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Noversa de Sousa R, Tascilar K, Corte G, Atzinger A, Minopoulou I, Ohrndorf S, Waldner M, Schmidkonz C, Kuwert T, Knieling F, Kleyer A, Ramming A, Schett G, Simon D, Fagni F. Metabolic and molecular imaging in inflammatory arthritis. RMD Open 2024; 10:e003880. [PMID: 38341194 PMCID: PMC10862311 DOI: 10.1136/rmdopen-2023-003880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
It is known that metabolic shifts and tissue remodelling precede the development of visible inflammation and structural organ damage in inflammatory rheumatic diseases such as the inflammatory arthritides. As such, visualising and measuring metabolic tissue activity could be useful to identify biomarkers of disease activity already in a very early phase. Recent advances in imaging have led to the development of so-called 'metabolic imaging' tools that can detect these changes in metabolism in an increasingly accurate manner and non-invasively.Nuclear imaging techniques such as 18F-D-glucose and fibroblast activation protein inhibitor-labelled positron emission tomography are increasingly used and have yielded impressing results in the visualisation (including whole-body staging) of inflammatory changes in both early and established arthritis. Furthermore, optical imaging-based bedside techniques such as multispectral optoacoustic tomography and fluorescence optical imaging are advancing our understanding of arthritis by identifying intra-articular metabolic changes that correlate with the onset of inflammation with high precision and without the need of ionising radiation.Metabolic imaging holds great potential for improving the management of patients with inflammatory arthritis by contributing to early disease interception and improving diagnostic accuracy, thereby paving the way for a more personalised approach to therapy strategies including preventive strategies. In this narrative review, we discuss state-of-the-art metabolic imaging methods used in the assessment of arthritis and inflammation, and we advocate for more extensive research endeavours to elucidate their full field of application in rheumatology.
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Affiliation(s)
- Rita Noversa de Sousa
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Serviço de Medicina Interna, Hospital Pedro Hispano, Matosinhos, Portugal
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Giulia Corte
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Armin Atzinger
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ioanna Minopoulou
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Waldner
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Institute for Medical Engineering, Ostbayerische Technische Hochschule Amberg-Weiden, Amberg, Germany
| | - Torsten Kuwert
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Nicoara AI, Sas LM, Bita CE, Dinescu SC, Vreju FA. Implementation of artificial intelligence models in magnetic resonance imaging with focus on diagnosis of rheumatoid arthritis and axial spondyloarthritis: narrative review. Front Med (Lausanne) 2023; 10:1280266. [PMID: 38173943 PMCID: PMC10761482 DOI: 10.3389/fmed.2023.1280266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Early diagnosis in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) is essential to initiate timely interventions, such as medication and lifestyle changes, preventing irreversible joint damage, reducing symptoms, and improving long-term outcomes for patients. Since magnetic resonance imaging (MRI) of the wrist and hand, in case of RA and MRI of the sacroiliac joints (SIJ) in case of axSpA can identify inflammation before it is clinically discernible, this modality may be crucial for early diagnosis. Artificial intelligence (AI) techniques, together with machine learning (ML) and deep learning (DL) have quickly evolved in the medical field, having an important role in improving diagnosis, prognosis, in evaluating the effectiveness of treatment and monitoring the activity of rheumatic diseases through MRI. The improvements of AI techniques in the last years regarding imaging interpretation have demonstrated that a computer-based analysis can equal and even exceed the human eye. The studies in the field of AI have investigated how specific algorithms could distinguish between tissues, diagnose rheumatic pathology and grade different signs of early inflammation, all of them being crucial for tracking disease activity. The aim of this paper is to highlight the implementation of AI models in MRI with focus on diagnosis of RA and axSpA through a literature review.
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Affiliation(s)
| | - Lorena-Mihaela Sas
- Radiology and Medical Imaging Laboratory, Craiova Emergency County Clinical Hospital, Craiova, Romania
- Department of Human Anatomy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Cristina Elena Bita
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Stefan Cristian Dinescu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Florentin Ananu Vreju
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Rani R, Raina N, Sharma A, Kumar P, Tulli HS, Gupta M. Advancement in nanotechnology for treatment of rheumatoid arthritis: scope and potential applications. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2023; 396:2287-2310. [PMID: 37166463 DOI: 10.1007/s00210-023-02514-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/25/2023] [Indexed: 05/12/2023]
Abstract
Rheumatoid arthritis is a hyperactive immune disorder that results in severe inflammation in synovial joints, cartilage, and bone deterioration, resulting in immobilization of joints. Traditional approaches for the treatment of rheumatoid arthritis are associated with some limiting factors such as suboptimal patient compliance, inability to control the progression of disorder, and safety concerns. Therefore, innovative drug delivery carriers for efficient therapeutic delivery at inflamed synovial sites with better safety assessment are urgently needed to address these issues. From this perspective, nanotechnology is an outstanding alternative to traditional drug delivery approaches, and it has shown great promise in developing novel carriers to treat rheumatoid arthritis. Considering the current research and future application of nanocarriers, it is believed that nanocarriers can be a crucial element in rheumatoid arthritis treatment. This paper covers all currently available pathophysiological aspects of rheumatoid arthritis and treatment options. Future research for the reduction of synovial inflammation should focus on developing multifunction nanoparticles capable of delivering therapeutic agents with improved safety, efficacy, and cost-effectiveness to be commercialized.
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Affiliation(s)
- Radha Rani
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Neha Raina
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, New Delhi, India
| | - Ajay Sharma
- Institute of Nuclear Medicine & Allied Sciences (INMAS-DRDO), Ministry of Defence, Brig. SK Mazumdar Marg, Lucknow Road, Timarpur, Delhi-110054, India
| | - Pramod Kumar
- Institute of Lung Health and Immunity, Helmholtz Zentrum München, 85764, Neuherberg, Germany
| | - Hardeep Singh Tulli
- Department of Biotechnology, Maharishi Markandeshwar Engineering College, Maharishi Markandeshwar (Deemed to Be University), Mullana-Ambala, 133207, India
| | - Madhu Gupta
- Department of Pharmaceutics, Delhi Pharmaceutical Sciences and Research University, New Delhi, India.
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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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Miyama K, Bise R, Ikemura S, Kai K, Kanahori M, Arisumi S, Uchida T, Nakashima Y, Uchida S. Deep learning-based automatic-bone-destruction-evaluation system using contextual information from other joints. Arthritis Res Ther 2022; 24:227. [PMID: 36192761 PMCID: PMC9528108 DOI: 10.1186/s13075-022-02914-7] [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: 08/05/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND X-ray images are commonly used to assess the bone destruction of rheumatoid arthritis. The purpose of this study is to propose an automatic-bone-destruction-evaluation system fully utilizing deep neural networks (DNN). This system detects all target joints of the modified Sharp/van der Heijde score (SHS) from a hand X-ray image. It then classifies every target joint as intact (SHS = 0) or non-intact (SHS ≥ 1). METHODS We used 226 hand X-ray images of 40 rheumatoid arthritis patients. As for detection, we used a DNN model called DeepLabCut. As for classification, we built four classification models that classify the detected joint as intact or non-intact. The first model classifies each joint independently, whereas the second model does it while comparing the same contralateral joint. The third model compares the same joint group (e.g., the proximal interphalangeal joints) of one hand and the fourth model compares the same joint group of both hands. We evaluated DeepLabCut's detection performance and classification models' performances. The classification models' performances were compared to three orthopedic surgeons. RESULTS Detection rates for all the target joints were 98.0% and 97.3% for erosion and joint space narrowing (JSN). Among the four classification models, the model that compares the same contralateral joint showed the best F-measure (0.70, 0.81) and area under the curve of the precision-recall curve (PR-AUC) (0.73, 0.85) regarding erosion and JSN. As for erosion, the F-measure and PR-AUC of this model were better than the best of the orthopedic surgeons. CONCLUSIONS The proposed system was useful. All the target joints were detected with high accuracy. The classification model that compared the same contralateral joint showed better performance than the orthopedic surgeons regarding erosion.
