. There are several imaging techniques available that differ regarding resolution, radiation exposure, time expending, precision, cost, availability or ability to predict disease progression. High-resolution peripheral quantitative computed tomography (HR-pQCT) that was introduced in 2004 allows the in vivo evaluation of peripheral bone microarchitecture and demonstrated high precision in assessing bone changes in inflammatory musculoskeletal diseases. This review summarizes the use of HR-pQCT for the evaluation of the hand skeleton in inflammatory joint diseases. We conducted a review of the literature regarding the protocols that involve hand joints assessment and evaluation of bone changes as erosions and osteophytes in chronic inflammatory diseases. Apart from measuring bone density and structure of the radius and the tibia, HR-pQCT has contributed to assessment of bone erosions and osteophytes, considered the hallmark of diseases as rheumatoid arthritis and psoriatic arthritis, respectively. In this way, there are some conventions recently established by rheumatic study groups that we just summarized here in order to standardize HR-pQCT measurements.
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Affiliation(s)
- Camille P Figueiredo
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina, FMUSP da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Mariana O Perez
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina, FMUSP da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Lucas Peixoto Sales
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina, FMUSP da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg and Universitatsklinikum, Erlangen, Germany
| | - Rosa M R Pereira
- Bone Metabolism Laboratory, Rheumatology Division, Faculdade de Medicina, FMUSP da Universidade de Sao Paulo, Sao Paulo, Brazil
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20
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Klose-Jensen R, Tse JJ, Keller KK, Barnabe C, Burghardt AJ, Finzel S, Tam LS, Hauge EM, Stok KS, Manske SL. High-Resolution Peripheral Quantitative Computed Tomography for Bone Evaluation in Inflammatory Rheumatic Disease. Front Med (Lausanne) 2020; 7:337. [PMID: 32766262 PMCID: PMC7381125 DOI: 10.3389/fmed.2020.00337] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/05/2020] [Indexed: 12/25/2022] Open
Abstract
High resolution peripheral quantitative computed tomography (HR-pQCT) is a 3-dimensional imaging modality with superior sensitivity for bone changes and abnormalities. Recent advances have led to increased use of HR-pQCT in inflammatory arthritis to report quantitative volumetric measures of bone density, microstructure, local anabolic (e.g., osteophytes, enthesiophytes) and catabolic (e.g., erosions) bone changes and joint space width. These features may be useful for monitoring disease progression, response to therapy, and are responsive to differentiating between those with inflammatory arthritis conditions and healthy controls. We reviewed 69 publications utilizing HR-pQCT imaging of the metacarpophalangeal (MCP) and/or wrist joints to investigate arthritis conditions. Erosions are a marker of early inflammatory arthritis progression, and recent work has focused on improvement and application of techniques to sensitively identify erosions, as well as quantifying erosion volume changes longitudinally using manual, semi-automated and automated methods. As a research tool, HR-pQCT may be used to detect treatment effects through changes in erosion volume in as little as 3 months. Studies with 1-year follow-up have demonstrated progression or repair of erosions depending on the treatment strategy applied. HR-pQCT presents several advantages. Combined with advances in image processing and image registration, individual changes can be monitored with high sensitivity and reliability. Thus, a major strength of HR-pQCT is its applicability in instances where subtle changes are anticipated, such as early erosive progression in the presence of subclinical inflammation. HR-pQCT imaging results could ultimately impact decision making to uptake aggressive treatment strategies and prevent progression of joint damage. There are several potential areas where HR-pQCT evaluation of inflammatory arthritis still requires development. As a highly sensitive imaging technique, one of the major challenges has been motion artifacts; motion compensation algorithms should be implemented for HR-pQCT. New research developments will improve the current disadvantages including, wider availability of scanners, the field of view, as well as the versatility for measuring tissues other than only bone. The challenge remains to disseminate these analysis approaches for broader clinical use and in research.
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Affiliation(s)
- Rasmus Klose-Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Justin J Tse
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Cheryl Barnabe
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Andrew J Burghardt
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, United States
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Medical Centre - University of Freiburg, Freiburg, Germany.,Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Parkville, VIC, Australia
| | - Sarah L Manske
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, AB, Canada.,Department of Radiology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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21
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Di Matteo A, Mankia K, Duquenne L, Cipolletta E, Wakefield RJ, Garcia-Montoya L, Nam JL, Emery P. Ultrasound erosions in the feet best predict progression to inflammatory arthritis in anti-CCP positive at-risk individuals without clinical synovitis. Ann Rheum Dis 2020; 79:901-907. [PMID: 32366522 DOI: 10.1136/annrheumdis-2020-217215] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/23/2020] [Accepted: 04/08/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To investigate, in anti-cyclic citrullinated peptide antibody positive (CCP+) at-risk individuals without clinical synovitis, the prevalence and distribution of ultrasound (US) bone erosions (BE), their correlation with subclinical synovitis and their association with the development of inflammatory arthritis (IA). METHODS Baseline US scans of 419 CCP+ at-risk individuals were analysed. BE were evaluated in the classical sites for rheumatoid arthritis damage: the second and fifth metacarpophalangeal (MCP2 and MCP5) joints, and the fifth metatarsophalangeal (MTP5) joints. US synovitis was defined as synovial hypertrophy (SH) ≥2 or SH ≥1+power Doppler signal ≥1. Subjects with ≥1 follow-up visit were included in the progression analysis (n=400). RESULTS BE were found in ≥1 joint in 41/419 subjects (9.8%), and in 55/2514 joints (2.2%). The prevalence of BE was significantly higher in the MTP5 joints than in the MCP joints (p<0.01). A significant correlation between BE and US synovitis in the MTP5 joints was detected (Cramer's V=0.37, p<0.01). The OR for the development of IA (ever) was highest for the following: BE in >1 joint 10.6 (95% CI 1.9 to 60.4, p<0.01) and BE and synovitis in ≥1 MTP5 joint 5.1 (95% CI 1.4 to 18.9, p=0.02). In high titre CCP+ at-risk individuals, with positive rheumatoid factor and BE in ≥1 joint, the OR increased to 16.9 (95% CI 2.1-132.8, p<0.01). CONCLUSIONS In CCP+ at-risk individuals, BE in the feet appear to precede the onset of clinical synovitis. BE in >1 joint, and BE in combination with US synovitis in the MTP5 joints, are the most predictive for the development of clinical arthritis.
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Affiliation(s)
- Andrea Di Matteo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,Clinica Reumatologica, Polytechnic University of Marche, Ancona, Marche, Italy
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Laurence Duquenne
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Edoardo Cipolletta
- Clinica Reumatologica, Polytechnic University of Marche, Ancona, Marche, Italy
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Leticia Garcia-Montoya
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Jacqueline Leong Nam
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK .,NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
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22
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Wu D, Griffith JF, Lam SHM, Wong P, Yue J, Shi L, Li EK, Cheng IT, Li TK, Hung VW, Qin L, Tam LS. Comparison of bone structure and microstructure in the metacarpal heads between patients with psoriatic arthritis and healthy controls: an HR-pQCT study. Osteoporos Int 2020; 31:941-950. [PMID: 31938819 DOI: 10.1007/s00198-020-05298-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/10/2020] [Indexed: 01/01/2023]
Abstract
UNLABELLED Human cadaveric study has indicated that the metacarpal head (MCH) is intracapsular in location. We hypothesized that exposure to the intra-articular inflammatory milieu in psoriatic arthritis (PsA) will lead to bone loss in the MCH. INTRODUCTION To compare the bone structure and microstructure in the MCH between patients with PsA and healthy controls by high-resolution peripheral quantitative CT (HR-pQCT), and to ascertain factors associated with bone loss in PsA patients. METHODS Sixty-two PsA patients without joint destruction and 62 age-, gender-, and body mass index-matched healthy subjects underwent HR-pQCT imaging of the second and third MCH (MCH 2&3). The number and volume of bone erosion and enthesiophytes, as well as volumetric bone mineral density (vBMD) and microstructure at the MCH 2&3, were recorded. Correlation analysis and multivariable linear regression models were used to determine the association of demographic and disease-specific variables with compromised bone structure and microstructure in PsA. RESULTS At the MCH 2&3, bone erosion (p = 0.003) and enthesiophyte (p = 0.000) volumes in PsA patients were significantly larger than healthy controls. In PsA patients, older age was associated with a larger erosion and enthesiophyte volume. Concerning the mean vBMD and microstructure at the MCH 2&3, PsA patients had significantly lower mean vBMD (average vBMD - 6.9%, trabecular vBMD - 8.8%, peri-trabecular vBMD - 7.7%, meta-trabecular vBMD - 9.8%), trabecular bone volume fraction (- 8.8%), and trabecular thickness (- 8.1%) compared with control subjects. Multivariable regression analysis revealed that older age and a higher C-reactive protein level were associated with trabecular bone loss. CONCLUSIONS PsA patients had a higher burden of bone damages (erosions and enthesiophytes) and trabecular bone loss compared with healthy control at the MCH. Inflammation contributed to the deterioration in trabecular microstructure in these patients.
