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Phatak S, Mahadevkar P, Chaudhari KS, Chakladar S, Jain S, Dhadge S, Jadhav S, Shah R, Bhalerao A, Patil A, Ingram JL, Goel P, Yajnik CS. Quantification of joint mobility limitation in adult type 1 diabetes. Front Endocrinol (Lausanne) 2023; 14:1238825. [PMID: 38027132 PMCID: PMC10657982 DOI: 10.3389/fendo.2023.1238825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
Aims Diabetic cheiroarthropathies limit hand mobility due to fibrosis and could be markers of a global profibrotic trajectory. Heterogeneity in definitions and lack of a method to measure it complicate studying associations with organ involvement and treatment outcomes. We measured metacarpophalangeal (MCP) joint extension as a metric and describe magnetic resonance (MR) imaging determinants of MCP restriction. Methods Adults with type 1 diabetes were screened for hand manifestations using a symptom questionnaire, clinical examination, and function [Duruoz hand index (DHI) and grip strength]. Patients were segregated by mean MCP extension (<20°, 20°-40°, 40°-60°, and >60°) for MR imaging (MRI) scanning. Patients in the four groups were compared using ANOVA for clinical features and MRI tissue measurements (tenosynovial, skin, and fascia thickness). We performed multiple linear regression for determinants of MCP extension. Results Of the 237 patients (90 men), 79 (33.8%) with cheiroarthropathy had MCP extension limitation (39° versus 61°, p < 0.01). Groups with limited MCP extension had higher DHI (1.9 vs. 0.2) but few (7%) had pain. Height, systolic blood pressure, and nephropathy were associated with mean MCP extension. Hand MRI (n = 61) showed flexor tenosynovitis in four patients and median neuritis in one patient. Groups with MCP mobility restriction had the thickest palmar skin; tendon thickness or median nerve area did not differ. Only mean palmar skin thickness was associated with MCP extension angle on multiple linear regression. Conclusion Joint mobility limitation was quantified by restricted mean MCP extension and had structural correlates on MRI. These can serve as quantitative measures for future associative and interventional studies.
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Affiliation(s)
- Sanat Phatak
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Pranav Mahadevkar
- Department of Musculoskeletal Radiology, Star Imaging and Research Centre, Pune, India
| | | | - Shreya Chakladar
- Department of Biology, Indian Institute of Science Education and Research, Pune, India
| | - Swasti Jain
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Smita Dhadge
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Sarita Jadhav
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Rohan Shah
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Aboli Bhalerao
- Diabetes Unit, King Edward Memorial (KEM) Hospital Research Centre, Pune, India
| | - Anupama Patil
- Department of Musculoskeletal Radiology, Star Imaging and Research Centre, Pune, India
| | - Jennifer L. Ingram
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, Duke University Medical Center, Durham, NC, United States
| | - Pranay Goel
- Department of Biology, Indian Institute of Science Education and Research, Pune, India
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van Dijk BT, Wisse LJ, van Steenbergen HW, Reijnierse M, Khidir SJH, DeRuiter MC, van der Helm-van Mil AHM. Interosseous tendon inflammation in the hands of patients with clinically suspect arthralgia: analysis of MRI data from a prospective cohort study. THE LANCET. RHEUMATOLOGY 2023; 5:e401-e412. [PMID: 38251551 PMCID: PMC7615884 DOI: 10.1016/s2665-9913(23)00129-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Inflammation around the tendons of interosseous muscles of the hand (interosseous tendon inflammation) was recently observed with MRI for the first time in patients with rheumatoid arthritis and in at-risk individuals with detectable anti-citrullinated protein antibodies, generating the hypothesis that interosseous tendon inflammation precedes clinical arthritis. To better understand the role of interosseous tendon inflammation during the development of rheumatoid arthritis, we studied the frequency of interosseous tendon inflammation in healthy individuals and in those with arthralgia that was suspected of progressing to rheumatoid arthritis (ie, clinically suspect arthralgia) and the association of interosseous tendon inflammation with other symptoms of inflamed joint tissues and with clinical arthritis development. METHODS Adult (age ≥18 years) patients who presented with clinically suspect arthralgia and symptom-free (control) individuals underwent contrast-enhanced hand MRI. MRIs were evaluated for interosseous tendon inflammation on the radial and ulnar sides of the second to fifth metacarpophalangeal joints, and for synovitis, tenosynovitis, and osteitis using the rheumatoid arthritis MRI scoring system. Patients with clinically suspect arthralgia were followed up for clinical arthritis development. The presence of local tenosynovium was examined using immunohistochemistry for anti-CD55 and anti-CD68 on tissue from the hands of three embalmed bodies donated for scientific research. The primary outcome for the cross-sectional part of the study was the presence of interosseous tendon inflammation on MRI. The primary outcome for the longitudinal part of the study was development of clinical arthritis. FINDINGS Between April 3, 2012, and May 20, 2020, 667 patients with clinically suspect arthralgia (mean age 44 years [SD 13], 504 [76%] were women and 163 [24%] were men) underwent contrast-enhanced hand MRI. Between Nov 1, 2013, and Nov 30, 2014, 193 symptom-free controls were recruited (mean age 50 years [SD 16], 136 [70%] were women and 57 [30%] were men). Two (1%) of 193 symptom-free controls had interosseous tendon inflammation. Immunohistochemistry of cadaveric hand tissues showed no tenosynovium surrounding interosseous tendons. At inclusion, 67 (10%) of 667 patients with clinically suspect arthralgia had interosseous tendon inflammation (p<0·0001 vs symptom-free controls). Interosseous tendon inflammation occurred more frequently if synovitis (odds ratio [OR] 2·2 [95% CI 1·2-4·2]), or tenosynovitis (OR 9·7 [5·5-17·0]), was present at metacarpophalangeal joints. A three-dimensional MRI reconstruction suggested confluency of interosseous tendon inflammation with metacarpophalangeal-flexor-tenosynovitis. 91 (16%) of 558 patients with clinically suspect arthralgia developed clinical arthritis during follow-up (median total follow-up 25·3 months [95% CI 25·1-25·5]). Patients with clinically suspect arthralgia with interosseous tendon inflammation had a higher risk of developing clinical arthritis (hazard ratio [HR] 4·5 [2·8-7·2]), which was attenuated but still significant after adjusting for concomitant synovitis, tenosynovitis, or osteitis (HR 1·7 [1·02-2·8]). INTERPRETATION Interosseous tendon inflammation is almost absent in symptom-free individuals but occurs in people with clinically suspect arthralgia, in whom it correlates with symptoms and is associated with the development of clinical arthritis. The absence of local tenosynovium suggests that interosseous tendon inflammation arises from expanding local subclinical inflammation in the pre-arthritis phase of rheumatoid arthritis. FUNDING European Research Council and the Dutch Arthritis Society.
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Affiliation(s)
- Bastiaan T van Dijk
- Department of Rheumatology, Leiden University Medical Centre, Leiden, Netherlands.
| | - Lambertus J Wisse
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Sarah J H Khidir
- Department of Rheumatology, Leiden University Medical Centre, Leiden, Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Centre, Leiden, Netherlands; Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
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Tolpadi AA, Luitjens J, Gassert FG, Li X, Link TM, Majumdar S, Pedoia V. Synthetic Inflammation Imaging with PatchGAN Deep Learning Networks. Bioengineering (Basel) 2023; 10:bioengineering10050516. [PMID: 37237586 DOI: 10.3390/bioengineering10050516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/14/2023] [Accepted: 04/22/2023] [Indexed: 05/28/2023] Open
Abstract
Background: Gadolinium (Gd)-enhanced Magnetic Resonance Imaging (MRI) is crucial in several applications, including oncology, cardiac imaging, and musculoskeletal inflammatory imaging. One use case is rheumatoid arthritis (RA), a widespread autoimmune condition for which Gd MRI is crucial in imaging synovial joint inflammation, but Gd administration has well-documented safety concerns. As such, algorithms that could synthetically generate post-contrast peripheral joint MR images from non-contrast MR sequences would have immense clinical utility. Moreover, while such algorithms have been investigated for other anatomies, they are largely unexplored for musculoskeletal applications such as RA, and efforts to understand trained models and improve trust in their predictions have been limited in medical imaging. Methods: A dataset of 27 RA patients was used to train algorithms that synthetically generated post-Gd IDEAL wrist coronal T1-weighted scans from pre-contrast scans. UNets and PatchGANs were trained, leveraging an anomaly-weighted L1 loss and global generative adversarial network (GAN) loss for the PatchGAN. Occlusion and uncertainty maps were also generated to understand model performance. Results: UNet synthetic post-contrast images exhibited stronger normalized root mean square error (nRMSE) than PatchGAN in full volumes and the wrist, but PatchGAN outperformed UNet in synovial joints (UNet nRMSEs: volume = 6.29 ± 0.88, wrist = 4.36 ± 0.60, synovial = 26.18 ± 7.45; PatchGAN nRMSEs: volume = 6.72 ± 0.81, wrist = 6.07 ± 1.22, synovial = 23.14 ± 7.37; n = 7). Occlusion maps showed that synovial joints made substantial contributions to PatchGAN and UNet predictions, while uncertainty maps showed that PatchGAN predictions were more confident within those joints. Conclusions: Both pipelines showed promising performance in synthesizing post-contrast images, but PatchGAN performance was stronger and more confident within synovial joints, where an algorithm like this would have maximal clinical utility. Image synthesis approaches are therefore promising for RA and synthetic inflammatory imaging.