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Affiliation(s)
- Kazuki Miyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan. .,Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka, 819-0395, Japan.
| | - Ryoma Bise
- Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka, 819-0395, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kazuhiro Kai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Masaya Kanahori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Shinkichi Arisumi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Taisuke Uchida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Seiichi Uchida
- Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka, 819-0395, Japan
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Virtual Monochromatic Images from Dual-Energy Computed Tomography Do Not Improve the Detection of Synovitis in Hand Arthritis. Diagnostics (Basel) 2022; 12:diagnostics12081891. [PMID: 36010241 PMCID: PMC9406820 DOI: 10.3390/diagnostics12081891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to investigate subtraction images from different polychromatic and virtual monochromatic reconstructions of dual-energy computed tomography (CT) for the detection of inflammation (synovitis/tenosynovitis or peritendonitis) in patients with hand arthritis. In this IRB-approved prospective study, 35 patients with acute hand arthritis underwent contrast-enhanced dual-energy CT and musculoskeletal ultrasound (MSUS) of the clinically dominant hand. CT subtractions (CT-S) were calculated from 80 and 135 kVp source data and monochromatic 50 and 70 keV images. CT-S and MSUS were scored for synovitis and tenosynovitis/peritendonitis. Specificity, sensitivity and diagnostic accuracy were assessed by using MSUS as a reference. Parameters of objective image quality were measured. Thirty-three patients were analyzed. MSUS was positive for synovitis and/or tenosynovitis/peritendonitis in 28 patients. The 70 keV images had the highest diagnostic accuracy, with 88% (vs. 50 keV, 82%; 80 kVp, 85%; and 135 kVp, 82%), and superior sensitivity, with 96% (vs. 50 keV: 86%, 80 kVp: 93% and 135 kVp: 79%). The 80 kVp images showed the highest signal- and contrast-to-noise ratio, while the 50 keV images provided the lowest image quality. While all subtraction methods of contrast-enhanced dual-energy CT proved to be able to detect inflammation with sufficient diagnostic accuracy, virtual monochromatic images with low keV showed no significant improvement over conventional subtraction techniques and lead to a loss of image quality.
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Salaffi F, Carotti M, Di Carlo M, Ceccarelli L, Farah S, Giovagnoni A. The value of ultrasound and magnetic resonance imaging scoring systems in explaining handgrip strength and functional impairment in rheumatoid arthritis patients: a pilot study. Radiol Med 2022; 127:652-663. [PMID: 35567732 PMCID: PMC9130172 DOI: 10.1007/s11547-022-01499-0] [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: 12/29/2021] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
Purpose The goal of this study is to investigate the relationship between joint inflammation and damage of the wrists and hands, measured by semiquantitative ultrasound and magnetic resonance imaging scoring systems, with functional disability and handgrip strength (HGs). Materials and methods Consecutive adult RA patients with active disease, as defined by a Disease Activity Score 28 joints C-reactive protein (DAS28-CRP) > 3.2, underwent a cross-sectional evaluation comprehensive of a clinimetric assessment, an HGs evaluation, an ultrasound assessment aimed at calculating the UltraSound-CLinical ARthritis Activity (US-CLARA), and a magnetic resonance imaging scored according to the modified Simplified Rheumatoid Arthritis Magnetic Resonance Imaging Score (mod SAMIS). The Spearman’s rho correlation coefficient was used to test the correlations. Results Sixty-six patients with RA were investigated (age 55.6 ± 12.2 years). The mod SAMIS total score and the US-CLARA had a weak but significant correlation (rho = 0.377, p = 0.0018). Among the mod SAMIS sub-scores, there was a significant relationship between mod SAMIS bone edema (SAMIS-BME) and US-CLARA (rho = 0.799, p < 0.001) and mod SAMIS synovitis (SAMIS synovitis) and US-CLARA (rho = 0.539, p < 0.001). There were also significant negative relationships between the HGs score and the mod SAMIS total score and US-CLARA (rho = − 0.309, p = 0.011 and rho = − 0.775, p < 0.0001, respectively). Conclusions BME and synovitis have an influence on the function of the upper extremities. The US-CLARA and the mod SAMIS total score are intriguing options for semiquantitative assessment of joint inflammation and damage in RA.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Clinic, Dipartimento Di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ospedale "Carlo Urbani", Jesi (Ancona), Italy
| | - Marina Carotti
- Dipartimento di Scienze Radiologiche, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Marco Di Carlo
- Rheumatology Clinic, Dipartimento Di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ospedale "Carlo Urbani", Jesi (Ancona), Italy.
| | - Luca Ceccarelli
- Department of Interventional and Diagnostic Radiology, Azienda Ospedaliero-Universitaria Sant'Anna, Ferrara, Italy
| | - Sonia Farah
- Rheumatology Clinic, Dipartimento Di Scienze Cliniche e Molecolari, Università Politecnica delle Marche, Ospedale "Carlo Urbani", Jesi (Ancona), Italy
| | - Andrea Giovagnoni
- Dipartimento di Scienze Radiologiche, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
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de Pablo P, Dinnes J, Berhane S, Osman A, Lim Z, Coombe A, Raza K, Filer A, Deeks JJ. Systematic review of imaging tests to predict the development of rheumatoid arthritis in people with unclassified arthritis. Semin Arthritis Rheum 2021; 52:151919. [PMID: 34782180 DOI: 10.1016/j.semarthrit.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To estimate and compare the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound, for the prediction of rheumatoid arthritis (RA) in unclassified arthritis (UA). METHODS MEDLINE, Embase and BIOSIS were searched from 1987 to May 2019. Studies evaluating any imaging test in participants with UA were eligible. Reference standards were RA classification criteria or methotrexate initiation. Two authors independently extracted data and assessed validity using QUADAS-2. Sensitivities and specificities were calculated for each imaging characteristic and joint area. Summary estimates with 95% confidence intervals (CI) were estimated where possible. RESULTS Nineteen studies were included; 13 evaluated MRI (n=1,143; 454 with RA) and 6 evaluated ultrasound (n=531; 205 with RA). Studies were limited by unclear recruitment procedures, inclusion of patients with RA at baseline, differential verification, lack of blinding and consensus grading. Study heterogeneity largely precluded meta-analysis, however summary sensitivity and specificity for MRI synovitis in at least one joint were 93% (95% CI 88%, 96%) and 25% (95% CI 13%, 41%) (3 studies). Specificities may be higher for other MRI characteristics but data are limited. Ultrasound results were difficult to synthesise due to different diagnostic thresholds and reference standards. CONCLUSION The evidence for MRI or ultrasound as single tests for predicting RA in people with UA is heterogeneous and of variable methodological quality. Larger studies using consensus grading and consistently defined RA diagnosis are needed to identify whether combinations of imaging characteristics, either alone or in combination with other clinical findings, can better predict RA in this population.
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Affiliation(s)
- Paola de Pablo
- Institute of Inflammation and Ageing, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK; Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jacqueline Dinnes
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Sarah Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aya Osman
- Institute of Inflammation and Ageing, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Zhia Lim
- Institute of Inflammation and Ageing, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - April Coombe
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karim Raza
- Institute of Inflammation and Ageing, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK; Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Andrew Filer
- Institute of Inflammation and Ageing, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Evaluation of Synovitis of Hand in Patients With Rheumatoid Arthritis Using Diffusion Kurtosis Magnetic Resonance Imaging: Initial Findings. J Comput Assist Tomogr 2021; 45:557-563. [PMID: 34176880 DOI: 10.1097/rct.0000000000001176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To explore the role of diffusion kurtosis magnetic resonance (MR) imaging in the noninvasive identification of synovitis in hand arthritis. METHODS A total of 30 patients with rheumatoid arthritis (RA) and 10 patients suspected of RA were enrolled in the prospective study. A 3.0-T MR imaging including the diffusion kurtosis MR imaging sequence (b = 0, 500, 1000, 1500, 2000 s·mm2) was performed. A total of 210 regions of interest were confirmed and diffusion kurtosis MR imaging parameters were generated. The suspected synovitis or effusion was scored on a scale of 0 (effusion) to 3 (mild, moderate, severe synovitis), according to RA-MR imaging scoring system. The performance of diffusion kurtosis MR imaging parameters (the apparent diffusion coefficient [ADC], diffusion coefficient [D], and kurtosis [K]) in distinguishing different synovitis scores was evaluated. RESULTS There were significant differences in ADC, D, and K values among different synovitis scores (all P < 0.001). Synovitis scores were negatively correlated with the ADC and D values significantly (r = -0.725, -0.757, respectively, all P < 0.001), but positively correlated with the K values significantly (r = 0.429, P < 0.001). The area under the curve values of D, ADC, and K values were 0.884, 0.874, and 0.728 for differentiating score 1-3 from score 0, respectively. Diffusion coefficient and ADC had similar diagnostic performance, and both were higher than K in detecting synovitis. No significant difference was found between the ADC and D values in detecting synovitis. CONCLUSIONS The diffusion kurtosis MR imaging may be feasible as a noninvasive method for the diagnosis and grading of synovitis in the hands of RA patients, and the D and ADC values showed similar diagnostic performance, both of which were higher than K values.