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Affiliation(s)
- D Wu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - J F Griffith
- Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - S H M Lam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - P Wong
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - J Yue
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - L Shi
- Research Centre for Medical Image Computing, Department of Imaging and Interventional Radiology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - E K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - I T Cheng
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - T K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - V W Hung
- Bone Quality and Health Centre of the Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - L Qin
- Bone Quality and Health Centre of the Department of Orthopedics & Traumatology, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - L-S Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
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23
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Ørnbjerg LM, Østergaard M. Assessment of structural damage progression in established rheumatoid arthritis by conventional radiography, computed tomography, and magnetic resonance imaging. Best Pract Res Clin Rheumatol 2020; 33:101481. [PMID: 32001166 DOI: 10.1016/j.berh.2019.101481] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Structural damage progression in patients with established rheumatoid arthritis (RA) has traditionally been assessed by conventional radiography (CR), which has proven its value in clinical practice and clinical trials over the past decades. The most prominent abnormalities visualized by CR in RA patients are erosions as a consequence of bone destruction and joint space narrowing (JSN) as a consequence of cartilage damage. Several validated scoring systems to quantify the structural joint damage and progression herein are available. Computed tomography and magnetic resonance imaging are newer, more sensitive methods for detection and monitoring of structural joint damage. A validated scoring system for magnetic resonance imaging of the hands and wrists exists, while no consensus has been reached on a scoring system for computed tomography. Structural damage identified by either CR or magnetic resonance imaging predicts a poorer disease course in patients with both early and established rheumatoid arthritis.
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Affiliation(s)
- Lykke Midtbøll Ørnbjerg
- Copenhagen Center for Arthritis Research, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark.
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, COPECARE, Center for Rheumatology and Spine Diseases, Centre of Head and Orthopedics, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark.
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24
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Falkowski AL, Jacobson JA, Kalia V, Atinga A, Gandikota G, Thiele RG. Ultrasound characterization of pseudoerosions and dorsal joint recess morphology of the hand and wrist in 100 asymptomatic subjects. Eur J Radiol 2020; 124:108842. [PMID: 32007818 DOI: 10.1016/j.ejrad.2020.108842] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 12/05/2019] [Accepted: 01/14/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To sonographically characterize pseudoerosions and dorsal joint recess and capsule morphology of the hand and wrist in 100 asymptomatic subjects. METHOD The metacarpal heads, and dorsal aspects of the lunate, triquetrum, and ulna were evaluated for pseudoerosions including measurements and sonographic characterization. The dorsal recesses of the metacarpophalangeal, radiocarpal, and midcarpal joints were also characterized with regards to echogenicity, fibrillar pattern, hyperemia, and measurements. RESULTS 100 subjects were included (average age 47 years, range 19-82 years; 52% male, 48% female). Pseudoerosions of metacarpophalangeal heads were seen in every subject, in all metacarpal heads, but most commonly the second and third (99% were bilateral, 97% were multiple); 81.5% involved at least three metacarpal heads; 99% were central with maximum depth of 2.6 mm. At the wrist, in 92% of subjects a bilateral pseudoerosion was present at the dorsal triquetrum, lunate, or ulna. Dorsal joint capsules and recesses at the metacarpophalangeal joints were isoechoic to subdermal fat and fibrillar measuring 3.1-6.3 mm in maximal thickness. The dorsal capsules and recesses of the radiocarpal and midcarpal joints were hypoechoic to subdermal fat, non-fibrillar and with maximal thickness of 3.9 and 3.4 mm, respectively. No hyperemia on color Doppler imaging was noted. CONCLUSIONS Pseudoerosions are common at the dorsal metacarpal heads, lunate, triquetrum, and ulna, which should not be mistaken for true inflammatory erosions. The characteristic appearances of dorsal joint capsules and recesses should not be confused with synovial hypertrophy.
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Affiliation(s)
- Anna L Falkowski
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48103, USA; Department of Radiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Jon A Jacobson
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48103, USA.
| | - Vivek Kalia
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48103, USA.
| | - Angela Atinga
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48103, USA; Department of Medical Imaging, University of Toronto, 263 McCaul Street, 4(th)Floor, Toronto, Ontario, M5T 1W7, Canada.
| | - Girish Gandikota
- Department of Radiology, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, Michigan, 48103, USA.
| | - Ralf G Thiele
- Department of Rheumatology, University of Rochester, 601 Elmwood Avenue, Box 695, Rochester, New York, 14642, USA.
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25
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Kaeley GS, Bakewell C, Deodhar A. The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Res Ther 2020; 22:1. [PMID: 31898524 PMCID: PMC6939339 DOI: 10.1186/s13075-019-2050-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Accepted: 11/05/2019] [Indexed: 11/13/2022] Open
Abstract
Early differentiation between different types of inflammatory arthritis and subsequent initiation of modern treatments can improve patient outcomes by reducing disease activity and preventing joint damage. Routine clinical evaluation, laboratory testing, and radiographs are typically sufficient for differentiating between inflammatory and predominantly degenerative arthritis (e.g., osteoarthritis). However, in some patients with inflammatory arthritis, these techniques fail to accurately identify the type of early-stage disease. Further evaluation by ultrasound imaging can delineate the inflammatory arthritis phenotype present. Ultrasound is a noninvasive, cost-effective method that enables the evaluation of several joints at the same time, including functional assessments. Further, ultrasound can visualize pathophysiological changes such as synovitis, tenosynovitis, enthesitis, bone erosions, and crystal deposits at a subclinical level, which makes it an effective technique to identify and differentiate most common types of inflammatory arthritis. Limitations associated with ultrasound imaging should be considered for its use in the differentiation and diagnosis of inflammatory arthritides.
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Affiliation(s)
- Gurjit S Kaeley
- Division of Rheumatology and Clinical Immunology, University of Florida College of Medicine, 653-1 West 8th St., LRC 2nd Floor L-14, Jacksonville, FL, 32209, USA.
| | | | - Atul Deodhar
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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Pang Q, Xu Y, Qi X, Huang L, Hung VW, Xu J, Liao R, Hou Y, Jiang Y, Yu W, Wang O, Li M, Xing X, Xia W, Qin L. Impaired bone microarchitecture in distal interphalangeal joints in patients with primary hypertrophic osteoarthropathy assessed by high-resolution peripheral quantitative computed tomography. Osteoporos Int 2020; 31:153-164. [PMID: 31646353 DOI: 10.1007/s00198-019-05168-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
UNLABELLED This study aimed to investigate the bone impairment in finger joints in PHO patients by HR-pQCT. Results showed distinguished differences in bone architecture and biomechanics parameters at DIPs between PHO patients and healthy controls using HR-pQCT assessment. Besides, serum PGE2, hsCRP and ESR levels were found negatively correlated with total vBMD. INTRODUCTION This study aimed to investigate the bone impairment in finger joints in primary hypertrophic osteoarthropathy (PHO) patients firstly by high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS Fifteen PHO patients and 15 healthy controls were enrolled in this study. Bone erosions in hands at distal interphalangeal joints (DIPs) in both PHO patients and controls were evaluated by X-ray. Bone geometry, vBMD, microstructure parameters, and size of individual bone erosion were also measured at the 3rd DIP by HR-pQCT as well. Blood biochemistry levels between the two groups were also compared. RESULTS Compared to X-ray, HR-pQCT assessment were more sensitive for detection of bone erosions, with 14 PHO patients by HR-pQCT versus ten PHO patients by X-ray judged at the 3rd DIP. The average depth, width, and volume of erosions size in PHO patients were 1.38 ± 0.80 mm, 0.79 ± 0.27 mm, and 1.71 ± 0.52 mm3, respectively. The bone cross-areas including total area (+ 25.3%, p ≤ 0.05), trabecular area (+ 56.2%, p ≤ 0.05), and cortical perimeter (+ 10.7%, p ≤ 0.05) at the defined region of interest of 3rd DIP was significantly larger than controls. Total vBMD was 11.9% lower in PHO patients compared with the controls (p ≤ 0.05). Biochemical test results showed the increased levels of inflammatory cytokines, bone resorption markers, and joint degeneration markers in PHO patients. Serum prostaglandin PGE2, high-sensitive C-reactive protein (hsCRP) and erythrocyte sedimentation rate (ESR) levels were found negatively correlated with total vBMD. CONCLUSIONS This study demonstrated higher sensitivity of the HR-pQCT measurement at DIPs by showing the differences in architecture and biomechanics parameters at DIPs between the PHO patients and healthy controls, which would be of interest clinically to investigate bone deterioration in PHO patients.