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Affiliation(s)
- Aniket A Tolpadi
- Department of Bioengineering, University of California, Berkeley, CA 94720, USA
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94158, USA
| | - Johanna Luitjens
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94158, USA
- Department of Radiology, Klinikum Großhadern, Ludwig-Maximilians-Universität, 81377 Munich, Germany
| | - Felix G Gassert
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94158, USA
- Department of Radiology, Klinikum Rechts der Isar, School of Medicine, Technical University of Munich, 81675 Munich, Germany
| | - Xiaojuan Li
- Department of Biomedical Imaging, Cleveland Clinic, Cleveland, OH 44106, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94158, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94158, USA
| | - Valentina Pedoia
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, CA 94158, USA
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Sahbudin I, Singh R, De Pablo P, Rankin E, Rhodes B, Justice E, Derrett-Smith E, Amft N, Narayan N, McGrath C, Baskar S, Trickey J, Maybury M, Raza K, Filer A. The value of ultrasound-defined tenosynovitis and synovitis in the prediction of persistent arthritis. Rheumatology (Oxford) 2023; 62:1057-1068. [PMID: 35412605 PMCID: PMC9977123 DOI: 10.1093/rheumatology/keac199] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The value of US-defined tenosynovitis in predicting the persistence of inflammatory arthritis is not well described. In particular, the predictive utility of US-defined tenosynovitis of larger tendons is yet to be reported. We assessed the value of US-defined tenosynovitis alongside US-defined synovitis and clinical and serological variables in predicting persistent arthritis in an inception cohort of DMARD-naïve patients with early arthritis. METHODS One hundred and fifty DMARD-naïve patients with clinically apparent synovitis of one or more joints and a symptom duration of ≤3 months underwent baseline clinical, laboratory and US (of 19 bilateral joints and 16 bilateral tendon compartments) assessments. Outcomes were classified as persistent or resolving arthritis after 18 months' follow-up. The predictive value of US-defined tenosynovitis for persistent arthritis was compared with those of US-defined synovitis, and clinical and serological variables. RESULTS At 18 months, 99 patients (66%) had developed persistent arthritis and 51 patients (34%) had resolving disease. Multivariate logistic regression analysis showed that US-detected digit flexor tenosynovitis [odds ratio (OR): 6.6, 95% CI: 2.0 , 22.1, P = 0.002] provided independent predictive data for persistence over and above the presence of US-detected joint synovitis and RF antibodies. In the RF/ACPA-negative subcohort, US-defined digit flexor tenosynovitis remained a significant predictive variable (OR: 4.7, 95% CI: 1.4, 15.8, P = 0.012), even after adjusting for US-defined joint synovitis. CONCLUSION US-defined tenosynovitis provided independent predictive data for the development of persistent arthritis. The predictive role of US-defined digit flexor tenosynovitis should be further assessed; investigators should consider including this tendon site as a candidate variable when designing imaging-based predictive algorithms for persistent inflammatory arthritis development.
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Affiliation(s)
- Ilfita Sahbudin
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham
NHS Foundation Trust
| | - Ruchir Singh
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS
Trust
| | - Paola De Pablo
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS
Trust
| | - Elizabeth Rankin
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Benjamin Rhodes
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Elizabeth Justice
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Emma Derrett-Smith
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Nicole Amft
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Nehal Narayan
- Rheumatology Department, University Hospitals Birmingham NHS Foundation
Trust, Birmingham, UK
| | - Catherine McGrath
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS
Trust
| | - Sangeetha Baskar
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS
Trust
| | - Jeanette Trickey
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham
NHS Foundation Trust
| | - Mark Maybury
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham
NHS Foundation Trust
| | - Karim Raza
- Rheumatology Research Group, Institute of Inflammation and
Ageing
- Research into Inflammatory Arthritis Centre, MRC Versus Arthritis Centre
for Musculoskeletal Ageing Research, University of Birmingham
- Department of Rheumatology, Sandwell and West Birmingham Hospitals NHS
Trust
| | - Andrew Filer
- Correspondence to: Andrew Filer, Reader in Translational
Rheumatology, Institute of Inflammation and Ageing, University of Birmingham, University
Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK. E-mail:
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van Dijk BT, Dakkak YJ, Matthijssen XME, Niemantsverdriet E, Reijnierse M, van der Helm‐van Mil AHM. Intermetatarsal Bursitis, a Novel Feature of Juxtaarticular Inflammation in Early Rheumatoid Arthritis Related to Clinical Signs: Results of a Longitudinal Magnetic Resonance Imaging Study. Arthritis Care Res (Hoboken) 2022; 74:1713-1722. [PMID: 33973415 PMCID: PMC9795989 DOI: 10.1002/acr.24640] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Intermetatarsal bursae in the forefeet possess a synovial lining similar to joints and tendon sheaths. Inflammation of these bursae (intermetatarsal bursitis [IMB]) was recently identified as specific for early rheumatoid arthritis (RA). The present study was undertaken to determine if IMB is indeed an RA feature by assessing the following: 1) the association with other local inflammatory measures (synovitis, tenosynovitis, and osteitis), 2) the association with clinical signs, and 3) whether it responds to disease-modifying antirheumatic drug (DMARD) therapy similarly to other local inflammatory measures. METHODS One hundred fifty-seven consecutive early RA patients underwent unilateral contrast-enhanced 1.5T forefoot magnetic resonance imaging (MRI) at diagnosis. MRIs were evaluated for IMB presence and for synovitis, tenosynovitis, and osteitis in line with the RA MRI Scoring (RAMRIS) system (summed as RAMRIS inflammation). MRIs at 4, 12, and 24 months were evaluated for IMB presence and size in patients who had IMB at baseline and received early DMARD therapy. Logistic regression and generalized estimating equations were used. Anti-citrullinated protein antibody (ACPA) stratification was performed. RESULTS Sixty-nine percent of RA patients had ≥1 IMB. In multivariable analysis on bursa level, presence of IMB was independently associated with local presence of synovitis and tenosynovitis, with odds ratios (OR) of 1.69 (95% confidence interval [95% CI] 1.12, 2.57) and 2.83 (95% CI 1.80, 4.44), respectively, but not osteitis. On the patient level, IMB presence was most strongly associated with tenosynovitis (OR 2.92 [95% CI 1.62, 5.24]). IMB presence was associated with local joint swelling (OR 2.7 [95% CI 1.3, 5.3]) and tenderness (OR 1.7 [95% CI 1.04, 2.9]) independent of RAMRIS inflammation. During treatment, IMB size decreased between 0 and 12 months. This decrease associated with decrease in RAMRIS inflammation, which was driven by synovitis decrease. Within ACPA-positive and ACPA-negative RA, similar results were obtained. CONCLUSION IMB particularly accompanies inflammation of the synovial lining of joints and tendon sheaths, showed a similar treatment response after DMARD initiation, and associates with typical clinical signs. These findings suggest that IMB represents a frequently present novel RA feature of juxtaarticular synovial inflammation.
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Schmitt R, Hesse N, Grunz JP. Tendons and Tendon Sheaths of the Hand - An Update on MRI. ROFO-FORTSCHR RONTG 2022; 194:1307-1321. [PMID: 35705165 DOI: 10.1055/a-1826-1007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The tendons of the hand run in close proximity to each other and within retinacular tunnels adjacent to articular joints, while forming intersections in characteristic locations. The enclosing tendon sheaths are often sites of systemic or infectious inflammation. METHOD This review article outlines the different entities of tendon and tendon sheath pathology and their manifestation in the hands. Diagnostic findings in tendon and tendon sheath disorders are illustrated using MRI imaging and discussed in context with the current literature. RESULTS AND CONCLUSION Overuse may cause stenosis in the fibrous outer layer of the retinacula and the A1 annular ligaments as well as tendinosis. In contrast, proliferative tenosynovitis is a disease of the synovial inner layer of the tendon sheath with tendon infiltration and tendinitis. Pyogenic tenosynovitis favors the flexor compartments. Because of the narrow spaces in the hand, a high-resolution MRI technique must be used. KEY POINTS · Diseases of the tendons and tendon sheaths may have a mechanical, degenerative, metabolic, systemic inflammatory, or infectious etiology.. · Fibrous tunnels and bony prominences in close proximity to crossing tendons predispose to mechanical tendon irritation at typical sites of the hand.. · Stenosing tenovaginitis occurs in the fibrous layer of the extensor retinaculum or the A1 annular pulleys. The most frequent manifestations are the "trigger finger" and de Quervain disease.. · Proliferative tenosynovitis affects the synovial layer of the tendon sheaths before infiltrating the tendons. The classic representative is rheumatoid arthritis.. CITATION FORMAT · Schmitt R, Hesse N, Grunz JP. Tendons and Tendon Sheaths of the Hand - An Update on MRI. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1826-1007.