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Kernder A, Sewerin P. [Diagnostic approach and differential diagnosis of mon- and oligoarthritis]. Dtsch Med Wochenschr 2021; 146:591-597. [PMID: 33931837 DOI: 10.1055/a-1294-1155] [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
Reasons of mon- and oligoarthritis are heterogeneous. The diagnostic approach includes a detailed medical anamnesis, physical examination and imaging (conventional X-ray, sonography, MRI and, CT). Analysis of the synovial fluid is required in suspected septic arthritis and frequently helps in diagnosis and differential diagnosis of crystal arthropathies. Dual-energy-CT (DECT) detects sodium urate crystals and can replace joint puncture in some cases. In addition to crystal arthropathies and septic arthritis, differential diagnosis of mon-/oligoarthritis includes reactive arthritis, arthrosis and monarthritic courses of SpA/PsA. A rheumatologist should be consulted particularly in the case of persistent monarthritides, in order to initiate a specific therapy to prevent secondary damage.
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Zhao J, Chen X, Ho KH, Cai C, Li CW, Yang M, Yi C. Nanotechnology for diagnosis and therapy of rheumatoid arthritis: Evolution towards theranostic approaches. CHINESE CHEM LETT 2021. [DOI: 10.1016/j.cclet.2020.11.048] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Aramaki T, Ueki Y, Kojima K, Kurushima S, Tsuji Y, Kawachi N, Iwamoto N, Ichinose K, Terada K, Eguchi K, Kawakami A. Clinical predictors of inadequate response to conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) including methotrexate (MTX) in untreated rheumatoid arthritis patients: A single-center observational study. Mod Rheumatol 2019; 30:50-57. [PMID: 30482075 DOI: 10.1080/14397595.2018.1553265] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Objectives: To investigate predictors of inadequate response to first conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) including methotrexate (MTX) in untreated rheumatoid arthritis (RA) patients in daily clinical practice.Methods: Inadequate response to MTX or other csDMARDs was defined as being not low disease activity at 12 months in more than 3 of 4 composite measures, and discontinuation or start of biologic DMARDs. The association between baseline factors and csDMARDs-IR was assessed by univariate and multivariate logistic regression analyses.Results: Four hundred and eleven and 146 patients were started on MTX and other csDMARDs, respectively; 218 patients were responsive to MTX, with a response rate of 47.0%. Tender joint count (TJC, ≥6 in 28joints, odds ratio [OR] = 1.67, 95% confidence interval [CI] 1.06-2.64) and CRP (≥1.0 mg/dL, OR = 1.72, 95%CI: 1.10-2.70) at baseline were identified as predictors on multivariate logistic regression analysis. TJC (OR = 3.60, 95%CI: 1.29-10.00) was the factor identified as a predictor of the development of other csDMARDs-IR.Conclusion: In this observational study, patients with untreated RA at risk of inadequate response to MTX included those with a higher TJC and higher CRP, while a higher TJC was the only independent predictor of an inadequate response to csDMARDs other than MTX.
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Affiliation(s)
| | - Yukitaka Ueki
- Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Kanako Kojima
- Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Shota Kurushima
- Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Yoshika Tsuji
- Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Natsumi Kawachi
- Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Naoki Iwamoto
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kunihiro Ichinose
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kaoru Terada
- Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Katsumi Eguchi
- Rheumatic Disease Center, Sasebo Chuo Hospital, Sasebo, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Kgoebane K, Ally MMTM, Duim-Beytell MC, Suleman FE. The role of imaging in rheumatoid arthritis. SA J Radiol 2018; 22:1316. [PMID: 31754498 PMCID: PMC6837821 DOI: 10.4102/sajr.v22i1.1316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/29/2018] [Indexed: 12/02/2022] Open
Abstract
Conventional radiographs of the hands and feet have traditionally been used in the diagnosis, management and monitoring of patients with rheumatoid arthritis (RA). However, they are not sensitive enough to detect changes early in the disease process. Erosions may only be visible up to two years after the onset of disease, and soft tissue involvement may not be detected at all. Early diagnosis can also be made challenging as markers such as erythrocyte sedimentation rate and C-reactive protein may be normal in up to 20% - 25% of cases. The latest classification criteria (American College of Rheumatology/European League Against Rheumatism [ACR/EULAR] Rheumatoid Arthritis Classification criteria 2010), often used to diagnose RA, incorporate the role of ultrasound and magnetic resonance imaging detection of synovitis, enabling earlier diagnosis and correct classification of patients. This article looks at the role of the various imaging modalities used in the diagnosis and management of RA.
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Sewerin P, Le L, Vordenbäumen S, Schleich C, Sengewein R, Brinks R, Pongratz G, Bleck E, Lesch J, Mansmann U, Schneider M, Ostendorf B. Rheumatoid Arthritis Magnetic Resonance Imaging Score Predicts Therapy Response: Results of the German ArthroMark Cohort. J Rheumatol 2018; 45:753-759. [PMID: 29606664 DOI: 10.3899/jrheum.170797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Markers for treatment response in rheumatoid arthritis (RA) are lacking. The aim of the study was to assess the performance of the RA magnetic resonance imaging (MRI) scoring system (RAMRIS) in combination with serum biomarkers to predict response to methotrexate (MTX) treatment in therapy-naive patients with early RA by using high-field MRI. METHODS Twenty-eight patients with RA were prospectively assessed with baseline 3-T MRI of the clinical dominant hand, 3 and 6 months after MTX. The patients met the 2010 American College of Rheumatology/European League Against Rheumatism (EULAR) criteria [average age 56.8 yrs (range 39-74); positive for rheumatoid factor and/or anticyclic citrullinated peptide antibodies; disease duration < 6 mos (range 2-23 weeks)]. RAMRIS and serum biomarkers consisting of various experimental proteins including receptor activator of nuclear factor-κB ligand (RANKL) were obtained. Remission or treatment response was defined according to EULAR. To adjust for intrapersonal correlation, generalized linear mixed models were used. RESULTS Treatment response at 3 months was associated to low RAMRIS erosion subscores and low total RAMRIS scores (p = 0.019 and 0.03, respectively). Remission at 6 months was associated to low RANKL levels (p = 0.033). In multivariate analyses, response at 3 and 6 months was predicted more accurately with the inclusion of total RAMRIS score, RAMRIS synovitis subscore at the second metacarpophalangeal (MCP) joint, or a combination of the two (p value likelihood ratio test = 0.035, 0.035, and 0.041, respectively). Remission was more accurately predicted with inclusion of RANKL, with no significant predictive effect of MRI. CONCLUSION Baseline total RAMRIS can predict EULAR response. RAMRIS synovitis subscore at the second MCP joint and RANKL are associated with response and remission, respectively.
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Affiliation(s)
- Philipp Sewerin
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany. .,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf.
| | - Lien Le
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
| | - Stefan Vordenbäumen
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
| | - Christoph Schleich
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
| | - Ruben Sengewein
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
| | - Ralph Brinks
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
| | - Georg Pongratz
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
| | - Ellen Bleck
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
| | - Juliane Lesch
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
| | - Ulrich Mansmann
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
| | - Matthias Schneider
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
| | - Benedikt Ostendorf
- From the Department and Hiller-Research-Unit for Rheumatology, and the Institute of Diagnostic and Interventional Radiology, Universitätsklinikum Düsseldorf (UKD), Heinrich-Heine-University Düsseldorf; University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology, Düsseldorf; the Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University, Munich, Germany.,P. Sewerin, MD, University Düsseldorf, Medical Faculty, Department of Endocrinology, Diabetology and Rheumatology; L. Le, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; S. Vordenbäumen, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; C. Schleich, MD, PhD, Department for Diagnostic and Interventional Radiology, UKD, Heinrich-Heine-University Düsseldorf; R. Sengewein, MD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; R. Brinks, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; G. Pongratz, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; E. Bleck, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; J. Lesch, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; U. Mansmann, PhD, Institute for Medical Information Sciences, Biometry and Epidemiology, Ludwig Maximilian University; M. Schneider, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf; B. Ostendorf, MD, PhD, Department and Hiller-Research-Unit for Rheumatology, UKD, Heinrich-Heine-University Düsseldorf
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15
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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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16
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Mikecz K. Editorial: Ratiometric Optical Imaging of Subclinical Inflammation With a Thrombin-Cleavable Probe: A Future Tool for the In Vivo Visualization of Clinically Silent Synovitis? Arthritis Rheumatol 2018; 70:4-6. [PMID: 28898572 PMCID: PMC5745257 DOI: 10.1002/art.40315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 11/09/2022]
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17
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Platten M, Kisten Y, Kälvesten J, Arnaud L, Forslind K, van Vollenhoven R. Fully automated joint space width measurement and digital X-ray radiogrammetry in early RA. RMD Open 2017; 3:e000369. [PMID: 28879043 PMCID: PMC5574453 DOI: 10.1136/rmdopen-2016-000369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 04/08/2017] [Accepted: 04/16/2017] [Indexed: 01/28/2023] Open
Abstract
Objectives To study fully automated digital joint space width (JSW) and bone mineral density (BMD) in relation to a conventional radiographic scoring method in early rheumatoid arthritis (eRA). Methods Radiographs scored by the modified Sharp van der Heijde score (SHS) in patients with eRA were acquired from the SWEdish FarmacOTherapy study. Fully automated JSW measurements of bilateral metacarpals 2, 3 and 4 were compared with the joint space narrowing (JSN) score in SHS. Multilevel mixed model statistics were applied to calculate the significance of the association between ΔJSW and ΔBMD over 1 year, and the JSW differences between damaged and undamaged joints as evaluated by the JSN. Results Based on 576 joints of 96 patients with eRA, a significant reduction from baseline to 1 year was observed in the JSW from 1.69 (±0.19) mm to 1.66 (±0.19) mm (p<0.01), and BMD from 0.583 (±0.068) g/cm2 to 0.566 (±0.074) g/cm2 (p<0.01). A significant positive association was observed between ΔJSW and ΔBMD over 1 year (p<0.0001). On an individual joint level, JSWs of undamaged (JSN=0) joints were wider than damaged (JSN>0) joints: 1.68 mm (95% CI 1.70 to 1.67) vs 1.54 mm (95% CI 1.63 to 1.46). Similarly the unadjusted multilevel model showed significant differences in JSW between undamaged (1.68 mm (95% CI 1.72 to 1.64)) and damaged joints (1.63 mm (95% CI 1.68 to 1.58)) (p=0.0048). This difference remained significant in the adjusted model: 1.66 mm (95% CI 1.70 to 1.61) vs 1.62 mm (95% CI 1.68 to 1.56) (p=0.042). Conclusions To measure the JSW with this fully automated digital tool may be useful as a quick and observer-independent application for evaluating cartilage damage in eRA. Trial registration number NCT00764725.