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Affiliation(s)
- Q Pang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
- Musculoskeletal Research Laboratory and Bone Quality and Health Assessment Centre, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, 5/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong, SAR, Hong Kong
| | - Y Xu
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
- Department of Endocrinology, The First Affiliated Hospital of Shanxi Medical University, Taiyuan, 030001, Shanxi, China
| | - X Qi
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - L Huang
- Musculoskeletal Research Laboratory and Bone Quality and Health Assessment Centre, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, 5/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong, SAR, Hong Kong
| | - V W Hung
- Musculoskeletal Research Laboratory and Bone Quality and Health Assessment Centre, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, 5/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong, SAR, Hong Kong
| | - J Xu
- Musculoskeletal Research Laboratory and Bone Quality and Health Assessment Centre, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, 5/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong, SAR, Hong Kong
| | - R Liao
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - Y Hou
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - Y Jiang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - W Yu
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - O Wang
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - M Li
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - X Xing
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China
| | - W Xia
- Department of Endocrinology, Key Laboratory of Endocrinology, Ministry of Health, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Shuaifuyuan No.1, Dongcheng District, Beijing, 100730, China.
| | - L Qin
- Musculoskeletal Research Laboratory and Bone Quality and Health Assessment Centre, Department of Orthopedics & Traumatology, The Chinese University of Hong Kong, 5/F Lui Che Woo Clinical Sciences Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong, SAR, Hong Kong.
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Pseudoerosions of Hands and Feet in Rheumatoid Arthritis: Anatomic Concepts and Redefinition. J Clin Med 2019; 8:jcm8122174. [PMID: 31835340 PMCID: PMC6947149 DOI: 10.3390/jcm8122174] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 01/05/2023] Open
Abstract
Rheumatoid arthritis is a chronic inflammatory disease characterized by the development of osseous and cartilaginous damage. The correct differentiation between a true erosion and other entities—then often called “pseudoerosions”—is essential to avoid misdiagnosing rheumatoid arthritis and to correctly interpret the progress of the disease. The aims of this systematic review were as follows: to create a definition and delineation of the term “pseudoerosion”, to point out morphological pitfalls in the interpretation of images, and to report on difficulties arising from choosing different imaging modalities. A systematic review on bone erosions in rheumatoid arthritis was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following search terms were applied in PubMed and Scopus: “rheumatoid arthritis”, “bone erosion”, “ultrasonography”, “radiography”, “computed tomography” and “magnetic resonance imaging”. Appropriate exclusion criteria were defined. The systematic review registration number is 138826. The search resulted ultimately in a final number of 25 papers. All indications for morphological pitfalls and difficulties utilizing imaging modalities were recorded and summarized. A pseudoerosion is more than just a negative definition of an erosion; it can be anatomic (e.g., a normal osseous concavity) or artefact-related (i.e., an artificial interruption of the calcified zones). It can be classified according to their configuration, shape, content, and can be described specifically with an anatomical term. “Calcified zone” is a term to describe the deep components of the subchondral, subligamentous and subtendinous bone, and may be applied for all non-cancellous borders of a bone, thus representing a third type of the bone matrix beside the cortical and the trabecular bone.
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Abstract
PURPOSE OF REVIEW The therapeutic response to biologic agents in psoriasis is significantly higher than observed in psoriatic arthritis (PsA). In this review, specific actions to improve treatment outcomes in PsA are discussed. RECENT FINDINGS Increased understanding of disease pathogenesis derived from improved preclinical models and advances in cell-based and molecular technologies provide new tools to identify therapeutic targets. In addition to the important contributions of metabolic comorbidities, chronic pain and the lack of a diagnostic biomarker signal the need for new strategies to improve outcomes. Potential strategies include the following: (1) discover a novel pathway or cellular subset, (2) apply stratification biomarkers to individualize therapy, (3) preclinical intervention, (4) combination therapy, (5) lifestyle modification, (6) address chronic pain and fatigue, and (7) multidisciplinary care. The future holds great promise for enhanced treatment responses in PsA based on improved understanding of individual variation in disease pathophysiology coupled with comprehensive and integrated treatment programs.
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Affiliation(s)
- Christopher Ritchlin
- Allergy, Immunology and Rheumatology Division, Center for Musculoskeletal Research, University of Rochester Medical Center, Box 695, Rochester, NY, 14642, USA.
| | - Jose U Scher
- Department of Medicine, Division of Rheumatology and Psoriatic Arthritis Center, New York University School of Medicine, New York, NY, USA
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Boylan M. Should ultrasound be used routinely in the diagnosis of rheumatoid arthritis? Ir J Med Sci 2019; 189:735-748. [PMID: 31646431 DOI: 10.1007/s11845-019-02096-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 09/04/2019] [Indexed: 12/29/2022]
Abstract
INTRODUCTION A growing body of evidence indicates the benefits of early diagnosis of rheumatoid arthritis (RA) and prompt treatment with disease-modifying anti-rheumatic drugs (DMARDS) in terms of relieving symptoms, improving prognosis, and reducing long-term complications. There is however some controversy over the most beneficial method of imaging in providing accurate early diagnosis. Though current practice favours clinical and radiological assessment, this is increasingly supplemented by ultrasound techniques (and, to a lesser extent, CT and MRI scanning). While EULAR and ESSR favour the use of ultrasonography (US) as the first-line investigation in cases of suspected RA, a recent NICE review upholds the traditional place of plain film radiographs of hands and feet to detect erosions as early signs of synovitis. This review considers the evidence for US in the early diagnosis of RA and the case for it becoming the primary assessment modality in rheumatology clinics. AIMS This paper aims to assess the current literature on the efficacy of ultrasonography in diagnosing early RA, by comparing US with alternative imaging modalities. The goal is to propose the most appropriate method of diagnosis to improve early initiation of DMARD treatment for optimum disease outcomes. METHODS Searches for related studies and review articles were carried out using electronic databases and hand searches. Additional references were gleaned from the bibliographies of included papers. Related articles and pop-outs from PubMed were also used. The search was refined in PubMed, by only using reviews which were written in English and published in past 10 years and had full free text available. RESULTS This review confirms that US has a high level of sensitivity in diagnosing RA (and hence a low risk of missing cases of RA which might benefit from early treatment with DMARDs). It also has a high level of specificity (and hence a low risk of falsely diagnosing somebody with RA who may suffer adverse effects of DMARD therapy). US is already widely available and well accepted by clinicians and patients. It does not involve exposure to radiation and can be readily delivered by appropriately trained staff. CONCLUSION This review of relevant studies indicates that US should become accepted as the investigation with the most favourable balance of benefits to risks in the early diagnosis of RA. Given the continuing controversy surrounding studies of different imaging techniques in RA, further research into the diagnostic role of US in RA is indicated.
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Affiliation(s)
- Maria Boylan
- Graduate Entry Medical School, University of Limerick - Faculty of Education & Health Services, Limerick, V94 T9PX, Ireland.