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Affiliation(s)
- Rainer Schmitt
- Department of Radiology, University Hospital, LMU Munich, Muenchen, Germany.,Department of Radiology, University Hospital Wuerzburg, Germany
| | - Nina Hesse
- Department of Radiology, University Hospital, LMU Munich, Muenchen, Germany
| | - Jan-Peter Grunz
- Department of Radiology, University Hospital Wuerzburg, Germany
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Ultrasound-detected tenosynovitis as a risk factor for flares in rheumatoid arthritis patients in clinical remission. Clin Rheumatol 2022; 41:1843-1849. [PMID: 35102535 DOI: 10.1007/s10067-022-06079-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/05/2022] [Accepted: 01/21/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Our objective was to investigate the value of ultrasound (US) detected synovitis and tenosynovitis as risk factors for short term flare in rheumatoid arthritis (RA) patients in clinical remission. METHODS Consecutive RA patients in clinical remission (DAS28 ERS < 2.6) for at least 3 months underwent Power Doppler ultrasound (PDUS) examination of 1st to 6th extensor compartments at the wrist, 2nd to 5th finger flexor, posterior tibial tendon, and peroneal tendons. To assess synovitis, carpal joints, 1st to 5th metacarpophalangeal (MCP) joints, and 2nd to 5th interphalangeal proximal (IPP) joints were bilaterally examined. Synovitis and tenosynovitis were defined according to OMERACT. Patients were followed for 1 year. Disease flare was defined as an increase in disease activity generating the need for a change in therapy by the attending rheumatologist. RESULTS Ninety patients were included. After 1 year of follow-up, 26 patients (29%) experienced a flare. At baseline 39%, 23% and 8% had US-detected synovitis, tenosynovitis or both, respectively. In the 1-year period after the baseline US examination, US-detected tenosynovitis (RR: 4.9; 95% CI: 2.2-10.8) was associated with an increased risk of exacerbation. This association was not shown with US-detected synovitis (RR: 1.3; 95% CI: 0.76-2.2). In the multivariate analysis, only subclinical tenosynovitis (OR: 9.8; 95% CI: 2.5-39.1; p = 0.001) and baseline DAS28 (OR: 5.7; 95% CI: 1.1-31.6; p = 0.047) were significantly associated with an increased risk of having a flare. CONCLUSION In our study, subclinical tenosynovitis was associated with disease flare in patients with RA in clinical remission. KEY POINTS • Synovitis and tenosynovitis are risk factors for short term flare in RA patients in clinical remission. • Subclinical tenosynovitis, but not synovitis, was associated with disease flare in patients with unstable remission. • Ultrasound-detected tenosynovitis could be useful to predict relapses in RA patients in clinical remission.
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van Dijk BT, Wouters F, van Mulligen E, Reijnierse M, van der Helm-van Mil AHM. During development of rheumatoid arthritis, intermetatarsal bursitis may occur before clinical joint swelling: a large imaging study in patients with clinically suspect arthralgia. Rheumatology (Oxford) 2021; 61:2805-2814. [PMID: 34791051 PMCID: PMC9258544 DOI: 10.1093/rheumatology/keab830] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 10/27/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives Intermetatarsal bursitis (IMB) represents juxta-articular synovial inflammation of the intermetatarsal bursae. Recent MRI studies identified IMB as feature of early RA, but whether IMB already occurs in the pre-arthritic phase is unknown. We performed a large MRI study in clinically suspect arthralgia (CSA) to assess the occurrence and prognostic value of IMB. Methods A total of 577 consecutive CSA patients underwent contrast-enhanced MRI of the forefoot, metacarpophalangeal joints and wrist. MRIs were evaluated for subclinical synovitis/tenosynovitis/osteitis in line with the RA MRI scoring system (summed as RAMRIS inflammation) and for IMB. IMB was considered present if uncommon in the general population at the same location (i.e. size scored above the 95th percentile in age-matched symptom-free controls). The relation of IMB with other MRI-detected subclinical inflammation (synovitis/tenosynovitis/osteitis) was studied. Cox-regression assessed the association with clinical arthritis development during median 25 months follow-up. ACPA stratification was performed. Results At presentation with CSA, 23% had IMB. IMB was more frequent in ACPA-positive than ACPA-negative CSA (47% vs 19%, P < 0.001). Patients with IMB were more likely to also have subclinical synovitis [OR 3.4 (95% CI 1.8, 6.5)] and tenosynovitis [5.9(2.8, 12.6)]. IMB conferred higher risk of developing arthritis [HR 1.6(1.0–2.7) adjusted for other subclinical inflammation]. IMB-presence predicted arthritis development in ACPA-positive CSA [adjusted HR 2.2(1.0–4.7)], but not in ACPA-negative CSA-patients [0.8(0.4–1.7)]. Conclusion Approximately a quarter of CSA patients have IMB, which is frequently accompanied by subclinical synovitis and tenosynovitis. IMB precedes development of clinical arthritis, particularly in ACPA-positive CSA. These results reinforce the notion that juxta-articular synovial inflammation is involved in the earliest phases of RA development.
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Affiliation(s)
- Bastiaan T van Dijk
- Department of Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Fenne Wouters
- Department of Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Elise van Mulligen
- Department of Rheumatology, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Centre, Leiden, the Netherlands.,Department of Rheumatology, Erasmus Medical Centre, Rotterdam, the Netherlands
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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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10
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Sidhu N, Wouters F, Niemantsverdriet E, van der Helm-van Mil AHM. MRI detected synovitis of the small joints predicts rheumatoid arthritis development in large joint undifferentiated inflammatory arthritis. Rheumatology (Oxford) 2021; 61:SI23-SI29. [PMID: 34164662 PMCID: PMC9015025 DOI: 10.1093/rheumatology/keab515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/11/2021] [Indexed: 11/25/2022] Open
Abstract
Objectives New onset undifferentiated large joint inflammatory arthritis can be diagnostically challenging. It is unknown how often these patients progress to RA, and how they can be identified at first presentation. We assessed clinical and serological features associated with RA development in patients with an undifferentiated mono- or oligo-articular large joint arthritis, and with keen interest in whether an MRI of the small joints of the hand and foot would aid diagnosis. Methods Leiden Early Arthritis Clinic includes 4018 patients; this prospective study follows 221 consecutively included patients with new onset undifferentiated large joint arthritis. Baseline clinical data and serology were obtained. Forty-five patients had MRIs (hand and foot). MRIs were scored according to the OMERACT RAMRIS. Univariable and multivariable logistic regression were assessed. Test characteristics, predictive values and net reclassification index (NRI) for RA were determined. Results Patients mostly presented with knee or ankle mono-arthritis. During the 12 months’ follow-up 17% developed RA. Autoantibody positivity (ACPA and/or RF) and MRI-detected synovitis in hands and feet were independently associated with RA development in multivariable analyses [odds ratio 10.29 (P = 0.014) and 7.88 (P = 0.017), respectively]. Positive predictive value of autoantibodies, MRI-detected synovitis and combination of both features was 63%, 55% and 100%, respectively. The addition of MRI-detected synovitis to autoantibody status improved diagnostic accuracy (NRI 18.1%). Conclusion In patients presenting with undifferentiated large joint arthritis, 17% will develop RA. Autoantibody positivity and subclinical synovitis are independent predictors. The data suggest MRI of small joints is beneficial for early identification of RA in large joint arthritis.