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Affiliation(s)
- Michael Platten
- Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden
| | - Yogan Kisten
- Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden
| | - Johan Kälvesten
- Medicine and Health Sciences, Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Sectra AB, Linköping, Sweden
| | - Laurent Arnaud
- Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden
| | - Kristina Forslind
- Department of Medicine, Section of Rheumatology, Helsingborg's Hospital, Helsingborg, Sweden.,Department of Clinical Sciences, Section of Rheumatology, Lund University, Helsingborg, Sweden
| | - Ronald van Vollenhoven
- Department of Medicine, Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Stockholm, Sweden.,Departments of AMC, READE and VUmc, Amsterdam Rheumatology & Immunology Center (ARC), Amsterdam, Netherlands
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18
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Inflammatory Joint Disorders and Neutrophilic Dermatoses: a Comprehensive Review. Clin Rev Allergy Immunol 2017; 54:269-281. [DOI: 10.1007/s12016-017-8629-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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19
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Rice DD, Abramovitch K, Roche S, Cora CA, Torralba KD, Christensen HL, Christiansen EL. Undiagnosed, chronic temporomandibular joint pain: making a case for FDG-PET/CT. Int J Rheum Dis 2017; 20:2122-2126. [PMID: 28730618 DOI: 10.1111/1756-185x.13134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Dwight D Rice
- Department of Radiology and Imaging Sciences, Loma Linda University, Loma Linda, California, USA
| | - Kenneth Abramovitch
- Department of Radiology and Imaging Sciences, Loma Linda University, Loma Linda, California, USA
| | - Susan Roche
- Department of Oral Surgery, Loma Linda University, Loma Linda, California, USA
| | - Cherie A Cora
- Department of Radiology and Imaging Sciences, Loma Linda University, Loma Linda, California, USA
| | - Karina D Torralba
- Division of Rheumatology, Loma Linda University, Loma Linda, California, USA
| | - Heidi L Christensen
- Division of General Dentistry, Loma Linda University, Loma Linda, California, USA
| | - Edwin L Christiansen
- Department of Radiology and Imaging Sciences, Loma Linda University, Loma Linda, California, USA
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20
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Boer AC, Burgers LE, Mangnus L, ten Brinck RM, Nieuwenhuis WP, van Steenbergen HW, Reijnierse M, Huizinga TWJ, van der Helm van Mil AHM. Using a reference when defining an abnormal MRI reduces false-positive MRI results—a longitudinal study in two cohorts at risk for rheumatoid arthritis. Rheumatology (Oxford) 2017; 56:1700-1706. [DOI: 10.1093/rheumatology/kex235] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Indexed: 11/14/2022] Open
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21
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Hoffmann B, Svensson CM, Straßburger M, Gebser B, Irmler IM, Kamradt T, Peter Saluz H, Thilo Figge M. Automated Quantification of Early Bone Alterations and Pathological Bone Turnover in Experimental Arthritis by in vivo PET/CT Imaging. Sci Rep 2017; 7:2217. [PMID: 28533505 PMCID: PMC5440413 DOI: 10.1038/s41598-017-02389-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 04/11/2017] [Indexed: 12/29/2022] Open
Abstract
The assessment of bone damage is required to evaluate disease severity and treatment efficacy both in arthritis patients and in experimental arthritis models. Today there is still a lack of in vivo methods that enable the quantification of arthritic processes at an early stage of the disease. We performed longitudinal in vivo imaging with [18F]-fluoride PET/CT before and after experimental arthritis onset for diseased and control DBA/1 mice and assessed arthritis progression by clinical scoring, tracer uptake studies and bone volume as well as surface roughness measurements. Arthritic animals showed significantly increased tracer uptake in the paws compared to non-diseased controls. Automated CT image analysis revealed increased bone surface roughness already in the earliest stage of the disease. Moreover, we observed clear differences between endosteal and periosteal sites of cortical bone regarding surface roughness. This study shows that in vivo PET/CT imaging is a favorable method to study arthritic processes, enabling the quantification of different aspects of the disease like pathological bone turnover and bone alteration. Especially the evaluation of bone surface roughness is sensitive to early pathological changes and can be applied to study the dynamics of bone erosion at different sites of the bones in an automated fashion.
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Affiliation(s)
- Bianca Hoffmann
- Departemet Cell and Molecular Biology, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany.,Friedrich Schiller University, Fürstengraben 1, 07743, Jena, Germany
| | - Carl-Magnus Svensson
- Applied Systems Biology, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany
| | - Maria Straßburger
- Transfer Group Anti-infectives, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany
| | - Björn Gebser
- Departemet Cell and Molecular Biology, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany
| | - Ingo M Irmler
- Institute of Immunology, Jena University Hospital, Leutragraben 3, 07743, Jena, Germany
| | - Thomas Kamradt
- Institute of Immunology, Jena University Hospital, Leutragraben 3, 07743, Jena, Germany
| | - Hans Peter Saluz
- Departemet Cell and Molecular Biology, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany. .,Friedrich Schiller University, Fürstengraben 1, 07743, Jena, Germany.
| | - Marc Thilo Figge
- Friedrich Schiller University, Fürstengraben 1, 07743, Jena, Germany. .,Applied Systems Biology, Leibniz-Institute for Natural Product Research and Infection Biology, Hans-Knöll-Institute, Beutenbergstr. 11a, 07745, Jena, Germany.
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22
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Bird P, Nicholls D, Barrett R, de Jager J, Griffiths H, Roberts L, Tymms K, McCloud P, Littlejohn G. Longitudinal study of clinical prognostic factors in patients with early rheumatoid arthritis: the PREDICT study. Int J Rheum Dis 2017; 20:460-468. [PMID: 28205333 DOI: 10.1111/1756-185x.13036] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIM To assess the association between baseline clinical prognostic factors and subsequent Disease Activity Score of 28 joints (DAS28) remission in early rheumatoid arthritis (RA). METHODS Data were collected using point of care clinical software from participating rheumatology centres. Patients aged 18 years or over whose date of clinical onset of RA was within the previous 12-24 months, who had at least 6 months of follow-up data and a DAS28-ESR (erythrocyte sedimentation rate) score recorded between 12 and 24 months from first being seen for RA were included. Data collected included baseline demographics, mode of disease onset, pattern of joint involvement at onset, smoking status, DAS28, rheumatoid factor (RF), anti-citrullinated peptide antibodies (ACPA), time from symptom onset to presentation and disease activity at baseline. Univariate and multivariate logistic regression of DAS28-ESR remission between 12 and 24 months after first assessment were performed. RESULTS Data from 1017 patients were analyzed: 70% female; mean age 60 years (SD: 14.7); 70% RF-positive, 58% ACPA-positive. The strongest age and sex adjusted baseline predictors of DAS28-ESR remission at 12-24 months were remission at baseline (odds ratio [OR]: 4.49, 95% CI: 2.17-9.29, P < 0.001), being male (OR: 2.42, 95% CI: 1.46-4.01, P < 0.001), abstaining from alcohol (P < 0.001) and being lower weight (OR: 0.98, 95% CI: 0.97-1.00, P = 0.015). There was no statistically significant association between joint onset patterns, mode of onset, RF, ACPA or smoking status. CONCLUSION In this observational study, patients with early RA at risk of not achieving remission include those with high disease activity at baseline, women, those who drink alcohol and those with higher body weight.