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Kwok WE, You Z, Monu J, He H. A Comparative Study of High-Resolution Chemical-Shift-Eliminated Magnetic Resonance Imaging of Finger Specimens with Microcomputed Tomography. J Clin Imaging Sci 2019; 9:19. [PMID: 31448170 PMCID: PMC6702894 DOI: 10.25259/jcis-20-2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/19/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE High-resolution images of finger joints with chemical-shift elimination can be obtained using an interleaved water-fat (IWF) sequence. This study assessed IWF imaging of finger joints in the delineation of bone structures by comparing images of cadaver fingers with those of microcomputed tomography (CT) that served as a standard reference. MATERIALS AND METHODS IWF images with spatial resolution of 176 µ × 176 µ × 300 µ were obtained from the distal and proximal interphalangeal joints of two cadaver finger specimens using a custom-built radiofrequency receive coil at 1.5T. Regular three-dimensional gradient-echo (GRE) images were also acquired with similar parameters and compared with the IWF images to evaluate the effects of chemical shift. Micro-CT scans were obtained and served as the standard reference. The image data were reviewed by two experienced musculoskeletal radiologists in consensus. The delineation of normal joint structures and abnormalities in the finger specimens as revealed by the magnetic resonance imaging (MRI) and micro-CT images were compared. The IWF and regular GRE images were assigned scores 0-3 for the depiction of apparent marginal bone defects, with zero being the same in appearance to the micro-CT image and three as having minimal resemblance to it. Statistical analysis of the scoring results was conducted to compare the two MRI techniques. RESULTS The high-resolution IWF images provided accurate delineation of bone and calcified structures as seen in micro-CT. The thickness of subchondral bone was depicted similarly on the IWF water + fat and the micro-CT images but not on the regular GRE images. The regular GRE sequence showed false marginal bone defects not observed with IWF and micro-CT. In addition, the IWF water-only images facilitated the identification of bone cyst by revealing its water content. CONCLUSION High-resolution IWF imaging should be useful for the early diagnosis and treatment assessment of arthritis and should also benefit basic research in the pathophysiology of the disease.
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Affiliation(s)
- Wingchi Edmund Kwok
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Zhigang You
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Johnny Monu
- Department of Imaging Sciences, University of Rochester, Rochester, New York, USA
| | - Hua He
- Department of Epidemiology, Tulane University School of Public Health and Tropic Medicine, New Orleans, Louisiana, United States
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Rubin DA. MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I. Imaging findings. Skeletal Radiol 2019; 48:677-695. [PMID: 30796506 DOI: 10.1007/s00256-019-03179-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/19/2019] [Accepted: 02/03/2019] [Indexed: 02/02/2023]
Abstract
The management of patients with rheumatoid arthritis (RA) has rapidly evolved with the development of newer disease-modifying drugs and the recognition that long-term damage can be mitigated by an earlier and more-informed use of these medications. Historically, radiographs were the mainstay of imaging in RA patients, but radiographic joint narrowing and erosions are late and insensitive findings in the disease. MRI (with intravenous contrast agent) and ultrasound (with power Doppler interrogation) of the hands and wrists are able to demonstrate erosions earlier and with greater sensitivity than radiographs. More importantly, these imaging studies also depict synovitis and active soft-tissue inflammation, which represents a precursor to structural damage. Additionally, MRI can show inflammation within the bones (osteitis), which is proving to be the most important prognosticator of an aggressive disease course. Part I of this review discusses the imaging techniques, pitfalls, definitions, and comparative studies of MRI and ultrasound for identifying and quantifying erosions, synovitis, and osteitis. Part II will demonstrate how these imaging findings influence the clinical management of RA patients throughout their disease course, from presentation through clinical remission.
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Affiliation(s)
- David A Rubin
- Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA.
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Ultrasound imaging in rheumatoid arthritis. Radiol Med 2019; 124:1087-1100. [DOI: 10.1007/s11547-019-01002-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 02/04/2019] [Indexed: 12/13/2022]
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Roux C, Gandjbakhch F, Pierreisnard A, Couderc M, Lukas C, Masri R, Sommier JP, Clerc-Urmes I, Baumann C, Chary-Valckenaere I, Loeuille D. Ultrasonographic criteria for the diagnosis of erosive rheumatoid arthritis using osteoarthritic patients as controls compared to validated radiographic criteria. Joint Bone Spine 2019; 86:467-474. [PMID: 30711693 DOI: 10.1016/j.jbspin.2019.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 01/23/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aims of this study were to compare characteristics of radiography (RX) and ultrasound (US) erosive lesions in rheumatoid arthritis (RA) and osteoarthritis (OA) patients (prevalence, topography and severity), to determine thresholds for the diagnosis of erosive RA based on US and to evaluate the performance of US and RX to establish a diagnosis of erosive RA differentiated from hand OA. METHODS Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or ACR hand OA criteria were prospectively included. A modified Sharp erosion score was assessed by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). Erosions in US were scored on six bilateral joints (MCP2-3, 5; MTP2-3, 5) with a four-grade scale to calculate total US score for erosions (USSe). RESULTS A total of 168 patients were included: 122 RA (32 early RA < 2 years; 90 late RA ≥ 2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients were eroded according to EULAR 2013 definition criteria with sensitivity at 34.4% and specificity at 89.1%. On US, 95 RA patients (21 early; 74 late) and 12 OA patients were eroded. Considering at least two joint facets eroded or at least one joint facet eroded at grade 2 on US, sensitivities were good (68-72.1%) and specificities excellent (89.1-100%). Agreement between RX and US was excellent (90-92%). The positive and negative likehood ratios were respectively 3.16 and 0.73 for radiography and 6.64 and 0.31 for US (for two facets eroded). CONCLUSION USSe can differentiate RA from OA in erosive disease and detect two times more patients with erosive RA than RX with excellent specificity and agreement.
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Affiliation(s)
- Camille Roux
- Department of rheumatology, university hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France.
| | | | - Audrey Pierreisnard
- Department of rheumatology, academic hospital Pitié Salpêtrière, 75013 Paris, France
| | - Marion Couderc
- Department of rheumatology, university hospital of Clermont- Ferrand, 63000 Clermont- Ferrand, France
| | - Cédric Lukas
- Department of rheumatology, university hospital of Lapeyronie, 34000 Montpellier, France
| | - Racha Masri
- Department of rheumatology, university hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Jean-Philippe Sommier
- Department of rheumatology, university hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Isabelle Clerc-Urmes
- Platform of clinical research support PARC (MDS unity), university Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Cédric Baumann
- Platform of clinical research support PARC (MDS unity), university Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Isabelle Chary-Valckenaere
- Department of rheumatology, university hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; Inserm, CIC-EC CIE6, university hospital of Nancy, epidemiology and clinical evaluation, 54500 Vandoeuvre-lès-Nancy, France
| | - Damien Loeuille
- Department of rheumatology, university hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; Inserm, CIC-EC CIE6, university hospital of Nancy, epidemiology and clinical evaluation, 54500 Vandoeuvre-lès-Nancy, France
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Scharmga A, Peters M, van den Bergh JP, Geusens P, Loeffen D, van Rietbergen B, Schoonbrood T, Vosse D, Weijers R, van Tubergen A. Development of a scoring method to visually score cortical interruptions on high-resolution peripheral quantitative computed tomography in rheumatoid arthritis and healthy controls. PLoS One 2018; 13:e0200331. [PMID: 29985943 PMCID: PMC6037386 DOI: 10.1371/journal.pone.0200331] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 06/25/2018] [Indexed: 01/10/2023] Open
Abstract
Objectives To develop a scoring method to visually score cortical interruptions in finger joints on High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT), determine its intra- and inter-reader reliability and test its feasibility. Methods The scoring method was developed by integrating results from in-depth discussions with experts, consensus meetings, multiple reading experiments and the literature. Cortical interruptions were scored by two independent readers in an imaging dataset with finger joints from patients with rheumatoid arthritis (RA) and healthy controls and assessed for adjacent trabecular distortion. Reliability for the total number of cortical interruptions per joint and per quadrant was calculated using intraclass correlation coefficient (ICC). Feasibility was tested by recording the time to analyze one joint. Results In 98 joints we identified 252 cortical interruptions, 17% had trabecular distortion. Mean diameter of the interruptions was significantly larger in patients with RA compared with healthy controls (0.88 vs 0.47 mm, p = 0.03). Intra-reader reliability was ICC 0.88 (95% CI 0.83;0.92) per joint and ICC 0.69 (95% CI 0.65;0.73) per quadrant. Inter-reader reliability was ICC 0.48 (95% CI 0.20;0.67) per joint and ICC 0.56 (95% CI 0.49;0.62) per quadrant. The time to score one joint was mean 9.2 (SD 4.9) min. Conclusions This scoring method allows detection of small cortical interruptions on HR-pQCT imaging of finger joints, which is promising for use in clinical studies.