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Affiliation(s)
- Navkiran Sidhu
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fenne Wouters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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11
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Møller-Bisgaard S, Georgiadis S, Hørslev-Petersen K, Ejbjerg B, Hetland ML, Ørnbjerg LM, Glinatsi D, Møller J, Boesen M, Stengaard-Pedersen K, Madsen OR, Jensen B, Villadsen JA, Hauge EM, Bennett P, Hendricks O, Asmussen K, Kowalski M, Lindegaard H, Bliddal H, Krogh NS, Ellingsen T, Nielsen AH, Balding L, Jurik AG, Thomsen HS, Østergaard M. Predictors of joint damage progression and stringent remission in patients with established rheumatoid arthritis in clinical remission. Rheumatology (Oxford) 2021; 60:380-391. [PMID: 32929463 DOI: 10.1093/rheumatology/keaa496] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/01/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To study if clinical, radiographic and MRI markers can predict MRI and radiographic damage progression and achievement of stringent remission in patients with established RA in clinical remission followed by a targeted treatment strategy. METHODS RA patients (DAS28-CRP <3.2, no swollen joints) receiving conventional synthetic DMARDs were randomized to conventional or MRI-targeted treat-to-target strategies with predefined algorithmic treatment escalations. Potentially predictive baseline variables were tested in multivariate logistic regression analyses. RESULTS In the 171 patients included, baseline MRI osteitis independently predicted progression in MRI erosion [odds ratio (OR) 1.13 (95% CI 1.06, 1.22)], joint space narrowing [OR 1.15 (95% CI 1.07, 1.24)] and combined damage [OR 1.23 (95% CI 1.13, 1.37)], while tenosynovitis independently predicted MRI erosion progression [OR 1.13 (95% CI 1.03, 1.25)]. A predictor of radiographic erosion progression was age, while gender predicted progression in joint space narrowing. Following an MRI treat-to-target strategy predicted stringent remission across all remission definitions: Clinical Disease Activity Index remission OR 2.94 (95% CI 1.25, 7.52), Simplified Disease Activity Index remission OR 2.50 (95% CI 1.01, 6.66), ACR/EULAR Boolean remission OR 5.47 (95% CI 2.33, 14.13). Similarly, low tender joint count and low patient visual analogue scale pain and global independently predicted achievement of more stringent remission. CONCLUSION Baseline MRI osteitis and tenosynovitis were independent predictors of 2 year MRI damage progression in RA patients in clinical remission, while independent predictors of radiographic damage progression were age and gender. Following an MRI treat-to-target strategy, low scores of patient-reported outcomes and low tender joint count predicted achievement of stringent remission. TRIAL REGISTRATION ClinicalTrials.gov (https://clinicaltrials.gov), NCT01656278.
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Affiliation(s)
- Signe Møller-Bisgaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - Stylianos Georgiadis
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Kim Hørslev-Petersen
- Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Bo Ejbjerg
- Department of Rheumatology, Slagelse Hospital, Slagelse, Denmark
| | - Merete Lund Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lykke Midtbøll Ørnbjerg
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Daniel Glinatsi
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Rheumatology, Skaraborg Hospital, Skövde, Sweden
| | - Jakob Møller
- Department of Radiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Mikael Boesen
- Department of Radiology, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Kristian Stengaard-Pedersen
- Department of Rheumatology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Ole Rintek Madsen
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Bente Jensen
- Department of Rheumatology, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark
| | | | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark
| | - Philip Bennett
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Gentofte, Hellerup, Denmark
| | - Oliver Hendricks
- Department of Rheumatology, Danish Hospital for Rheumatic Diseases, Sønderborg, Denmark
| | - Karsten Asmussen
- Department of Rheumatology, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Marcin Kowalski
- Department of Rheumatology, Hjørring Hospital, Hjørring, Denmark
| | - Hanne Lindegaard
- Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
| | - Henning Bliddal
- Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | | | - Torkell Ellingsen
- Rheumatology Research Unit, Odense University Hospital, Odense, Denmark
| | | | - Lone Balding
- Department of Radiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Anne Grethe Jurik
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Henrik S Thomsen
- Department of Radiology, Herlev and Gentofte University Hospital, Herlev, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Centre for Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Differentiating rheumatoid and psoriatic arthritis: a systematic analysis of high-resolution magnetic resonance imaging features-preliminary findings. Skeletal Radiol 2021; 50:531-541. [PMID: 32845377 PMCID: PMC7811987 DOI: 10.1007/s00256-020-03588-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/07/2020] [Accepted: 08/16/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Because of overlapping phenotypical presentations, the diagnostic differentiation of rheumatoid arthritis (RA) and psoriatic arthritis (PsA) remains challenging. Thus, this study aimed to examine the diagnostic value of distinct imaging features obtained by high-resolution 3-T MRI for the diagnostic differentiation. MATERIALS AND METHODS Seventeen patients with PsA and 28 patients with RA were imaged at high resolution using 3-T MRI scanners and a dedicated 16-channel hand coil. All images were analyzed according to the outcome measures in rheumatology clinical trials' (OMERACT) RAMRIS (Rheumatoid Arthritis Magnetic Resonance Imaging Score) and PsAMRIS (Psoriatic Arthritis Magnetic Resonance Imaging Score) for the presence and intensity of synovitis, flexor tenosynovitis, bone edema, bone erosion, periarticular inflammation, bone proliferation, and joint space narrowing. Next, odds ratios (OR) were calculated to determine the strength of the associations between these imaging features, demographic characteristics, and the outcome RA vs. PsA. RESULTS PsA could be differentiated from RA by extracapsular inflammatory changes (PsAMRIS sub-score "periarticular inflammation"), with low odds for the presence of RA (OR of 0.06, p < 0.01) at all metacarpophalangeal (MCP) joints. A prediction model informed by the items that were strongest associated with the presence of RA or PsA demonstrated excellent differentiating capability with an area under the curve of 98.1%. CONCLUSION High-resolution imaging is beneficial for the identification of relevant imaging features that may assist the clinical differentiation of inflammatory conditions of the hand. At the MCP level, extracapsular inflammatory changes were strongly associated with PsA and may consequently allow the imaging differentiation of PsA and RA.
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13
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Kaeley GS, Roth J. Imaging in rheumatic and musculoskeletal conditions: State of the art and challenges. Best Pract Res Clin Rheumatol 2020; 34:101643. [DOI: 10.1016/j.berh.2020.101643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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14
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Ranganath VK, Hammer HB, McQueen FM. Contemporary imaging of rheumatoid arthritis: Clinical role of ultrasound and MRI. Best Pract Res Clin Rheumatol 2020; 34:101593. [PMID: 32988757 DOI: 10.1016/j.berh.2020.101593] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Magnetic resonance imaging (MRI) and musculoskeletal ultrasound (MSUS) are sensitive imaging modalities used by clinicians to assist in decision-making in the management of rheumatoid arthritis (RA). This review will examine the utility of MRI and MSUS in diagnosing RA, predicting RA flares, tapering therapy, assessing remission, and examining difficult periarticular features. We will also outline the strengths and weaknesses of utilizing MRI and MSUS as outcome measures in the management of RA.
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Affiliation(s)
- Veena K Ranganath
- University of California, David Geffen School of Medicine, Los Angeles, USA.
| | - Hilde B Hammer
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
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15
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Shiraishi M, Fukuda T, Igarashi T, Tokashiki T, Kayama R, Ojiri H. Differentiating Rheumatoid and Psoriatic Arthritis of the Hand: Multimodality Imaging Characteristics. Radiographics 2020; 40:1339-1354. [PMID: 32735474 DOI: 10.1148/rg.2020200029] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Accurate diagnosis and therapeutic intervention at an early stage is paramount for the management of rheumatoid arthritis (RA) and psoriatic arthritis (PsA), which are the two major types of inflammatory arthritis that involve the hand joints. As more disease-specific medications are developed, medication selection according to the correct diagnosis becomes more important. A delay in diagnosis and inappropriate medication selection may result in poor functional prognosis. However, clinical differentiation between RA and PsA can be challenging and may become largely dependent on imaging interpretation results. Although there is substantial overlap in the imaging findings of RA and PsA, there are differences in the affected primary target sites, reflected by the various patterns of joint involvement, and different microanatomic localization of abnormalities within a single joint in each disease. Therefore, appropriate use of various imaging modalities and accurate image interpretation add significant value to the diagnosis and treatment process. The synovio-entheseal complex is an important concept for understanding the imaging features of PsA. The authors review the different features of RA and PsA of the hands seen with various imaging modalities, including radiography, US, MRI, and dual-energy CT, with updates on the contemporary role of imaging in diagnosis and treatment. The radiologist should have sufficient knowledge to interpret imaging findings and understand the strengths and weaknesses of each modality to recommend the appropriate imaging method and differentiate both diseases accurately. ©RSNA, 2020.