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Affiliation(s)
- Paul Bird
- University of New South Wales and Combined Rheumatology Practice, Kogarah, New South Wales, Australia
| | - Dave Nicholls
- Coast Joint Care, Maroochydore, Queensland, Australia
| | - Rina Barrett
- Roche Products, Pty. Limited, Sydney, New South Wales, Australia
| | | | | | | | - Kathleen Tymms
- Canberra Rheumatology, Canberra, Australian Capital Territory, Australia
| | - Philip McCloud
- McCloud Consulting Group, Sydney, New South Wales, Australia
| | - Geoffrey Littlejohn
- Monash Medical Centre, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
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23
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Narayan N, Owen DR, Taylor PC. Advances in positron emission tomography for the imaging of rheumatoid arthritis. Rheumatology (Oxford) 2017; 56:1837-1846. [DOI: 10.1093/rheumatology/kew484] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Indexed: 12/27/2022] Open
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24
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Fatima F, Fei Y, Ali A, Mohammad M, Erlandsson MC, Bokarewa MI, Nawaz M, Valadi H, Na M, Jin T. Radiological features of experimental staphylococcal septic arthritis by micro computed tomography scan. PLoS One 2017; 12:e0171222. [PMID: 28152087 PMCID: PMC5289588 DOI: 10.1371/journal.pone.0171222] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 01/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Permanent joint dysfunction due to bone destruction occurs in up to 50% of patients with septic arthritis. Recently, imaging technologies such as micro computed tomography (μCT) scan have been widely used for preclinical models of autoimmune joint disorders. However, the radiological features of septic arthritis in mice are still largely unknown. METHODS NMRI mice were intravenously or intra-articularly inoculated with S. aureus Newman or LS-1 strain. The radiological and clinical signs of septic arthritis were followed for 10 days using μCT. We assessed the correlations between joint radiological changes and clinical signs, histological changes, and serum levels of cytokines. RESULTS On days 5-7 after intravenous infection, bone destruction verified by μCT became evident in most of the infected joints. Radiological signs of bone destruction were dependent on the bacterial dose. The site most commonly affected by septic arthritis was the distal femur in knees. The bone destruction detected by μCT was positively correlated with histological changes in both local and hematogenous septic arthritis. The serum levels of IL-6 were significantly correlated with the severity of joint destruction. CONCLUSION μCT is a sensitive method for monitoring disease progression and determining the severity of bone destruction in a mouse model of septic arthritis. IL-6 may be used as a biomarker for bone destruction in septic arthritis.
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Affiliation(s)
- Farah Fatima
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- Department of Pathology and Forensic Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Ying Fei
- Department of Microbiology and Immunology, Affiliated Hospital of GuiZhou Medical University, Guiyang, P.R. China
| | - Abukar Ali
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Majd Mohammad
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Malin C. Erlandsson
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Maria I. Bokarewa
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Muhammad Nawaz
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- Department of Pathology and Forensic Medicine, Ribeirao Preto School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Hadi Valadi
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Manli Na
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Tao Jin
- Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
- Department of Rheumatology, Sahlgrenska University Hospital, Göteborg, Sweden
- * E-mail:
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25
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Affiliation(s)
- Yun Young Choi
- Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Korea
| | - Ji Young Kim
- Department of Nuclear Medicine, Hanyang University Medical Center, Seoul, Korea
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26
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Migliore A, Bizzi E, Petrella L, Bruzzese V, Cassol M, Integlia D. The Challenge of Treating Early-Stage Rheumatoid Arthritis: The Contribution of Mixed Treatment Comparison to Choosing Appropriate Biologic Agents. BioDrugs 2016; 30:105-15. [PMID: 26905069 DOI: 10.1007/s40259-016-0164-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Use of biologic drugs is approved for treatment in rheumatoid arthritis (RA), both in established disease and at the early stage of RA (ERA). Identification of ERA and an early therapeutic strategy would lead to greater clinical improvement. Only a few indirect comparisons of the efficacy of different biologic agents in established RA have been performed and, to date, no studies reporting direct comparisons have been performed in ERA. OBJECTIVE The aim of this study was to compare, by use of a mixed treatment comparison (MTC), the efficacy profiles of biologic agents in ERA. METHODS An extensive literature search was performed to identify results of randomized, controlled trials (RCTs) evaluating biologic agents at licensed doses to treat patients affected by ERA. The primary end points for the analysis were the American College of Rheumatology 20% improvement (ACR20), ACR50, and ACR70 responses from baseline to various times of follow-up. WinBUGS 1.4 software (MRC Biostatistics Unit, Cambridge, UK) was used to perform the analyses. The MTC results are reported as the relative risk of a response for every single treatment coadministered with methotrexate, versus methotrexate plus placebo, which was used as a comparator in all RCTs. RESULTS Ten scientific papers met the study inclusion criteria and were included in the analysis. Data on the use of infliximab, adalimumab, etanercept, abatacept, golimumab, and rituximab were included. No studies reported on the use of certolizumab pegol or tocilizumab in ERA. All biologic agents coadministered with methotrexate proved to be more efficacious than methotrexate plus placebo in inducing ACR20, ACR50, and ACR70 responses. The biologic agent characterized by the highest probability of inducing an ACR70 response was adalimumab (33.28%). Etanercept was the biologic agent with the highest probability of inducing ACR20 and ACR50 responses, in comparison with all other biologic agents, with probability rates of 62.95 and 37.1%, respectively. CONCLUSION In our analysis, adalimumab proved to be the biologic agent with the highest probability of inducing an ACR70 response in patients affected by ERA, while etanercept was the biologic agent with the highest probability of inducing ACR50 and ACR20 responses.
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Affiliation(s)
- Alberto Migliore
- Rheumatology Department, San Pietro Fatebenefratelli Hospital, via Cassia 600, 00189, Rome, Italy.,International Society For Pharmacoeconomics and Outcomes Research (ISPOR), Rome, Italy
| | - Emanuele Bizzi
- Rheumatology Department, San Pietro Fatebenefratelli Hospital, via Cassia 600, 00189, Rome, Italy.
| | - Lea Petrella
- Methods and Models for Economics, Territory and Finance (MEMOTEF) Department, Sapienza University of Rome, Rome, Italy
| | - Vincenzo Bruzzese
- Internal Medicine and Gastroenterology Department, Nuovo Regina Margherita Hospital, Rome, Italy
| | - Maurizio Cassol
- Internal Medicine Department, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Davide Integlia
- Integrated Solutions Health Economics and Organization (ISHEO), Rome, Italy
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27
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Burge AJ, Nwawka OK, Berkowitz JL, Potter HG. Imaging of Inflammatory Arthritis in Adults. Rheum Dis Clin North Am 2016; 42:561-585. [DOI: 10.1016/j.rdc.2016.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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28
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Specificity Evaluation and Disease Monitoring in Arthritis Imaging with Complement Receptor of the Ig superfamily targeting Nanobodies. Sci Rep 2016; 6:35966. [PMID: 27779240 PMCID: PMC5078791 DOI: 10.1038/srep35966] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 10/05/2016] [Indexed: 12/02/2022] Open
Abstract
Single-photon emission computed tomography combined with micro-CT (SPECT/μCT) imaging using Nanobodies against complement receptor of the Ig superfamily (CRIg), found on tissue macrophages such as synovial macrophages, has promising potential to visualize joint inflammation in experimental arthritis. Here, we further addressed the specificity and assessed the potential for arthritis monitoring. Signals obtained with 99mTc-labelled NbV4m119 Nanobody were compared in joints of wild type (WT) versus CRIg−/− mice with collagen-induced arthritis (CIA) or K/BxN serum transfer-induced arthritis (STIA). In addition, SPECT/μCT imaging was used to investigate arthritis development in STIA and in CIA under dexamethasone treatment. 99mTc-NbV4m119 accumulated in inflamed joints of WT, but not CRIg−/− mice with CIA and STIA. Development and spontaneous recovery of symptoms in STIA was reflected in initially increased and subsequently reduced joint accumulation of 99mTc-NbV4m119. Dexamethasone treatment of CIA mice reduced 99mTc-NbV4m119 accumulation as compared to saline control in most joints except knees. SPECT/μCT imaging with 99mTc-NbV4m119 allows specific assessment of inflammation in different arthritis models and provides complementary information to clinical scoring for quantitatively and non-invasively monitoring the pathological process and the efficacy of arthritis treatment.