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Affiliation(s)
- Andrea Scharmga
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- * E-mail:
| | - Michiel Peters
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Joop P. van den Bergh
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Viecuri Medical Center, Venlo, The Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Piet Geusens
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Daan Loeffen
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bert van Rietbergen
- Department of Medical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Orthopaedic surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Thea Schoonbrood
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Debby Vosse
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - René Weijers
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Astrid van Tubergen
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands
- CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
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Yue J, Wu D, Tam LS. The role of imaging in early diagnosis and prevention of joint damage in inflammatory arthritis. Expert Rev Clin Immunol 2018; 14:499-511. [PMID: 29754519 DOI: 10.1080/1744666x.2018.1476849] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Inflammatory arthritis is characterized by chronic inflammation in the synovium, associated with degradation of cartilage and erosion of juxta-articular bone. The bone loss and joint destruction mediated by aberrant immunological responses resulting in proinflammatory cytokine release and various immune cell activation are known as osteoimmunology. Areas covered: A structured literature search including Medline and PubMed, Cochrane meta-analyses and abstracts of international congresses was performed to review joint damage in inflammatory arthritis in terms of pathogenesis, novel imaging assessment, and prevention. Expert commentary: Deeper understanding of the integration of the skeletal and immune as well as inflammatory system is paving the way to prevent bone loss and bone destruction in inflammatory arthritis. With the availability of various imaging modalities such as ultrasound, magnetic resonance imaging (MRI) and high-resolution peripheral quantitative computed tomography (HR-pQCT), we are now able to detect early joint damage, early diagnosis of inflammatory arthritis, monitor the progression or even ascertain whether the inflammatory process is effectively suppressed to allow repair of joint damage by novel therapeutic agents.
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Affiliation(s)
- Jiang Yue
- a Department of Medicine & Therapeutics , The Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Dongze Wu
- a Department of Medicine & Therapeutics , The Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin , Hong Kong
| | - Lai-Shan Tam
- a Department of Medicine & Therapeutics , The Prince of Wales Hospital, The Chinese University of Hong Kong , Shatin , Hong Kong
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Peters M, de Jong J, Scharmga A, van Tubergen A, Geusens P, Loeffen D, Weijers R, Boyd SK, Barnabe C, Stok KS, van Rietbergen B, van den Bergh J. An automated algorithm for the detection of cortical interruptions and its underlying loss of trabecular bone; a reproducibility study. BMC Med Imaging 2018; 18:13. [PMID: 29764383 PMCID: PMC5952860 DOI: 10.1186/s12880-018-0255-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 04/30/2018] [Indexed: 01/19/2023] Open
Abstract
Background We developed a semi-automated algorithm that detects cortical interruptions in finger joints using high-resolution peripheral quantitative computed tomography (HR-pQCT), and extended it with trabecular void volume measurement. In this study we tested the reproducibility of the algorithm using scan/re-scan data. Methods Second and third metacarpophalangeal joints of 21 subjects (mean age 49 (SD 11) years, 17 early rheumatoid arthritis and 4 undifferentiated arthritis, all diagnosed < 1 year ago) were imaged twice by HR-pQCT on the same day with repositioning between scans. The images were analyzed twice by one operator (OP1) and once by an additional operator (OP2), who independently corrected the bone contours when necessary. The number, surface and volume of interruptions per joint were obtained. Intra- and inter-operator reliability and intra-operator reproducibility were determined by intra-class correlation coefficients (ICC). Intra-operator reproducibility errors were determined as the least significant change (LSCSD). Results Per joint, the mean number of interruptions was 3.1 (SD 3.6), mean interruption surface 4.2 (SD 7.2) mm2, and mean interruption volume 3.5 (SD 10.6) mm3 for OP1. Intra- and inter-operator reliability was excellent for the cortical interruption parameters (ICC ≥0.91), except good for the inter-operator reliability of the interruption surface (ICC = 0.70). The LSCSD per joint was 4.2 for the number of interruptions, 5.8 mm2 for interruption surface, and 3.2 mm3 for interruption volume. Conclusions The algorithm was highly reproducible in the detection of cortical interruptions and their volume. Based on the LSC findings, the potential value of this algorithm for monitoring structural damage in the joints in early arthritis patients needs to be tested in clinical studies. Electronic supplementary material The online version of this article (10.1186/s12880-018-0255-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M Peters
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202, Maastricht, AZ, the Netherlands. .,CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands. .,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.
| | - J de Jong
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202, Maastricht, AZ, the Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - A Scharmga
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202, Maastricht, AZ, the Netherlands.,CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - A van Tubergen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202, Maastricht, AZ, the Netherlands.,CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - P Geusens
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202, Maastricht, AZ, the Netherlands.,CAPHRI, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - D Loeffen
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - R Weijers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - S K Boyd
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - C Barnabe
- Cumming School of Medicine, McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - K S Stok
- Department of Biomedical Engineering, the University of Melbourne, Melbourne, Australia
| | - B van Rietbergen
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands.,Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - J van den Bergh
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202, Maastricht, AZ, the Netherlands.,NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
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Effect of treat-to-target strategies on bone erosion progression in early rheumatoid arthritis: An HR-pQCT study. Semin Arthritis Rheum 2018; 48:374-383. [PMID: 29858113 DOI: 10.1016/j.semarthrit.2018.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 03/12/2018] [Accepted: 05/01/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To investigate the efficacy of two tight-control treatment strategies aimed at simplified disease activity score [SDAI] remission (SDAI ≤ 3.3) compared to DAS28 remission (DAS28 < 2.6) on progression of bone erosions in early rheumatoid arthritis (ERA) patients using high-resolution peripheral quantitative computed tomography (HR-pQCT). METHODS This was an open-label study in which 80 early RA patients were randomized to receive 1-year of tight-control treatment. Group 1 (n = 37) aimed at SDAI ≤ 3.3 and group 2 (n = 43) aimed at DAS28-CRP < 2.6. The number and size of bone erosions, as well as the bone mineral density (BMD) surrounding bone erosion at the second metacarpophalangeal joint (MCP2), were measured at baseline and 12 months. RESULTS After 12 months, images were analyzed in 63 patients. Changes in clinical parameters, number and size of bone erosions as well as the BMD surrounding bone erosion between the two treatment groups were similar. Therefore, a post-hoc analysis including all 63 patients was performed to elucidate the independent predictors of erosion progression and repair. Multivariate analysis revealed that not achieving sustained SDAI remission at month 6, 9 and 12 (p = 0.034) and rheumatoid factor >16U (p = 0.021) were independent predictors associated with an increase in erosion volume. Logistic regression analysis showed that achieving sustained SDAI remission (p = 0.043) was associated with partial erosion repair. CONCLUSIONS Although more stringent treatment target did not notably affect clinical treatment outcome and erosion progression at 1 year, achieving sustained SDAI remission was found to be associated with partial erosion repair.
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Jacobson JA, Roberts CC, Bencardino JT, Appel M, Arnold E, Baccei SJ, Cassidy RC, Chang EY, Fox MG, Greenspan BS, Gyftopoulos S, Hochman MG, Mintz DN, Newman JS, Rosenberg ZS, Shah NA, Small KM, Weissman BN. ACR Appropriateness Criteria ® Chronic Extremity Joint Pain-Suspected Inflammatory Arthritis. J Am Coll Radiol 2018; 14:S81-S89. [PMID: 28473097 DOI: 10.1016/j.jacr.2017.02.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 01/30/2017] [Accepted: 02/02/2017] [Indexed: 02/07/2023]
Abstract
Evaluation for suspected inflammatory arthritis as a cause for chronic extremity joint pain often relies on imaging. This review first discusses the characteristic osseous and soft tissue abnormalities seen with inflammatory arthritis and how they may be imaged. It is essential that imaging results are interpreted in the context of clinical and serologic results to add specificity as there is significant overlap of imaging findings among the various types of arthritis. This review provides recommendations for imaging evaluation of specific types of inflammatory arthritis, including rheumatoid arthritis, seronegative spondyloarthropathy, gout, calcium pyrophosphate dihydrate disease (or pseudogout), and erosive osteoarthritis. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Jon A Jacobson
- Principal Author, University of Michigan Medical Center, Ann Arbor, Michigan.