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Affiliation(s)
- Megumi Shiraishi
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takeshi Fukuda
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takao Igarashi
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Tadashi Tokashiki
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Reina Kayama
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroya Ojiri
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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16
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Smerilli G, Di Matteo A, Cipolletta E, Carloni S, Incorvaia A, Di Carlo M, Grassi W, Filippucci E. Ultrasound assessment of carpal tunnel in rheumatoid arthritis and idiopathic carpal tunnel syndrome. Clin Rheumatol 2020; 40:1085-1092. [PMID: 32696282 PMCID: PMC7895772 DOI: 10.1007/s10067-020-05293-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/09/2020] [Accepted: 07/13/2020] [Indexed: 11/29/2022]
Abstract
Objectives To comparatively assess the sonographic spectrum of carpal tunnel syndrome (CTS) in patients with rheumatoid arthritis (RA) and in patients with idiopathic CTS. Methods Fifty-seven RA patients and 25 idiopathic CTS patients were consecutively enrolled. The diagnosis of CTS in RA patients was made according to clinical history and examination. The following sonographic findings were assessed at carpal tunnel level: median nerve cross-sectional area (CSA) at the carpal tunnel proximal inlet, finger flexor tendons tenosynovitis, radio-carpal synovitis and intraneural power Doppler (PD) signal. Results CTS was diagnosed in 15/57 RA patients (26.3%). Twenty-three RA wrists with CTS, 84 RA wrists without CTS and 34 idiopathic CTS wrists were evaluated. The average CSA of the median nerve was higher in idiopathic CTS than in RA wrists with CTS (17.7 mm2 vs 10.6 mm2, p < 0.01). A higher rate of inflammation of synovial structures (flexor tendons sheath and/or radio-carpal joint) was found in RA wrists with CTS compared with those without CTS (p = 0.04) and idiopathic CTS (p = 0.02). Intraneural PD signal was more common in CTS (in both RA and idiopathic CTS) wrists compared with wrists without CTS (p < 0.01). Conclusion The sonographic spectrum of CTS in RA patients is characterized by an inflammatory pattern, defined by the presence of finger flexor tendons tenosynovitis and/or radio-carpal joint synovitis. Conversely, a marked median nerve swelling is the dominant feature in idiopathic CTS. Intraneural PD signal is a frequent finding in both conditions.Key Points • Carpal tunnel syndrome (CTS) associated with rheumatoid arthritis (RA) and idiopathic CTS have distinct ultrasound patterns. • The most characteristic sonographic features of CTS in RA patients are those indicative of synovial tissue inflammation at carpal tunnel level. Conversely, marked median nerve swelling is the dominant finding in idiopathic CTS. • Intraneural power Doppler signal is a frequent finding in both conditions. • In patients with CTS, differently from electrophysiology, US can provide clues prompting a rheumatology referral in case of prominent inflammatory findings at carpal tunnel level. |
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Affiliation(s)
- Gianluca Smerilli
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy.
| | - Andrea Di Matteo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy.,Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy
| | - Sergio Carloni
- Orthopaedic Unit, "Carlo Urbani" Hospital, Via Aldo Moro 25, Jesi, Italy
| | - Antonella Incorvaia
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy
| | - Walter Grassi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, "Carlo Urbani" Hospital, Polytechnic University of Marche, Via Aldo Moro 25, 60035, Jesi, Italy
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Ultrasonography in Early Rheumatoid Arthritis of Hand and Wrist Joints: Comparison with Magnetic Resonance Imaging. Indian J Orthop 2020; 54:695-703. [PMID: 32850035 PMCID: PMC7429602 DOI: 10.1007/s43465-020-00178-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 06/19/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The aim of the study was to evaluate the use of ultrasonography (USG) including power Doppler in detecting hand and wrist joint changes in early rheumatoid arthritis (RA) and to compare USG findings with magnetic resonance imaging (MRI). MATERIALS AND METHODS Thirty-four patients diagnosed as RA by 2010 ACR/EULAR criteria; with the onset of symptoms within last one year, were included in the study after institute ethical clearance and informed consent to undergo USG and contrast-enhanced MRI of the dominant affected hand. Second to fifth metacarpophalangeal (MCP) joints, second to fifth proximal interphalangeal (PIP) joints and wrist joints (total nine joints) were evaluated for synovitis, erosions along with tenosynovitis. USG and MRI features were compared; agreement on the two imaging modalities as well as sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of ultrasonography compared to MRI (gold standard) was calculated. RESULTS One hundred thirty-six MCP, 136 PIP and 34 wrist joints (total 306 joints) and 136 flexor tendons were evaluated. The sensitivity, specificity, PPV, NPV and diagnostic accuracy of USG for diagnosing synovitis was 78.6%, 91.1%, 86.1%, 85.8%, 86.3%; for erosions 67.2%, 97.5%, 84.8%, 90.5%, 91.5%; for tenosynovitis 86.5%, 100%, 100%, 92.3% and 94.8% respectively. The overall agreement between USG and MRI for detection of synovitis was achieved in 83% joints and for erosions in 89.5% joints. CONCLUSION In early RA, USG was nearly as effective in diagnosing features of joint and tendon sheath involvement, with relatively better performance of USG for tenosynovitis. The performance of USG in diagnosing erosions was limited likely due to difficult access of three-dimensional joint structure.
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18
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Revision Carpal Tunnel Release: Risk Factors and Rate of Secondary Surgery. Plast Reconstr Surg 2020; 145:1204-1214. [DOI: 10.1097/prs.0000000000006742] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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19
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Dakkak YJ, Jansen FP, DeRuiter MC, Reijnierse M, van der Helm-van Mil AHM. Rheumatoid Arthritis and Tenosynovitis at the Metatarsophalangeal Joints: An Anatomic and MRI Study of the Forefoot Tendon Sheaths. Radiology 2020; 295:146-154. [PMID: 32043949 PMCID: PMC7212020 DOI: 10.1148/radiol.2020191725] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Although tenosynovitis in the hands is associated with rheumatoid arthritis (RA), it is unknown whether tenosynovitis of the forefoot is associated with RA. Purpose To determine the anatomy of tendon sheaths of the forefoot and the relationship between MRI-detected tenosynovitis at metatarsophalangeal (MTP) joints and RA. Materials and Methods Fourteen forefeet of donated bodies were examined at flexor tendons and extensor tendons for the presence and course of tendon sheaths. In the prospective study between June 2013 and March 2016, newly presenting patients with RA, patients with other early arthritides, and healthy control participants all underwent MRI of unilateral MTP joints 1-5. MRI studies were scored by two independent readers for tenosynovitis, synovitis, and bone marrow edema. The association between the presence of these features and RA was examined by using logistic regression. Results Macroscopically, all extensor and flexor tendons crossing MTP joints demonstrated sheaths surrounding tendons. Microscopically, a synovial sheath was present. MRI evaluation was performed in 634 participants: 157 newly presenting patients with RA (109 women; mean age, 59 years ± 11 [standard deviation]), 284 patients with other early arthritides (158 women; mean age, 56 years ± 17), and 193 healthy control participants (136 women; mean age, 50 years ± 16). MRI-detected tenosynovitis was associated with RA, both when compared with patients with other arthritides (odds ratio [OR], 2.5; 95% confidence interval [CI]: 1.7, 3.9; P < .001) and healthy control participants (OR, 46; 95% CI: 14, 151; P < .001). The association was OR of 2.4 (95% CI: 1.5, 3.8; P < .001) for flexor tendons and OR of 3.1 (95% CI: 1.9, 5.2; P < .001) for extensor tendons. The sensitivity of tenosynovitis in RA was 65 of 157 (41%; 95% CI: 35%, 50%). The specificity for RA was 63 of 284 (78%; 95% CI: 72%, 82%) compared with other arthritides, and three of 193 (98%; 95% CI: 96%, 99%) compared with healthy control participants. Conclusion Tendons at metatarsophalangeal joints are surrounded by tenosynovium. MRI-detected tenosynovitis at metatarsophalangeal joints was specific for rheumatoid arthritis when compared with findings in patients with other arthritides and findings in healthy control participants. © RSNA, 2020 Online supplemental material is available for this article.