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Wang MY, Wang XB, Sun XH, Liu FL, Huang SC. Diagnostic value of high-frequency ultrasound and magnetic resonance imaging in early rheumatoid arthritis. Exp Ther Med 2016; 12:3035-3040. [PMID: 27882112 DOI: 10.3892/etm.2016.3695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/19/2016] [Indexed: 12/24/2022] Open
Abstract
Early diagnosis and management improve the outcome of patients with rheumatoid arthritis (RA). The present study explored the application of high-frequency ultrasound (US) and magnetic resonance imaging (MRI) in the detection of early RA. Thirty-nine patients (20 males and 19 females) diagnosed with early RA were enrolled in the study. A total of 1,248 positions, including 858 hand joints and 390 tendons, were examined by high-frequency US and MRI to evaluate the presence of bone erosion, bone marrow edema (BME), synovial proliferation, joint effusion, tendinitis and tendon sheath edema. The imaging results of the above abnormalities, detected by US, were compared with those identified using MRI. No statistically significant overall changes were observed between high-frequency US and MRI in detecting bone erosion [44 (5.1%) vs. 35 (4.1%), respectively; P>0.05], tendinitis [18 (4.6%) vs. 14 (1.5%), respectively; P>0.05] and tendon sheath edema [37 (9.5%) vs. 30 (7.7%), respectively; P>0.05]. Significant differences were observed between high-frequency US and MRI with regards to the detection of synovial proliferation [132 (15.4%) vs. 66 (7.7%), respectively; P<0.05] and joint effusion [89 (10.4%) vs. 52 (6.1%), respectively; P<0.05]. In addition, significant differences were identified between the detection of BME using MRI compared with high-frequency US (5.5 vs. 0%, respectively; P<0.05). MRI and high-frequency US of the dominant hand and wrist joints were comparably sensitive to bone erosion, tendinitis and tendon sheath edema. However, MRI was more sensitive in detecting bone marrow edema in early RA, while US was more sensitive in the evaluation of joint effusion and synovial proliferation. In conclusion, US and MRI are promising for the detection and diagnosis of inflammatory activity in patients with RA.
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Affiliation(s)
- Ming-Yu Wang
- Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Xian-Bin Wang
- Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Xue-Hui Sun
- Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Feng-Li Liu
- Department of Rheumatology and Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Sheng-Chuan Huang
- Department of Rheumatology and Ultrasonography, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
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Soldatos T, Pezeshk P, Ezzati F, Karp DR, Taurog JD, Chhabra A. Cross-sectional imaging of adult crystal and inflammatory arthropathies. Skeletal Radiol 2016; 45:1173-91. [PMID: 27209200 DOI: 10.1007/s00256-016-2402-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 02/02/2023]
Abstract
This article highlights the key aspects and current perspectives of the role of cross-sectional imaging in adult crystal and inflammatory arthropathies in adults, briefly discussing CT, and particularly focusing on MRI and US imaging as it supplements the conventional radiography. The role of conventional and advanced MR imaging techniques and imaging findings in this domain is discussed and illustrated with case examples. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article contains images and data, which were collected from patients as a part of a retrospective IRB from the institutional teaching files and informed consent was waived.
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Affiliation(s)
| | - Parham Pezeshk
- Musculoskeletal Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA
| | - Fatemeh Ezzati
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David R Karp
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joel D Taurog
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA. .,Musculoskeletal Radiology, Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Nakashima Y, Tamai M, Kita J, Michitsuji T, Shimizu T, Fukui S, Umeda M, Nishino A, Suzuki T, Horai Y, Okada A, Nishimura T, Koga T, Kawashiri SY, Iwamoto N, Ichinose K, Hirai Y, Arima K, Yamasaki S, Nakamura H, Origuchi T, Takao S, Uetani M, Aoyagi K, Eguchi K, Kawakami A. Magnetic Resonance Imaging Bone Edema at Enrollment Predicts Rapid Radiographic Progression in Patients with Early RA: Results from the Nagasaki University Early Arthritis Cohort. J Rheumatol 2016; 43:1278-84. [PMID: 27134251 DOI: 10.3899/jrheum.150988] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To clarify whether magnetic resonance imaging (MRI) bone edema predicts the development of rapid radiographic progression (RRP) in the Nagasaki University Early Arthritis Cohort of patients with early-stage rheumatoid arthritis (RA). METHODS Patients with early-stage RA (n = 76) were enrolled and underwent 1.5-T MRI of both wrists and finger joints. Synovitis, bone edema, and bone erosion were evaluated using the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS). RRP was defined as an annual increment > 3 at 1 year by the Genant-modified Sharp score of plain radiographs. A multivariate logistic regression analysis was performed to establish the risk factors for RRP. RESULTS Median disease duration at enrollment was 3 months. RRP was found in 12 of the 76 patients at 1 year. A univariate analysis revealed that matrix metalloprotease-3, RAMRIS bone edema score, and RAMRIS bone erosion score were associated with RRP. Multivariate logistic regression analyses demonstrated that the RAMRIS bone edema score at enrollment (5-point increase, OR 2.18, 95% CI 1.32-3.59, p = 0.002) was the only independent predictor of the development of RRP at 1 year. A receiver-operating characteristic analysis identified the best cutoff value for RAMRIS bone edema score as 5. RRP was significantly rare among the patients with a RAMRIS bone edema score < 5 at enrollment (2 from 50 patients). CONCLUSION Our findings suggest that MRI bone edema is closely associated with the development of RRP in patients with early-stage RA. Physicians should carefully control the disease activity when MRI bone edema is observed in patients with early RA.
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Affiliation(s)
- Yoshikazu Nakashima
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Mami Tamai
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Junko Kita
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Toru Michitsuji
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Toshimasa Shimizu
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Shoichi Fukui
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Masataka Umeda
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Ayako Nishino
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Takahisa Suzuki
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Yoshiro Horai
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Akitomo Okada
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Takayuki Nishimura
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Tomohiro Koga
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Shin-Ya Kawashiri
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Naoki Iwamoto
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Kunihiro Ichinose
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Yasuko Hirai
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Kazuhiko Arima
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Satoshi Yamasaki
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Hideki Nakamura
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Tomoki Origuchi
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Shoichiro Takao
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Masataka Uetani
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Kiyoshi Aoyagi
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Katsumi Eguchi
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
| | - Atsushi Kawakami
- From the Department of Immunology and Rheumatology, and Department of Public Health, and Department of Health Sciences, Nagasaki University Graduate School of Biomedical Sciences; Japanese Red Cross Nagasaki Genbaku Hospital; Department of Radiology and Radiation Research, Nagasaki University Hospital, Nagasaki; Department of Clinical Immunology and Rheumatology, Hiroshima University, Hiroshima; Department of Radiology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima; Sasebo Chuo Hospital, Sasebo, Japan.Y. Nakashima, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Tamai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; J. Kita, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Michitsuji, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Shimizu, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Fukui, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; M. Umeda, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Nishino, MD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; T. Suzuki, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; Y. Horai, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; A. Okada, MD, PhD, Japanese Red Cross Nagasaki Genbaku Hospital; T. Nishimura, PhD, Department of Public Health, Nagasaki University Graduate School of Biomedical Sciences; T. Koga, MD, PhD, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences; S. Kawashiri, MD
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Peterfy C, Burmester GR, Bykerk VP, Combe BG, DiCarlo JC, Furst DE, Huizinga TWJ, Wong DA, Conaghan PG, Emery P. Sustained improvements in MRI outcomes with abatacept following the withdrawal of all treatments in patients with early, progressive rheumatoid arthritis. Ann Rheum Dis 2016; 75:1501-5. [PMID: 26865601 PMCID: PMC4975847 DOI: 10.1136/annrheumdis-2015-208258] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 01/16/2016] [Indexed: 12/25/2022]
Abstract
Objectives To assess structural damage progression with subcutaneous abatacept (ABA) in the Assessing Very Early Rheumatoid arthritis Treatment (AVERT) trial following abrupt withdrawal of all rheumatoid arthritis (RA) medication in patients achieving Disease Activity Score (DAS)-defined remission or low disease activity. Methods Patients with early, active RA were randomised to ABA plus methotrexate (ABA/MTX) 125 mg/week, ABA 125 mg/week or MTX for 12 months. All RA treatments were withdrawn after 12 months in patients with DAS28 (C reactive protein (CRP)) <3.2. Adjusted mean changes from baseline in MRI-based synovitis, osteitis and erosion were calculated for the intention-to-treat population. Results 351 patients were randomised and treated: ABA/MTX (n=119), ABA (n=116) or MTX (n=116). Synovitis and osteitis improved, and progression of erosion was statistically less with ABA/MTX versus MTX at month 12 (−2.35 vs −0.68, −2.58 vs −0.68, 0.19 vs 1.53, respectively; p<0.01 for each) and month 18 (−1.34 vs −0.49 −2.03 vs 0.34, 0.13 vs 2.0, respectively; p<0.01 for erosion); ABA benefits were numerically intermediate to those for ABA/MTX and MTX. Conclusions Structural benefits with ABA/MTX or ABA may be maintained 6 months after withdrawal of all treatments in patients who have achieved remission or low disease activity. Trial registration number NCT01142726; Results.
