Radiographic Methods of Assessment (Scoring) of Rheumatic Disease

Wrist ultrasound analysis of patients with early rheumatoid arthritis

In the present study, we evaluated 42 wrists using the semi-quantitative scales power Doppler ultrasound (PDUS) and gray scale ultrasound (GSUS) with scores ranging from 0 to 3 and correlated the results with clinical, laboratory and radiographic data. Twenty-one patients (17 women and 4 men) with rheumatoid arthritis according to criteria of the American College of Rheumatology were enrolled in the study from September 2008 to July 2009 at Universidade Estadual de Campinas (UNICAMP). The average disease duration was 14 months. The patients were 66.6% Caucasians and 33.3% non-Caucasians, with a mean age of 42 and 41 years, respectively. A dorsal longitudinal scan was performed by ultrasound on the radiocarpal and midcarpal joints using GE LOGIQ XP-linear ultrasound and a high frequency (8-10 MHz) transducer. All patients were X-rayed, and the Larsen score was determined for the joints, with grades ranging from 0 to V. This study showed significant correlations between clinical, sonographic and laboratory data: GSUS and swollen right wrist (r = 0.546), GSUS of right wrist and swelling of left wrist (r = 0.511), PDUS of right wrist and pain in left wrist (r = 0.436), PDUS of right wrist and C-reactive protein (r = 0.466). Ultrasound can be considered a useful tool in the diagnosis of synovitis in early rheumatoid arthritis mainly when the anti-cyclic citrullinated peptide and rheumatoid factor are negative, and can lead to an early change in the therapeutic decision.

Measurement of structural abnormalities in arthritis using radiographic images

This article reviewed the current methods for scoring radiographic abnormalities in RA with emphasis on reliability. There is disagreement on the expected course of RA with usual treatment and there is no clear resolution of this disagreement although several factors that contribute to this disagreement have been identified. Scoring joint damage has been effective in establishing benefit from drug treatment for nine agents, five within the last 3 years. Scoring will continue to be used to examine the benefit of new agents in the immediate years to come. A panel of experienced readers agreed that some repair of erosion damage was seen with available treatment. The extent of damage that is reversible has not been established and the frequency of any degree of repair remains unknown. Several methods of true measurement of erosions and joint space width have been reported. They have not found a place in daily practice or in research studies, probably because experience is too limited to know whether they are more powerful in detecting real progression of disease than scoring methods. Several problems that are related to standardizing methods of measuring joint space width were identified.

Increased release of bone sialoprotein into synovial fluid reflects tissue destruction in rheumatoid arthritis

OBJECTIVE

Bone sialoprotein (BSP) was quantified in synovial fluids and sera from rheumatoid arthritis (RA) patients to elucidate whether its release from bone relates to the degree of joint tissue destruction. Osteocalcin was assayed for comparison.

METHODS

BSP and osteocalcin levels were determined by immunoassays of knee synovial fluids and of sera from RA patients who were selected on the basis of radiographic knee joint tissue damage.

RESULTS

Synovial fluid concentrations of BSP increased with increasing degrees of knee joint damage (rs = 0.6848, P < 0.001). Synovial fluid concentrations of osteocalcin did not relate to the degree of joint damage. Serum concentrations of BSP were increased, but did not relate to the degree of joint damage. Serum concentrations of osteocalcin were normal, but increased within the range of normal during progression of joint destruction (rs = 0.4567, P < 0.001).

CONCLUSION

Quantification of BSP in synovial fluid holds promise as a useful means of assessing the degree of tissue damage at the molecular level in patients with RA.