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Affiliation(s)
- Yousra J Dakkak
- From the Departments of Rheumatology (Y.J.D., A.H.M.v.d.H.v.M.), Anatomy & Embryology (F.P.J., M.C.D.), and Radiology (M.R.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Friso P Jansen
- From the Departments of Rheumatology (Y.J.D., A.H.M.v.d.H.v.M.), Anatomy & Embryology (F.P.J., M.C.D.), and Radiology (M.R.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Marco C DeRuiter
- From the Departments of Rheumatology (Y.J.D., A.H.M.v.d.H.v.M.), Anatomy & Embryology (F.P.J., M.C.D.), and Radiology (M.R.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Monique Reijnierse
- From the Departments of Rheumatology (Y.J.D., A.H.M.v.d.H.v.M.), Anatomy & Embryology (F.P.J., M.C.D.), and Radiology (M.R.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Annette H M van der Helm-van Mil
- From the Departments of Rheumatology (Y.J.D., A.H.M.v.d.H.v.M.), Anatomy & Embryology (F.P.J., M.C.D.), and Radiology (M.R.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
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20
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Kerrigan SA, McInnes IB. Reflections on ‘older’ drugs: learning new lessons in rheumatology. Nat Rev Rheumatol 2020; 16:179-183. [DOI: 10.1038/s41584-020-0375-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2020] [Indexed: 12/18/2022]
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21
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Subedi A, Williams SG, Yao L, Maharjan S, Strauss J, Sharon E, Thomas A, Apolo AB, Gourh P, Hasni SA, Gulley JL, Kaplan MJ, Katz JD, Gupta S. Use of Magnetic Resonance Imaging to Identify Immune Checkpoint Inhibitor-Induced Inflammatory Arthritis. JAMA Netw Open 2020; 3:e200032. [PMID: 32101306 PMCID: PMC7137682 DOI: 10.1001/jamanetworkopen.2020.0032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE Immune checkpoint inhibitors (ICIs) have transformed the treatment paradigm for an ever-increasing number of cancers. However, their use has also led to the emergence of immune-related adverse events, such as ICI-induced inflammatory arthritis. A reproducible, reliable, and accessible modality is needed to assess and distinguish early ICI-induced inflammatory arthritis and help in management. Magnetic resonance imaging (MRI) of joints may be helpful for early diagnosis, guiding therapeutic decision-making, and identifying patients at high risk for erosive disease. OBJECTIVE To assess the role of MRI of joints in patients with ICI-induced inflammatory arthritis. DESIGN, SETTING, AND PARTICIPANTS This retrospective case series included patients enrolled at the National Institutes of Health Clinical Center in Bethesda, Maryland. Patients were evaluated by the rheumatology consultation service between December 27, 2016, and May 28, 2019. A retrospective health record review was performed to determine demographic characteristics, clinical characteristics of inflammatory arthritis and malignant tumors, and imaging findings. Inclusion criteria were patients who were enrolled on various institutional review board-approved protocols of ICIs, developed joint-related symptoms, and had MRI data for at least 1 joint. Data were analyzed from June 1, 2019, to September 1, 2019. EXPOSURES Undergoing MRI of at least 1 joint. MAIN OUTCOMES AND MEASURES All MRIs were reviewed for synovitis, tenosynovitis, bone marrow edema, and soft tissue conditions. RESULTS A total of 8 patients (mean [SD] age, 58.8 [5.2] years; 6 women and 2 men) between the ages of 50 and 65 years who were undergoing ICI therapy for a variety of malignant tumors were included in this study. Only 1 patient was receiving combined ICI therapy. The results of 13 separate MRI examinations were reviewed. The most commonly performed MRIs were of the hands and wrists (9 MRIs), followed by knee examinations (3 MRIs). Tenosynovitis and synovitis were frequently seen in the hands and wrists. Bone marrow edema and erosions were also found in 3 patients, suggesting early damage. In larger joints (ie, knees and ankles), joint effusions and synovial thickening were characteristic. Most patients (5 patients) were treated with corticosteroids and had good responses. In patients with high-risk features on MRI imaging (eg, bone marrow edema, erosions), disease-modifying antirheumatic drug therapy was also discussed as a treatment option. CONCLUSIONS AND RELEVANCE These findings suggest that advanced imaging may help to distinguish ICI-induced inflammatory arthritis from other causes of joint pain, aid in identifying patients at increased risk of joint damage, and provide utility in monitoring inflammatory arthritis treatment response in patients receiving ICI therapy.
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Affiliation(s)
- Ananta Subedi
- Formerly Office of the Clinical Director, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
- WakeMed Physician Practices, Raleigh, North Carolina
| | - Sandra G. Williams
- Office of the Clinical Director, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Lawrence Yao
- Clinical Center, Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland
| | - Suresh Maharjan
- Department of Internal Medicine, Alameda Health System, Oakland, California
| | - Julius Strauss
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Elad Sharon
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, Maryland
| | - Anish Thomas
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrea B. Apolo
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Pravitt Gourh
- Office of the Clinical Director, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sarfaraz A. Hasni
- Office of the Clinical Director, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
- Intramural Research Program, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - James L. Gulley
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Mariana J. Kaplan
- Intramural Research Program, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - James D. Katz
- Office of the Clinical Director, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Sarthak Gupta
- Office of the Clinical Director, Intramural Research Program, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
- Intramural Research Program, Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
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22
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Ganguly A, Chaudhary SR, Rai M, Kesavanarayanan V, Aniq H. Thenar lumps: a review of differentials. Clin Radiol 2019; 74:978.e15-978.e27. [PMID: 31594559 DOI: 10.1016/j.crad.2019.08.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 08/28/2019] [Indexed: 10/25/2022]
Abstract
Most soft-tissue lumps in the hand are benign, with ganglions being the commonest, but in the thenar region, solid soft-tissue masses are more common than a ganglion. In this review, we focus on soft-tissue lesions (neoplastic and non-neoplastic) presenting as a palpable lump in this region. A specific diagnosis can often be reached using ultrasonography and/or magnetic resonance imaging. Most of these lesions are managed in local hospitals or primary care, whereas some are referred to specialist centres. This review article will help both general and musculoskeletal radiologists to diagnose and characterise these lesions, provide a guide for further imaging, and provide an insight into imaging features that may need specific investigations such as core biopsy, tertiary referral, and further review at multidisciplinary meetings.
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Affiliation(s)
- A Ganguly
- Department of Radiology, Warrington and Halton Hospitals NHS Foundation Trust, Lovely Lane, Warrington, Cheshire WA5 1QG, UK
| | - S R Chaudhary
- Department of Radiology, Warrington and Halton Hospitals NHS Foundation Trust, Lovely Lane, Warrington, Cheshire WA5 1QG, UK.
| | - M Rai
- Department of Radiology, Warrington and Halton Hospitals NHS Foundation Trust, Lovely Lane, Warrington, Cheshire WA5 1QG, UK
| | - V Kesavanarayanan
- Department of Radiology, Warrington and Halton Hospitals NHS Foundation Trust, Lovely Lane, Warrington, Cheshire WA5 1QG, UK
| | - H Aniq
- Department of Radiology, Royal Liverpool & Broadgreen University Hospitals NHS Trust, Prescot St, Liverpool, Merseyside L7 8XP, UK
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23
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Choi HJ, Lee SJ, Kim JY, Sung YK, Choi YY. The Correlation Between Tenosynovitis Pattern on Two-Phase Bone Scintigraphy and Clinical Manifestation in Patients with Suspected Rheumatoid Arthritis. Nucl Med Mol Imaging 2019; 53:278-286. [PMID: 31456861 DOI: 10.1007/s13139-019-00596-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 04/24/2019] [Accepted: 05/14/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To investigate the correlation between the tenosynovitis pattern on two-phase bone scintigraphy (2P-BS) and clinical manifestation in patients with suspected rheumatoid arthritis (RA). Method 2P-BS including technetium-99m-methylene diphosphonate blood pool and bone phase imaging in 402 consecutive patients with clinically suspected RA were retrospectively reviewed. According to 2010 RA Classification Criteria, patients were grouped as RA and non-RA. Visual assessment of all fingers, toes, wrists, and ankles on 2P-BS was performed. Clinical suspected tenosynovitis was evaluated on physical examination. Rheumatoid factor, anti-cyclic citrullinated protein antibody, C-reactive protein, and estimated sedimentation rate were obtained. Radiographic findings were also used to define early and established arthritis. Results Tenosynovitis pattern was detected in 12.7% (51/402 patients) on 2P-BS. A total of 94.1% (48/51) were diagnosed as RA vs. 5.9% (3/51) as non-RA. Of the 48 RA patients with positive 2P-BS finding, 85.4% (41/48) had early arthritis and 14.6% (7/48) had established arthritis. On physical examination, tenosynovitis was suspected in 21.9% (88/402). A total of 56.8% (50/88) belonged to the RA group and 43.2% (38/88) to the non-RA group. The tenosynovitis pattern of 2P-BS and physical examination showed statistical difference and moderate agreement. The positive tenosynovitis pattern on 2P-BS represented up to 26.408 of odds ratio which was highest among the RA-associated factors. Conclusion Tenosynovitis pattern on 2P-BS was more commonly detected in the RA group and was more frequently associated with early arthritis pattern. Therefore, 2P-BS could give additional information for the detection of subclinical tenosynovitis in early or preclinical RA patients.