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Affiliation(s)
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-University Medicine Berlin, Berlin, Germany
| | - Vivian P Bykerk
- Department of Rheumatology, Hospital for Special Surgery, Weill Cornell Medical College, New York, New York, USA
| | - Bernard G Combe
- Department of Rheumatology, Service d'Immuno-Rheumatologie, Montpellier, France
| | | | - Daniel E Furst
- Department of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Virtanen H, Autio A, Siitonen R, Liljenbäck H, Saanijoki T, Lankinen P, Mäkilä J, Käkelä M, Teuho J, Savisto N, Jaakkola K, Jalkanen S, Roivainen A. 68Ga-DOTA-Siglec-9--a new imaging tool to detect synovitis. Arthritis Res Ther 2015; 17:308. [PMID: 26530096 PMCID: PMC4632466 DOI: 10.1186/s13075-015-0826-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 09/15/2015] [Indexed: 11/15/2022] Open
Abstract
Introduction Vascular adhesion protein-1 (VAP-1) is an adhesion molecule, which upon inflammation is rapidly translocated from intracellular sources to the endothelial cell surface. We have recently discovered that sialic acid- binding immunoglobulin-like lectin 9 (Siglec-9) is a leukocyte ligand of VAP-1 and that 68Ga-labeled Siglec-9 motif peptide facilitates in vivo imaging of inflammation. This study evaluated the feasibility of 68Ga-DOTA-Siglec-9 positron emission tomography (PET) for the assessment of synovitis. Methods Rabbits with synovial inflammation were injected with 18F-FDG or 68Ga-DOTA-Siglec-9 and studied by gamma counting and autoradiography. Certain rabbits were also examined with magnetic resonance imaging (MRI). After PET imaging, rabbits were intravenously administered with anti-VAP-1 antibody to evaluate luminal expression of VAP-1 by immunohistochemistry. Finally, binding of Siglec-9 peptide and VAP-1 positive vessels were evaluated by double staining of rheumatoid arthritis synovium. Results Intra-articular injection of hemagglutinin induced mild synovial inflammation in rabbit knee with luminal expression of VAP-1. Synovitis was clearly visualized by 68Ga-DOTA-Siglec-9 PET in addition to 18F-FDG-PET and MRI. Compared with the 18F-FDG, the ex vivo inflamed-to-control synovium ratio of 68Ga-DOTA-Siglec-9 was similar (1.7 ± 0.4 vs. 1.5 ± 0.2, P = 0.32). Double staining revealed that Siglec-9 peptide binds to VAP-1 positive vessels in human rheumatoid synovium. Conclusion Ga-DOTA-Siglec-9 PET tracer detected VAP-1 positive vasculature in the mild synovitis of rabbits comparable with 18F-FDG, suggesting its potential for in vivo imaging of synovial inflammation in patients with rheumatic diseases.
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Affiliation(s)
- Helena Virtanen
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20521, Finland.
| | - Anu Autio
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20521, Finland.
| | - Riikka Siitonen
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20521, Finland.
| | - Heidi Liljenbäck
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20521, Finland. .,Turku Center for Disease Modeling, University of Turku, Turku, Finland.
| | - Tiina Saanijoki
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20521, Finland.
| | - Petteri Lankinen
- Department of Orthopaedic Surgery and Traumatology, University of Turku, Turku, Finland.
| | - Jussi Mäkilä
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20521, Finland. .,Department of Cell Biology and Anatomy, University of Turku, Turku, Finland.
| | - Meeri Käkelä
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20521, Finland.
| | - Jarmo Teuho
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20521, Finland.
| | - Nina Savisto
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20521, Finland.
| | - Kimmo Jaakkola
- VTT Technical Research Centre of Finland, Medical Biotechnology, Turku, Finland.
| | - Sirpa Jalkanen
- MediCity Research Laboratory, University of Turku, Turku, Finland.
| | - Anne Roivainen
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, FI-20521, Finland. .,Turku Center for Disease Modeling, University of Turku, Turku, Finland.
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Kisten Y, Györi N, Af Klint E, Rezaei H, Levitsky A, Karlsson A, van Vollenhoven R. Detection of clinically manifest and silent synovitis in the hands and wrists by fluorescence optical imaging. RMD Open 2015; 1:e000106. [PMID: 26535142 PMCID: PMC4612680 DOI: 10.1136/rmdopen-2015-000106] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 01/11/2023] Open
Abstract
Objectives The correct identification of synovitis is critical for achieving optimal therapy results. Fluorescence optical imaging (FOI) is a novel modality based on the use of an intravenous fluorophore, which enables fluorescent imaging of the hands and wrists with increased focal optical signal intensities in areas of high perfusion and/or capillary leakage. The study objective was to determine the diagnostic utility of FOI in detecting apparent and clinically non-apparent active synovitis. Methods Bilateral hand and wrist joints (n=872) of 26 patients with inflammatory arthritis assessed by standard clinical examination, musculoskeletal ultrasound (MSUS) and FOI were studied. Synovitis was defined as tender and swollen joints on clinical examination, presence of synovial thickening and intra-articular Doppler signals on MSUS, and abnormal focal optical signal intensities on FOI, respectively. Subclinical synovitis was defined as being clinically non-apparent, but positively inflamed on MSUS. Results Depending on the standard used to define inflammation, FOI ranged from 73–83% sensitive and 83–95% specific for detecting manifest synovitis. For detecting clinically silent synovitis, the sensitivity, specificity and positive and negative predictive values of FOI were 80%, 96%, 77% and 97%, respectively. Conclusions The high degree of agreement between MSUS and FOI suggest its use in clinical practice, especially when MSUS is not available, in order to identify synovitis earlier and with greater confidence. FOI may be particularly useful in identifying patients with clinically non-apparent joint inflammation of the hands and/or wrists.
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Affiliation(s)
- Yogan Kisten
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Noémi Györi
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Erik Af Klint
- The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Hamed Rezaei
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden ; The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Adrian Levitsky
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Anna Karlsson
- The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Ronald van Vollenhoven
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden ; The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
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Khairnar A, Marchand F, Vidal A, Etienne M, Miladi I, Auzeloux P, Cachin F, Eschalier A, Chezal JM, Ardid D, Miot-Noirault E. 99mTc-NTP 15-5 Imaging for Cartilage Involvement in Experimental Rheumatoid Arthritis: Comparison with Routinely Used Molecular Imaging Methods and Sensitivity to Chronic Nonsteroidal Antiinflammatory Drug Treatment. J Nucl Med 2015; 56:798-804. [PMID: 25840975 DOI: 10.2967/jnumed.114.151415] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 02/10/2015] [Indexed: 01/01/2023] Open
Abstract
UNLABELLED This study determined, using the intraarticular complete Freund adjuvant arthritis mice model, whether the radiotracer (99m)Tc-N-(triethylammonium)-3-propyl-[15]ane-N5 ((99m)Tc-NTP 15-5) targeting proteoglycans has a pathophysiologic validity for in vivo imaging of rheumatoid arthritis (RA) and its response to chronic nonsteroidal antiinflammatory drugs. METHODS We investigated the time course of cartilage remodeling by (99m)Tc-NTP 15-5 scintigraphy, bone damages by (99m)Tc-hydroxymethylene diphosphonate imaging, inflammation by (18)F-FDG PET, and joint proteoglycan content and pain behavior in animals, without and with meloxicam treatment. Paw circumference, thermal pain behavior, and histology as well as proteoglycan content of the whole joint were determined. RESULTS (99m)Tc-NTP 15-5 showed specific tracer accumulation within RA joints, with a significant increase in scintigraphic ratio observed in RA versus shams from day 3 to day 28. (18)F-FDG evidenced uptake in RA joints from day 15 to day 29. Animals treated with meloxicam (5 mg/kg) exhibited a dose-dependent decrease in both (99m)Tc-NTP 15-5 and (18)F-FDG uptake ratios versus saline-treated animals. (99m)Tc-hydroxymethylene diphosphonate bone scans were only positive at day 14 in RA versus shams, with a significant effect of meloxicam. An increase in proteoglycans of RA joint and thermal pain behavior were observed and were dose-dependently reduced by meloxicam. CONCLUSION These experimental results bring data in favor of the (99m)Tc-NTP 15-5 radiotracer for assessing, in vivo, cartilage remodeling in RA that could be used to monitor therapy.