| | | | - Jenny T Bencardino
- Panel Vice-Chair, New York University School of Medicine, New York, New York
| | - Marc Appel
- James J. Peters VA Medical Center, Bronx, New York, American Academy of Orthopaedic Surgeons
| | - Erin Arnold
- Orthopaedics and Rheumatology of the North Shore, Skokie, Illinois. American College of Rheumatology
| | | | - R Carter Cassidy
- UK Healthcare Spine and Total Joint Service, Lexington, Kentucky. American Academy of Orthopaedic Surgeons
| | - Eric Y Chang
- VA San Diego Healthcare System, San Diego, California
| | - Michael G Fox
- University of Virginia Health System, Charlottesville, Virginia
| | | | | | - Mary G Hochman
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | - Nehal A Shah
- Brigham & Women's Hospital, Boston, Massachusetts
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Ibrahim-Nasser N, Marotte H, Valery A, Salliot C, Toumi H, Lespessailles E. Precision and sources of variability in the assessment of rheumatoid arthritis erosions by HRpQCT. Joint Bone Spine 2018; 85:211-217. [DOI: 10.1016/j.jbspin.2017.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 02/15/2017] [Indexed: 01/14/2023]
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Zabotti A, Bandinelli F, Batticciotto A, Scirè CA, Iagnocco A, Sakellariou G. Musculoskeletal ultrasonography for psoriatic arthritis and psoriasis patients: a systematic literature review. Rheumatology (Oxford) 2017; 56:1518-1532. [PMID: 28521047 DOI: 10.1093/rheumatology/kex179] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Indexed: 12/15/2022] Open
Abstract
Objective To systematically review the role of musculoskeletal US in patients suffering from PsA or psoriasis (Pso) in terms of prevalence, diagnosis, prognosis, monitoring and treatment. Methods A systematic literature review was conducted through medical databases (MEDLINE via PubMed, Embase) and the grey literature up to September 2015 to inform a new study of the Musculoskeletal Ultrasound Study Group of the Italian Society for Rheumatology. All articles reporting data on musculoskeletal US in PsA or Pso were included and extracted according to the underlying clinical question. Results A total of 86 publications were included. The prevalence of US abnormalities showed a wide range for each examined feature (e.g. 37-95% for entheses thickness of the lower limbs). The performance of US for diagnosis of disease or elementary lesions was variable across studies, but no study evaluated the overall performance of US in addition to clinical findings for diagnosing PsA. Considering US in defining PsA and Pso prognosis, several works focused on US of entheses of lower limbs in Pso, while for the monitoring of PsA activity five different scoring systems were identified. Last, the results of the role of US in guiding intra-articular interventions were controversial for the clinical outcomes, but in favour of US for accuracy. Conclusion despite the recognized importance of US in the management of PsA and Pso, this review clearly demonstrated the need of pivotal research in order to optimize the use of US in the diagnosis and monitoring of psoriatic disease.
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Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical and Biological Sciences, University Hospital Santa Maria della Misericordia, Udine
| | - Francesca Bandinelli
- Rheumatology Unit, Azienda Sanitaria di Firenze, S. Giovanni di Dio Hospital, Florence
| | | | - Carlo Alberto Scirè
- Epidemiology Unit of the Italian Society for Rheumatology (SIR), Milan.,Department of Medical Sciences, Section of Rheumatology, University of Ferrara, Ferrara
| | - Annamaria Iagnocco
- Dipartimento di Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin
| | - Garifallia Sakellariou
- Division of Rheumatology, IRCCS Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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Chang EY, Chen KC, Huang BK, Kavanaugh A. Adult Inflammatory Arthritides: What the Radiologist Should Know. Radiographics 2017; 36:1849-1870. [PMID: 27726745 DOI: 10.1148/rg.2016160011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Developments and improvements in knowledge are rapid and ongoing in both the radiologic and rheumatologic fields. During the past decade, the roles of imaging and the radiologist in the assessment and management of many inflammatory rheumatologic diseases have undergone several changes. To remain effective in patient care, the radiologist needs to be aware of these changes when recommending and interpreting imaging examinations for the referring physician. The goal of contemporary rheumatoid arthritis (RA) management is to redefine RA as a disease that is no longer characterized by erosions, which reflect established or long-standing untreated disease. Most cases of RA are now diagnosed clinically, but imaging increases diagnostic confidence, is superior to clinical examination for the detection of joint inflammation, and plays an important role in patient management. The concept of the seronegative spondyloarthritides has recently been redefined by the Assessment of SpondyloArthritis International Society (ASAS). This new set of ASAS classification criteria divides the spectrum of spondyloarthritis on the basis of predominantly axial skeletal clinical manifestations or predominantly peripheral skeletal clinical manifestations. For axial spondyloarthritis, magnetic resonance imaging and radiography play crucial roles for classification and diagnosis. For both peripheral spondyloarthritis and psoriatic arthritis, the radiologist can provide important information that influences classification and diagnosis, including documenting radiologic evidence of juxta-articular new bone formation, diagnosing sacroiliitis, or delineating the presence and extent of enthesitis and dactylitis. The radiologist's familiarity with recent classification criteria, in addition to the traditional diagnostic characteristics of the individual inflammatory arthritides, maximizes the productive interface between the radiologist and the rheumatologist. ©RSNA, 2016.
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Affiliation(s)
- Eric Y Chang
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Karen C Chen
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Brady K Huang
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Arthur Kavanaugh
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
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Vascular channels in metacarpophalangeal joints: a comparative histologic and high-resolution imaging study. Sci Rep 2017; 7:8966. [PMID: 28827584 PMCID: PMC5566954 DOI: 10.1038/s41598-017-09363-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/24/2017] [Indexed: 02/02/2023] Open
Abstract
We evaluated whether cortical interruptions classified as vascular channel (VC) on high-resolution peripheral quantitative computed tomography (HR-pQCT) could be confirmed by histology. We subsequently evaluated the image characteristics of histologically identified VCs on matched single and multiplane HR-pQCT images. Four 3-mm thick portions in three anatomic metacarpophalangeal joint specimens were selected for histologic sectioning. First, VCs identified with HR-pQCT were examined for confirmation on histology. Second and independently, VCs identified by histology were matched to single and multiplane HR-pQCT images to assess for presence of cortical interruptions. Only one out of five cortical interruptions suggestive for VC on HR-pQCT could be confirmed on histology. In contrast, 52 VCs were identified by histology of which 39 (75%) could be classified as cortical interruption or periosteal excavation on matched single HR-pQCT slices. On multiplane HR-pQCT images, 11 (21%) showed a cortical interruption in at least two consecutive slices in two planes, 36 (69%) in at least one slice in two planes and five (10%) showed no cortical interruption. Substantially more VCs were present in histology sections than initially suggested by HR-pQCT. The small size and heterogeneous presentation, limit the identification as VC on HR-pQCT.
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Stok KS, Finzel S, Burghardt AJ, Conaghan PG, Barnabe C. The SPECTRA Collaboration OMERACT Special Interest Group: Current Research and Future Directions. J Rheumatol 2017; 44:1911-1915. [PMID: 28765253 DOI: 10.3899/jrheum.161197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/03/2017] [Indexed: 01/17/2023]
Abstract
OBJECTIVE High-resolution peripheral quantitative computed tomography (HR-pQCT) has the potential to improve radiographic progression determination in clinical trials and longitudinal observational studies. The goal of this work was to describe the current state of research presented at Outcome Measures in Rheumatology (OMERACT) 2016 and ensuing future directions outlined during discussion among attendees. METHODS At OMERACT 2016, SPECTRA (Study grouP for xtrEme-Computed Tomography in Rheumatoid Arthritis) introduced efforts to (1) validate the HR-pQCT according to OMERACT guidelines, focusing on rheumatoid arthritis (RA), and (2) find alternatives for automated joint space width (JSW) analysis. The Special Interest Group (SIG) was presented to patient research partners, physicians/researchers, and SIG leaders followed by a 40-min discussion on future directions. RESULTS A consensus definition for RA erosion using HR-pQCT was demonstrated through a systematic literature review and a Delphi exercise. Histopathology and perfusion studies were presented that analyzed the true characteristics of cortical breaks in HR-pQCT images, and to provide criterion validity. Results indicate that readers were able to discriminate between erosion and small vascular channels. Moderate reliability (ICC 0.206-0.871) of direct erosion size measures was shown, which improved (> 0.9) only when experienced readers were considered. Quantification of erosion size was presented for scoring, direct measurement, and volumetric approaches, as well as a reliability exercise for direct measurement. Three methods for JSW measurement were compared, all indicating excellent reproducibility with differences at the extremes (i.e., near-zero and joint edge thickness). CONCLUSION Initial reports on HR-pQCT are promising; however, to consider its use in clinical trials and longitudinal observational studies, it is imperative to assess the responsiveness of erosion measurement quantification.