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Affiliation(s)
- Hyung Jin Choi
- 1Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04764 South Korea
| | - Soo Jin Lee
- 1Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04764 South Korea
| | - Ji Young Kim
- 2Department of Nuclear Medicine, Hanyang University Guri Hospital, 153 Kyougchun-ro, Guri-si, Gyeonggi-do 11923 South Korea
| | - Yoon-Kyoung Sung
- 3Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04764 South Korea
| | - Yun Young Choi
- 1Department of Nuclear Medicine, Hanyang University Medical Center, 222-1 Wangsimni-ro, Seongdong-gu, Seoul, 04764 South Korea
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24
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Rubin DA. MR and ultrasound of the hands and wrists in rheumatoid arthritis. Part II. Added clinical value. Skeletal Radiol 2019; 48:837-857. [PMID: 30806723 DOI: 10.1007/s00256-019-03180-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/03/2019] [Accepted: 02/03/2019] [Indexed: 02/02/2023]
Abstract
Advanced imaging has become just as vital for diagnosing, staging, and monitoring disease in rheumatoid arthritis (RA) patients as it is for cancer patients. Part 1 of this review discussed synovitis, tenosynovitis, erosions, and osteitis-key imaging findings that occur in patients with RA. Part 2 will now show how these features, in combination with clinical and serologic data, can assist clinical decision-making at various stages of a patient's disease course. Specifically, assessing current disease activity and prognosticating future aggressiveness inform treatment decisions at initial presentation, during medical treatment, and at clinical remission. In addition to summarizing the current literature on advanced imaging in RA, clinical examples from different stages throughout the disease course will illustrate practical approaches for applying these research results. Last, this review will describe potential future roles of imaging in RA patients.
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Affiliation(s)
- David A Rubin
- Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd., St. Louis, MO, 63110, USA.
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25
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Rubin DA. MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I. Imaging findings. Skeletal Radiol 2019; 48:677-695. [PMID: 30796506 DOI: 10.1007/s00256-019-03179-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/19/2019] [Accepted: 02/03/2019] [Indexed: 02/02/2023]
Abstract
The management of patients with rheumatoid arthritis (RA) has rapidly evolved with the development of newer disease-modifying drugs and the recognition that long-term damage can be mitigated by an earlier and more-informed use of these medications. Historically, radiographs were the mainstay of imaging in RA patients, but radiographic joint narrowing and erosions are late and insensitive findings in the disease. MRI (with intravenous contrast agent) and ultrasound (with power Doppler interrogation) of the hands and wrists are able to demonstrate erosions earlier and with greater sensitivity than radiographs. More importantly, these imaging studies also depict synovitis and active soft-tissue inflammation, which represents a precursor to structural damage. Additionally, MRI can show inflammation within the bones (osteitis), which is proving to be the most important prognosticator of an aggressive disease course. Part I of this review discusses the imaging techniques, pitfalls, definitions, and comparative studies of MRI and ultrasound for identifying and quantifying erosions, synovitis, and osteitis. Part II will demonstrate how these imaging findings influence the clinical management of RA patients throughout their disease course, from presentation through clinical remission.
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Affiliation(s)
- David A Rubin
- Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Boulevard, St. Louis, MO, 63110, USA.
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26
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Li N, Jiang L, Cai Y, Liu JY, Zhao T, Kong N, Yu Y, Xuan DD, Zou H, Xue Y, Wan W. The correlation between interleukin-34 and bone erosion under ultrasound in rheumatoid arthritis. Mod Rheumatol 2019; 30:269-275. [PMID: 30880555 DOI: 10.1080/14397595.2019.1593576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background: Rheumatoid arthritis (RA) is a chronic inflammatory arthropathy characterized by excessive synovial hyperplasia and progressive joint destruction. Pro-inflammatory cytokines play major roles in the regulation of synovial inflammation. The contribution of interleukin-34 (IL-34) in RA pathogenesis has been strongly suggested in clinical studies.Aim: To investigate the correlation between plasma IL-34 and disease parameters in RA patients including disease activity score (DAS28), receptor activator of NF-[Formula: see text]B ligand (RANKL) concentration, synovitis and bone erosions under ultrasound.Methods: 60 RA patients and 20 healthy controls were from Huashan Hospital, patient's medical history, physical examination, laboratory examination and ultrasound data were collected and recorded, respectively. Blood samples of all participants were collected and the levels of IL-34 and RANKL were tested. The levels of IL-34 and RANKL in RA patients were compared with those of healthy controls. Furthermore, the correlation between IL-34, RANKL and disease parameters in RA patients was analyzed.Results: Both plasma levels of IL-34 and RANKL in RA patients were significantly higher than the healthy controls (p < .05). IL-34 was significantly related to disease activity scores (r = 0.43, p = .001); RANKL (r = 0.46, p = .0003) and bone erosions by ultrasound (r = 0.38, p = .002).Conclusions: The plasma IL-34 concentration in RA was significantly higher than the healthy controls and was significantly correlated with RANKL, as well as disease activity score and bone erosions by ultrasound. The IL-34 may be a new biological marker for disease activity and predictor for bone erosions in RA. Targeting IL-34 holds promise in the management of RA and, potentially, other osteoclasts driven diseases (erosive osteoarthritis and psoriatic arthritis for example).
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Affiliation(s)
- Na Li
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China.,The Fifth People's Hospital of Shanghai, Fudan University, Shanghai, China
| | - Li Jiang
- Department of Rheumatology, Linyi People's Hospital, Shandong, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Yehua Cai
- Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China.,Department of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Jia Yan Liu
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Tianyi Zhao
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Ning Kong
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Yiyun Yu
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Dan Dan Xuan
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Hejian Zou
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Yu Xue
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
| | - Weiguo Wan
- Department of Rheumatology, Huashan Hospital, Fudan University, Shanghai, China.,Institute of Rheumatology, Immunology and Allergy, Fudan University, Shanghai, China
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27
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Kawashiri S, Fujikawa K, Nishino A, Takatani A, Shimizu T, Umeda M, Fukui S, Igawa T, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Mizokami A, Maeda T, Kawakami A. Combination of ultrasound power Doppler‐verified synovitis and seropositivity accurately identifies patients with early‐stage rheumatoid arthritis. Int J Rheum Dis 2019; 22:842-851. [DOI: 10.1111/1756-185x.13543] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 02/14/2019] [Accepted: 02/16/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Shin‐ya Kawashiri
- Department of Community Medicine Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Keita Fujikawa
- Department of Rheumatology Isahaya General Hospital Isahaya Japan
| | - Ayako Nishino
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Ayuko Takatani
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Toshimasa Shimizu
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Masataka Umeda
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Shoichi Fukui
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Takeshi Igawa
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tomohiro Koga
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki 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
| | - Mami Tamai
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Hideki Nakamura
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Tomoki Origuchi
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Akinari Mizokami
- Department of Rheumatology Isahaya General Hospital Isahaya Japan
| | - Takahiro Maeda
- Department of Community Medicine Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology Nagasaki University Graduate School of Biomedical Sciences Nagasaki Japan
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28
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Miller JB, Danoff SK, Bingham CO, Paik JJ, Mecoli CA, Tiniakou E, Christopher-Stine L, Albayda J. Sonographic findings from inflammatory arthritis due to antisynthetase syndrome. Clin Rheumatol 2019; 38:1477-1483. [PMID: 30810913 DOI: 10.1007/s10067-019-04471-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 01/29/2019] [Accepted: 02/06/2019] [Indexed: 10/27/2022]
Abstract
Inflammatory arthritis is a common feature of antisynthetase syndrome. Ultrasonography is able to characterize important features of bone and tendon pathology but has not been evaluated in this setting. We review the sonographic findings in a series of patients with antisynthetase syndrome and inflammatory arthritis. A retrospective chart review was performed of patients with antisynthetase syndrome-associated inflammatory arthritis who had undergone ultrasound imaging for joint pathology. Seventeen sonographic assessments of eight patients were included. Synovial hypertrophy was seen in all eight patients, with active Doppler signal present in six patients (13 of 17 ultrasound locations). Tendon involvement was common, with tenosynovitis in seven patients (11 of 17 ultrasound locations). Erosions were present in five patients. Musculoskeletal ultrasound showed significant joint pathology including proliferative synovitis and tenosynovitis. This may be severe and associated with erosive disease. Further systematic studies are needed to better understand the articular involvement of antisynthetase syndrome. Key points • Marked inflammatory change-with proliferative synovitis, tenosynovitis, and erosions-can be seen in selected patients with antisynthetase syndrome (ASyS). • Inflammatory arthritis from ASyS can be severe and erosive in the absence of RF and ACPA and can be refractory to immunosuppressive therapy used to manage the myositis and interstitial lung disease. • Systematic sonographic evaluation of patients with ASyS is needed to further evaluate pathology and treatment response of inflammatory arthritis.