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Affiliation(s)
- Amit Khairnar
- Clermont Université, Université d'Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, Clermont-Ferrand, France INSERM, U 990, Clermont-Ferrand, France Clermont Université, Université d'Auvergne, Pharmacologie Fondamentale et Clinique de la Douleur, Clermont-Ferrand, France INSERM U1107 NEURO-DOL, Clermont-Ferrand, France; and
| | - Fabien Marchand
- Clermont Université, Université d'Auvergne, Pharmacologie Fondamentale et Clinique de la Douleur, Clermont-Ferrand, France INSERM U1107 NEURO-DOL, Clermont-Ferrand, France; and
| | - Aurélien Vidal
- Clermont Université, Université d'Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, Clermont-Ferrand, France INSERM, U 990, Clermont-Ferrand, France
| | - Monique Etienne
- Clermont Université, Université d'Auvergne, Pharmacologie Fondamentale et Clinique de la Douleur, Clermont-Ferrand, France INSERM U1107 NEURO-DOL, Clermont-Ferrand, France; and
| | - Imen Miladi
- Clermont Université, Université d'Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, Clermont-Ferrand, France INSERM, U 990, Clermont-Ferrand, France
| | - Philippe Auzeloux
- Clermont Université, Université d'Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, Clermont-Ferrand, France INSERM, U 990, Clermont-Ferrand, France
| | - Florent Cachin
- Clermont Université, Université d'Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, Clermont-Ferrand, France INSERM, U 990, Clermont-Ferrand, France CLCC Jean Perrin, Clermont-Ferrand, France
| | - Alain Eschalier
- Clermont Université, Université d'Auvergne, Pharmacologie Fondamentale et Clinique de la Douleur, Clermont-Ferrand, France INSERM U1107 NEURO-DOL, Clermont-Ferrand, France; and
| | - Jean-Michel Chezal
- Clermont Université, Université d'Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, Clermont-Ferrand, France INSERM, U 990, Clermont-Ferrand, France
| | - Denis Ardid
- Clermont Université, Université d'Auvergne, Pharmacologie Fondamentale et Clinique de la Douleur, Clermont-Ferrand, France INSERM U1107 NEURO-DOL, Clermont-Ferrand, France; and
| | - Elisabeth Miot-Noirault
- Clermont Université, Université d'Auvergne, Imagerie Moléculaire et Thérapie Vectorisée, BP 10448, Clermont-Ferrand, France INSERM, U 990, Clermont-Ferrand, France
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Sevilla RS, Cruz F, Chiu CS, Xue D, Bettano KA, Zhu J, Chakravarthy K, Faltus R, Wang S, Vanko A, Robinson G, Zielstorff M, Miao J, Leccese E, Conway D, Moy LY, Dogdas B, Cicmil M, Zhang W. Development and optimization of a high-throughput micro-computed tomography imaging method incorporating a novel analysis technique to evaluate bone mineral density of arthritic joints in a rodent model of collagen induced arthritis. Bone 2015; 73:32-41. [PMID: 25482211 DOI: 10.1016/j.bone.2014.11.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 11/10/2014] [Accepted: 11/18/2014] [Indexed: 11/18/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease resulting in joint inflammation, pain, and eventual bone loss. Bone loss and remodeling caused by symmetric polyarthritis, the hallmark of RA, is readily detectable by bone mineral density (BMD) measurement using micro-CT. Abnormalities in these measurements over time reflect the underlying pathophysiology of the bone. To evaluate the efficacy of anti-rheumatic agents in animal models of arthritis, we developed a high throughput knee and ankle joint imaging assay to measure BMD as a translational biomarker. A bone sample holder was custom designed for micro-CT scanning, which significantly increased assay throughput. Batch processing 3-dimensional image reconstruction, followed by automated image cropping, significantly reduced image processing time. In addition, we developed a novel, automated image analysis method to measure BMD and bone volume of knee and ankle joints. These improvements significantly increased the throughput of ex vivo bone sample analysis, reducing data turnaround from 5 days to 24 hours for a study with 200 rat hind limbs. Taken together, our data demonstrate that BMD, as quantified by micro-CT, is a robust efficacy biomarker with a high degree of sensitivity. Our innovative approach toward evaluation of BMD using optimized image acquisition and novel image processing techniques in preclinical models of RA enables high throughput assessment of anti-rheumatic agents offering a powerful tool for drug discovery.
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Affiliation(s)
- Raquel S Sevilla
- Imaging-Boston, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Francisco Cruz
- Informatics IT, Merck Research Laboratories, 126 E. Lincoln Avenue, PO Box 2000, Rahway, NJ 07065, USA
| | - Chi-Sung Chiu
- Respiratory & Immunology Pharmacology, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Dahai Xue
- Imaging-West Point, Merck Research Laboratories, Sumneytown Pike, West Point, PA 19486, USA
| | - Kimberly A Bettano
- Imaging-Boston, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Joe Zhu
- Imaging-Boston, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Kalyan Chakravarthy
- Respiratory & Immunology Pharmacology, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Robert Faltus
- Respiratory & Immunology Pharmacology, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Shubing Wang
- Biometrics Research, Merck Research Laboratories, RY34-300, 126 Lincoln Avenue, Rahway, NJ 07065, USA
| | - Amy Vanko
- Imaging-Boston, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Gain Robinson
- Imaging-Boston, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Mark Zielstorff
- Respiratory & Immunology Pharmacology, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - John Miao
- Respiratory & Immunology Pharmacology, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Erica Leccese
- Respiratory & Immunology Pharmacology, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Donald Conway
- Compound Management and Engineering, Merck Research Laboratories, 126 E. Lincoln Avenue, PO Box 2000, Rahway, NJ 07065, USA
| | - Lily Y Moy
- Respiratory & Immunology Pharmacology, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Belma Dogdas
- Informatics IT, Merck Research Laboratories, 126 E. Lincoln Avenue, PO Box 2000, Rahway, NJ 07065, USA
| | - Milenko Cicmil
- Respiratory & Immunology Pharmacology, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA
| | - Weisheng Zhang
- Imaging-Boston, Merck Research Laboratories, 33 Avenue Louis Pasteur, Boston, MA 02115, USA.
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Takahashi H, Yamashita H, Kubota K, Miyata Y, Okasaki M, Morooka M, Takahashi Y, Kaneko H, Kano T, Mimori A. Differences in fluorodeoxyglucose positron emission tomography/computed tomography findings between elderly onset rheumatoid arthritis and polymyalgia rheumatica. Mod Rheumatol 2014; 25:546-51. [DOI: 10.3109/14397595.2014.978936] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Vordenbäumen S, Schleich C, Lögters T, Sewerin P, Bleck E, Pauly T, Müller-Lutz A, Antoch G, Schneider M, Miese F, Ostendorf B. Dynamic contrast-enhanced magnetic resonance imaging of metacarpophalangeal joints reflects histological signs of synovitis in rheumatoid arthritis. Arthritis Res Ther 2014; 16:452. [PMID: 25270553 PMCID: PMC4201730 DOI: 10.1186/s13075-014-0452-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 09/04/2014] [Indexed: 12/29/2022] Open
Abstract
Introduction Synovial inflammation and joint destruction in rheumatoid arthritis (RA) may progress despite clinical remission. Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is increasingly used to detect synovial inflammation in RA. Although small joints such as metacarpophalangeal (MCP) joints are mainly affected by RA, MRI findings have never been directly compared to histological synovitis in MCP synovial tissue. The objective of the current study was therefore to analyse if DCE-MRI relates to histological signs of synovitis small RA joints. Methods In 9 RA patients, DCE-MRI (3 Tesla, dynamic 2D T1 weighted turbo-flash sequence) of the hand was performed prior to arthroscopically-guided synovial biopsies from the second MCP of the imaged hand. Maximum enhancement (ME), rate of early enhancement, and maximum rate of enhancement were assessed in the MCP. Synovial biopsies were stained for determination of sublining CD68 and the Synovitis Score. Correlations between MRI and histological data were calculated according to Spearman. Results ME of the MCP significantly correlated to sublining CD68 staining (r = 0.750, P = 0.02), the Synovitis Score (r = 0.743, P = 0.02), and the subscores for lining layer hypertrophy (r = 0.789, P = 0.01) and cellular density (r = 0.842; P = 0.004). Conclusions Perfusion imaging of synovial tissue in RA finger joints employing DCE-MRI reflects histological synovial inflammation. According to our study, ME is the most closely associated parameter amongst the measures considered.
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Abstract
For decades, diagnostic imaging in rheumatology has used conventional radiography. Over the past 10 years, MRI and ultrasonography have clearly shown their potential in diagnostic imaging in rheumatology and their use is revolutionizing the management of chronic arthritis, revealing subclinical inflammation and predicting progression of joint damage. Although validation processes for these imaging modalities are still ongoing, several investigations have now established the positive correlation between subclinical synovitis and radiographic progression of joint damage. Despite the available evidence and the diagnostic potential, there remains a substantial proportion of rheumatologists for whom MRI and ultrasonography findings do not influence their clinical decision-making. This Perspectives will discuss the key issues related to diagnostic imaging in patients with chronic arthritis, outlining how new imaging techniques have evolved over the past two decades and presenting the most attractive technological advances in this field.
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