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Affiliation(s)
- Kathryn S Stok
- From the Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Departments of Medicine and Community Health Sciences, University of Calgary; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada. .,K.S. Stok, PhD, Senior Lecturer, Institute for Biomechanics, ETH Zurich, and Department of Biomedical Engineering, University of Melbourne; S. Finzel, MD, Senior Attending Physician, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg; A.J. Burghardt, BS, Research Specialist, Department of Radiology and Biomedical Imaging, University of California; P.G. Conaghan, MD, PhD, Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre; C. Barnabe, MD, MSc, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary.
| | - Stephanie Finzel
- From the Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Departments of Medicine and Community Health Sciences, University of Calgary; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,K.S. Stok, PhD, Senior Lecturer, Institute for Biomechanics, ETH Zurich, and Department of Biomedical Engineering, University of Melbourne; S. Finzel, MD, Senior Attending Physician, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg; A.J. Burghardt, BS, Research Specialist, Department of Radiology and Biomedical Imaging, University of California; P.G. Conaghan, MD, PhD, Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre; C. Barnabe, MD, MSc, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary
| | - Andrew J Burghardt
- From the Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Departments of Medicine and Community Health Sciences, University of Calgary; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,K.S. Stok, PhD, Senior Lecturer, Institute for Biomechanics, ETH Zurich, and Department of Biomedical Engineering, University of Melbourne; S. Finzel, MD, Senior Attending Physician, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg; A.J. Burghardt, BS, Research Specialist, Department of Radiology and Biomedical Imaging, University of California; P.G. Conaghan, MD, PhD, Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre; C. Barnabe, MD, MSc, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary
| | - Philip G Conaghan
- From the Institute for Biomechanics, ETH Zurich, Zurich, Switzerland; Department of Biomedical Engineering, University of Melbourne, Melbourne, Victoria, Australia; Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Departments of Medicine and Community Health Sciences, University of Calgary; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.,K.S. Stok, PhD, Senior Lecturer, Institute for Biomechanics, ETH Zurich, and Department of Biomedical Engineering, University of Melbourne; S. Finzel, MD, Senior Attending Physician, Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg; A.J. Burghardt, BS, Research Specialist, Department of Radiology and Biomedical Imaging, University of California; P.G. Conaghan, MD, PhD, Professor, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre; C. Barnabe, MD, MSc, Associate Professor, Departments of Medicine and Community Health Sciences, University of Calgary, and McCaig Institute for Bone and Joint Health, University of Calgary
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Peters M, Scharmga A, van Tubergen A, Arts J, Loeffen D, Weijers R, van Rietbergen B, Geusens P, van den Bergh JP. The Reliability of a Semi-automated Algorithm for Detection of Cortical Interruptions in Finger Joints on High Resolution CT Compared to MicroCT. Calcif Tissue Int 2017; 101:132-140. [PMID: 28349184 PMCID: PMC5498594 DOI: 10.1007/s00223-017-0264-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/01/2017] [Indexed: 12/19/2022]
Abstract
We developed a semi-automated algorithm for the detection of cortical interruptions in finger joints using high-resolution peripheral quantitative computed tomography (HR-pQCT). Here, we tested its reliability compared to microCT (µCT) as gold standard. Nineteen joints of 10 female anatomic index fingers were imaged by HR-pQCT and µCT (82 and 18 µm isotropic voxel sizes, respectively). The algorithm was applied for detection of cortical interruptions of different minimum diameters (range >0.16 to >0.50 mm). Reliability was tested at the joint level with intra-class correlation coefficient (ICC) for the number of interruptions and interruption surface, and at the level of a single interruption for matching between HR-pQCT and µCT with a fixed interruption diameter (>0.10 mm) on µCT. The positive predictive value (PPV0.10mm) and sensitivity0.10mm were evaluated. The mean number of interruptions per joint depended on the diameter cut-off and ranged from 3.4 to 53.5 on HR-pQCT and from 1.8 to 45.1 on µCT for interruptions >0.50 to >0.16 mm, respectively. Reliability at the joint level was almost perfect (ICC ≥0.81) for both the number and surface of interruptions >0.16 and >0.33 mm. As expected, the PPV0.10mm increased with increasing interruption diameter from 84.9 to 100%, for interruptions >0.16 and >0.50 mm, respectively. However, the sensitivity0.10mm decreased with increasing interruption diameter from 62.4 to 4.7%. This semi-automated algorithm for HR-pQCT in finger joints performed best for the detection of cortical interruptions with a minimum diameter of >0.16 or >0.33 mm, showing almost perfect reliability at the joint level and interruptions matched with those on µCT.
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Affiliation(s)
- M Peters
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
- Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands.
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - A Scharmga
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - A van Tubergen
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands
| | - J Arts
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - D Loeffen
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - R Weijers
- Department of Radiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - B van Rietbergen
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - P Geusens
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- Research School CAPHRI, School for Public Health and Primary Care, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - J P van den Bergh
- Division of Rheumatology, Department of Internal Medicine, Maastricht University Medical Center, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
- NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands
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Yue J, Griffith JF, Xiao F, Shi L, Wang D, Shen J, Wong P, Li EK, Li M, Li TK, Zhu TY, Hung VW, Qin L, Tam LS. Repair of Bone Erosion in Rheumatoid Arthritis by Denosumab: A High-Resolution Peripheral Quantitative Computed Tomography Study. Arthritis Care Res (Hoboken) 2017; 69:1156-1163. [PMID: 27768831 DOI: 10.1002/acr.23133] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/12/2016] [Accepted: 10/18/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To compare the bone healing effects of denosumab and alendronate in female rheumatoid arthritis (RA) patients by high-resolution peripheral quantitative computed tomography. METHODS This is a post hoc analysis of a randomized controlled trial. Forty patients were randomized in a 1:1 ratio to receive either subcutaneous denosumab (60 mg) once or oral alendronate (70 mg) weekly for 6 months. The size of individual bone erosions and the presence and extent of erosion-associated sclerosis (marginal osteosclerosis) were measured in the second metacarpal head of the nondominant hand at baseline, 3 months, and 6 months. RESULTS Forty-two erosions were identified at baseline. After 6 months, the width, depth, and volume of erosion significantly decreased in the denosumab group (-0.23 mm, -0.16 mm, -0.91 mm3 , respectively; all P < 0.01), whereas these parameters significantly increased in the alendronate group (0.19 mm, 0.32 mm, and 1.38 mm3 , respectively; all P < 0.01; between-group differences, P < 0.01 for all). Quantitative analysis showed that the bone mineral density of the erosion margin significantly increased only after treatment by denosumab (19.75 mg/cm3 ; P < 0.05 for denosumab, and -5.44 mg/cm3 ; P = 0.51 for alendronate; P < 0.05 for between-group differences). CONCLUSION Inhibition of receptor activator of NF-κB ligand by denosumab can induce partial repair of erosions in patients with RA, while erosions continued to progress in patients treated with alendronate. Combining denosumab with disease-modifying antirheumatic drugs may be considered for RA patients with progressive bone erosions.
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Affiliation(s)
- Jiang Yue
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - James F Griffith
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Fan Xiao
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lin Shi
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Defeng Wang
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jiayun Shen
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Priscilla Wong
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Edmund K Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Martin Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tena K Li
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Tracy Y Zhu
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Vivian W Hung
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Ling Qin
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Lai-Shan Tam
- The Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
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Ultrasound-detected bone erosion is a relapse risk factor after discontinuation of biologic disease-modifying antirheumatic drugs in patients with rheumatoid arthritis whose ultrasound power Doppler synovitis activity and clinical disease activity are well controlled. Arthritis Res Ther 2017; 19:108. [PMID: 28545509 PMCID: PMC5445491 DOI: 10.1186/s13075-017-1320-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 05/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the present study, we explored the risk factors for relapse after discontinuation of biologic disease-modifying antirheumatic drug (bDMARD) therapy in patients with rheumatoid arthritis (RA) whose ultrasound power Doppler (PD) synovitis activity and clinical disease activity were well controlled. METHODS In this observational study in clinical practice, the inclusion criteria were based on ultrasound disease activity and clinical disease activity, set as low or remission (Disease Activity Score in 28 joints based on erythrocyte sedimentation rate <3.2). Ultrasound was performed in 22 joints of bilateral hands at discontinuation for evaluating synovitis severity and presence of bone erosion. Patients with a maximum PD score ≤1 in each joint were enrolled. Forty patients with RA were consecutively recruited (November 2010-March 2015) and discontinued bDMARD therapy. Variables at the initiation and discontinuation of bDMARD therapy that were predictive of relapse during the 12 months after discontinuation were assessed. RESULTS The median patient age was 54.5 years, and the median disease duration was 3.5 years. Nineteen (47.5%) patients relapsed during the 12 months after the discontinuation of bDMARD therapy. Logistic regression analysis revealed that only the presence of bone erosion detected by ultrasound at discontinuation was predictive of relapse (OR 8.35, 95% CI 1.78-53.2, p = 0.006). No clinical characteristics or serologic biomarkers were significantly different between the relapse and nonrelapse patients. The ultrasound synovitis scores did not differ significantly between the groups. CONCLUSIONS Our findings are the first evidence that ultrasound bone erosion may be a relapse risk factor after the discontinuation of bDMARD therapy in patients with RA whose PD synovitis activity and clinical disease activity are well controlled.
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Peters M, Scharmga A, de Jong J, van Tubergen A, Geusens P, Arts JJ, Loeffen D, Weijers R, van Rietbergen B, van den Bergh J. An automated algorithm for the detection of cortical interruptions on high resolution peripheral quantitative computed tomography images of finger joints. PLoS One 2017; 12:e0175829. [PMID: 28426705 PMCID: PMC5402632 DOI: 10.1371/journal.pone.0175829] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Accepted: 04/01/2017] [Indexed: 11/25/2022] Open
Abstract
Objectives To introduce a fully-automated algorithm for the detection of small cortical interruptions (≥0.246mm in diameter) on high resolution peripheral quantitative computed tomography (HR-pQCT) images, and to investigate the additional value of manual correction of the automatically obtained contours (semi-automated procedure). Methods Ten metacarpophalangeal joints from seven patients with rheumatoid arthritis (RA) and three healthy controls were imaged with HR-pQCT. The images were evaluated by an algorithm according to the fully- and semi-automated procedure for the number and surface of interruptions per joint. Reliability between the fully- and semi-automated procedure and between two independent operators was tested using intra-class correlation coefficient (ICC) and the proportion of matching interruptions. Validity of single interruptions detected was tested by comparing it to visual scoring, as gold standard. The positive predictive value (PPV) and sensitivity were calculated. Results The median number of interruptions per joint was 14 (range 2 to 59) and did not significantly differ between the fully- and semi-automated procedure (p = 0.37). The median interruption surface per joint was significantly higher with the fully- vs. semi-automated procedure (respectively, 8.6mm2 vs. 5.8mm2 and 6.1mm2, p = 0.01). Reliability was almost perfect between the fully- and semi-automated procedure for both the number and surface of interruptions (ICC≥0.95) and the proportion of matching interruptions was high (≥76%). Also the inter-operator reliability was almost perfect (ICC≥0.97, proportion of matching interruptions 92%). The PPV ranged from 27.6% to 29.9%, and sensitivity from 69.7% to 76.3%. Most interruptions detected with the algorithm, did show an interruption on a 2D grayscale image. However, this interruption did not meet the criteria of an interruption with visual scoring. Conclusion The algorithm for HR-pQCT images detects cortical interruptions, and its interruption surface. Reliability and validity was comparable for the fully- and semi-automated procedures. However, we advise the use of the semi-automated procedure to assure quality. The algorithm is a promising tool for a sensitive and objective assessment of cortical interruptions in finger joints assessed by HR-pQCT.
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Affiliation(s)
- M. Peters
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- * E-mail:
| | - A. Scharmga
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
| | - J. de Jong
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - A. van Tubergen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
| | - P. Geusens
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- CAPHRI, School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - J. J. Arts
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - D. Loeffen
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - R. Weijers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - B. van Rietbergen
- Department of Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
- Faculty of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - J. van den Bergh
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Centre, Maastricht, the Netherlands
- NUTRIM School for Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, the Netherlands
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Internal Medicine, VieCuri Medical Centre, Venlo, the Netherlands
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Recommendations for the use of ultrasound and magnetic resonance in patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2016; 14:9-19. [PMID: 28029551 DOI: 10.1016/j.reuma.2016.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA). METHODS Recommendations were generated following a nominal group technique. A panel of experts, consisting of 15 rheumatologists and 3 radiologists, was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of experts voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. RESULTS A total of 20 recommendations were proposed. They include the validity of US and MRI regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. CONCLUSIONS These recommendations will help clinicians use US and MRI in RA patients.
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Nagaraj S, Finzel S, Stok KS, Barnabe C. High-resolution Peripheral Quantitative Computed Tomography Imaging in the Assessment of Periarticular Bone of Metacarpophalangeal and Wrist Joints. J Rheumatol 2016; 43:1921-1934. [DOI: 10.3899/jrheum.160647] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective.To synthesize descriptions of periarticular findings at the metacarpophalangeal (MCP) and wrist joints in different types of arthritis and in the normal state imaged by high-resolution peripheral quantitative computed tomography (HR-pQCT); to assemble the literature reporting on the ability of HR-pQCT to detect findings relative to other imaging modalities; and to collate results on the reproducibility of image interpretation.Methods.A systematic literature review was performed using terms for HR-pQCT and MCP or wrist joints using medical literature databases and conference abstracts. Any study describing predefined pathology findings, comparison to another radiographic technique, or a measure of reproducibility was included with no limitation by disease state.Results.We identified 44 studies meeting inclusion criteria from the 1901 articles identified by our search. All 44 reported on pathology findings, including erosions (n = 31), bone microarchitecture (n = 10) and bone mineral density (n = 10) variables, joint space evaluation (n = 7), or osteophyte characterization (n = 7). Seventeen of the studies compared HR-pQCT findings to either plain radiography (n = 9), ultrasound (n = 4), magnetic resonance imaging (n = 5), or microcomputed tomography (n = 2), with HR-pQCT having high sensitivity for erosion detection. Twenty-four studies included an assessment of reproducibility with good to excellent metrics, and highlighting the critical importance of positioning when assessing joint space variables.Conclusion.Despite high sensitivity for erosion detection and good reproducibility, more research is required to determine where HR-pQCT can be applied to enhance our understanding of periarticular bone changes in a variety of arthritis conditions.
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Barnabe C, Toepfer D, Marotte H, Hauge EM, Scharmga A, Kocijan R, Kraus S, Boutroy S, Schett G, Keller KK, de Jong J, Stok KS, Finzel S. Definition for Rheumatoid Arthritis Erosions Imaged with High Resolution Peripheral Quantitative Computed Tomography and Interreader Reliability for Detection and Measurement. J Rheumatol 2016; 43:1935-1940. [DOI: 10.3899/jrheum.160648] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Objective.High-resolution peripheral quantitative computed tomography (HR-pQCT) sensitively detects erosions in rheumatoid arthritis (RA); however, nonpathological cortical bone disruptions are potentially misclassified as erosive. Our objectives were to set and test a definition for pathologic cortical bone disruptions in RA and to standardize reference landmarks for measuring erosion size.Methods.HR-pQCT images of metacarpophalangeal joints of RA and control subjects were used in an iterative process to achieve consensus on the definition and reference landmarks. Independent readers (n = 11) applied the definition to score 58 joints and measure pathologic erosions in 2 perpendicular multiplanar reformations for their maximum width and depth. Interreader reliability for erosion detection and variability in measurements between readers [root mean square coefficient of variation (RMSCV), intraclass correlation (ICC)] were calculated.Results.Pathologic erosions were defined as cortical breaks extending over a minimum of 2 consecutive slices in perpendicular planes, with underlying trabecular bone loss and a nonlinear shape. Interreader agreement for classifying pathologic erosions was 90.2%, whereas variability for width and depth erosion assessment was observed (RMSCV perpendicular width 12.3%, axial width 20.6%, perpendicular depth 24.0%, axial depth 22.2%; ICC perpendicular width 0.206, axial width 0.665, axial depth 0.871, perpendicular depth 0.783). Mean erosion width was 1.84 mm (range 0.16–8.90) and mean depth was 1.86 mm (range 0.30–8.00).Conclusion.We propose a new definition for erosions visualized with HR-pQCT imaging. Interreader reliability for erosion detection is good, but further refinement of selection of landmarks for erosion size measurement, or automated volumetric methods, will be pursued.
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