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Affiliation(s)
- John B Miller
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA.
| | - Sonye K Danoff
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Clifton O Bingham
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Julie J Paik
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Christopher A Mecoli
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Eleni Tiniakou
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Lisa Christopher-Stine
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA.,Department of Neurology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
| | - Jemima Albayda
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Ave, Mason F Lord Building Center Tower, Suite 4100, Baltimore, MD, 21224, USA
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29
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What is the additional value of MRI of the foot to the hand in undifferentiated arthritis to predict rheumatoid arthritis development? Arthritis Res Ther 2019; 21:56. [PMID: 30764871 PMCID: PMC6376768 DOI: 10.1186/s13075-019-1845-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 02/05/2019] [Indexed: 11/10/2022] Open
Abstract
Background MRI-detected subclinical joint inflammation in the hand joints of patients with undifferentiated arthritis (UA) predicts progression to rheumatoid arthritis (RA). It is unknown if adding MRI of the foot increases predictive accuracy compared to the hand alone. Methods 1.5-T contrast-enhanced MRI of the unilateral foot (MTP-1-5) and hand (MCP-2-5 and wrist) was performed in 123 patients presenting with UA (not fulfilling the 2010 RA criteria) and scored for bone marrow edema (BME), synovitis and tenosynovitis. Symptom-free controls (n = 193) served as a reference for defining an abnormal MRI. Patients were followed for RA development ≤ 1 year, defined as fulfilling the classification criteria or initiation of disease-modifying antirheumatic drugs because of the expert opinion of RA. The added predictive value of foot MRI to hand MRI was evaluated. Results Fifty-two percent developed RA. Foot tenosynovitis was predictive (OR 2.55, 95% CI 1.01–6.43), independent of BME and synovitis (OR 3.29, 95% CI 1.03–10.53), but not independent of CRP and number of swollen joints (OR 2.14, 95% CI 0.77–5.95). Hand tenosynovitis was also predictive independent of BME and synovitis (OR 3.99, 95% CI 1.64–9.69) and independent of CRP and swollen joints (OR 2.36, 95% CI 1.04–5.38). Adding foot tenosynovitis to hand tenosynovitis changed the sensitivity from 72 to 73%, specificity from 59 to 54% and AUC from 0.66 to 0.64; the net reclassification index was − 3.5. Conclusion MRI-detected tenosynovitis of the foot predicts progression to RA. However, adding MRI of the foot does not improve the predictive accuracy compared to MRI of the hand alone. In view of cost reduction, the performance of foot MRI for prognostic purposes in UA can be omitted. Electronic supplementary material The online version of this article (10.1186/s13075-019-1845-7) contains supplementary material, which is available to authorized users.
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Patients with Rheumatoid Arthritis Were Associated with a Risk of Rotator Cuff Diseases. J Clin Med 2019; 8:jcm8020129. [PMID: 30678235 PMCID: PMC6406446 DOI: 10.3390/jcm8020129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 11/17/2022] Open
Abstract
Rheumatoid arthritis (RA) commonly causes inflammation in the joints and periarticular structures. The association between RA and rotator cuff (RC) has been reported; however, epidemiological studies on RA and RC tendons are scant. Therefore, we investigated RC disease (RCD) risk and analyzed the effects of RA medication, steroids, and methotrexate, on the risk of RCD for patients with RA. We conducted a retrospective cohort study with a 6-year longitudinal follow-up in Taiwan. Patients who received RA diagnoses between 2004 and 2008 were enrolled in the study cohort. The non-RA control cohort comprised age- and sex-matched controls. Propensity score matching was used for other comorbidities and treatments. The hazard ratios (HRs) and adjusted HRs (aHRs) were estimated after confounders were adjusted for. Effects of steroid and methotrexate use on RCD risk were also analyzed. We enrolled 4521 RA patients (study cohort) and 22,605 matched controls. RCD incidence was 145 and 91 per 100,000 person-years in the RA and control cohorts, respectively. In the RA cohort, the crude HR for RCD was 1.62 (95% confidence interval (CI), 1.41–1.86, p < 0.001), and the aHR was 1.56 (95% CI, 1.36–1.79, p < 0.001). The methotrexate nonusers exhibited an aHR (vs. controls) of 1.61 (95% CI, 1.40–1.85, p < 0.001), but the methotrexate users did not have a significantly higher aHR than the controls. The steroid nonusers had an aHR (vs. controls) of 1.69 (95% CI, 1.46–1.96, p < 0.001), but the aHR of the steroid users was not significantly higher than the control aHR. Patients with RA had a higher risk for RCD compared with the non-RA control cohort. Steroids or methotrexate use significantly reduces the risk of RCD occurrence in patients with RA. Treatment for RCD symptoms and controlling inflammatory process are important to ensure high-quality care for patients with RA.
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Sahbudin I, Pickup L, Nightingale P, Allen G, Cader Z, Singh R, de Pablo P, Buckley CD, Raza K, Filer A. The role of ultrasound-defined tenosynovitis and synovitis in the prediction of rheumatoid arthritis development. Rheumatology (Oxford) 2018; 57:1243-1252. [PMID: 29618136 PMCID: PMC6037116 DOI: 10.1093/rheumatology/key025] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 01/24/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES Tenosynovitis (TS) is common in early arthritis. However, the value of US-defined TS in predicting RA development is unclear. We assessed the predictive utility of US-defined TS alongside US-defined synovitis and clinical and serological variables in a prospective cohort of early arthritis patients. METHODS One hundred and seven patients with clinically apparent synovitis of one or more joint and symptom duration ⩽3 months underwent baseline clinical, laboratory and US assessment of 19 bilateral joint sites and 16 bilateral tendon compartments. Diagnostic outcome was determined after 18 months, applying the 2010 ACR/EULAR classification criteria for RA. The predictive values of US-defined TS for persistent RA were compared with those of US-defined synovitis, clinical and serological variables. RESULTS A total of 4066 US joint sites and 3424 US tendon compartments were included in the analysis. Forty-six patients developed persistent RA, 17 patients developed non-RA persistent disease and 44 patients had resolving disease at follow-up. US-defined TS in at least one tendon compartment at baseline was common in all groups (RA 85%, non-RA persistent disease 71% and resolving 70%). On multi-variate analysis, US-defined digit flexor TS provided independent predictive data over and above the presence of ACPA and US-defined joint synovitis. CONCLUSION US-defined digit flexor TS provided independent predictive data for persistent RA development in patients with early arthritis. The predictive utility of this tendon site should be further assessed in a larger cohort; investigators designing imaging-based predictive algorithms for RA development should include this tendon component as a candidate variable.
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Affiliation(s)
- Ilfita Sahbudin
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Luke Pickup
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Peter Nightingale
- Rheumatology Department, Wolfson Computer Laboratory, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Gina Allen
- Green Templeton College, University of Oxford, Oxford, UK
| | - Zaeem Cader
- Division of Gastroenterology and Hepatology, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Ruchir Singh
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paola de Pablo
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Christopher D Buckley
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - Karim Raza
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK.,MRC-ARUK Centre for Musculoskeletal Ageing Research, University of Birmingham, Birmingham, UK
| | - Andrew Filer
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK.,University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
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Ammitzbøll-Danielsen M, Østergaard M, Naredo E, Iagnocco A, Möller I, D'Agostino MA, Gandjbakhch F, Terslev L. The Use of the OMERACT Ultrasound Tenosynovitis Scoring System in Multicenter Clinical Trials. J Rheumatol 2017; 45:165-169. [PMID: 29247153 DOI: 10.3899/jrheum.170501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To test the sensitivity to change of the Outcome Measures in Rheumatology Clinical Trials (OMERACT) ultrasound (US) scoring system for tenosynovitis when applied in a multicenter design. METHODS RA patients with US-verified tenosynovitis were recruited when scheduled for treatment intensification. Tenosynovitis was assessed at baseline, and 3 and 6 months followup, using the semiquantitative OMERACT scoring system. RESULTS Expressed in median (25th; 75th percentiles), the overall greyscale and Doppler score decreased significantly from baseline at 4 (2; 7) and 3 (2; 6), to 6 months at 2 (0; 3) and 0 (0; 1, p < 0.01), respectively, and showed high responsiveness (standardized response mean ≥ 0.8). CONCLUSION The OMERACT US scoring system for tenosynovitis showed high responsiveness, supporting its use for diagnosing and monitoring tenosynovitis in multicenter trials.
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Affiliation(s)
- Mads Ammitzbøll-Danielsen
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy; Servicio de Reumatología, Instituto Poal de Reumatologia Barcelona, Barcelona, Spain; Department of Rheumatology, AP-HP Ambroise Paré Hospital, Boulogne-Billancourt, Université Versailles Saint Quentin en Yvelines; Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP, Université Paris 6-UPMC, Paris, France. .,M. Ammitzbøll-Danielsen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; E. Naredo, MD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, and Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz; A. Iagnocco, MD, Professor, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino; I. Möller, MD, Servicio de Reumatología, Instituto Poal de Reumatologia; M.A. D'Agostino, MD, PhD, Professor, Department of Rheumatology, AP-HP Ambroise Paré Hospital; F. Gandjbakhch, MD, Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP; L. Terslev, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet.
| | - Mikkel Østergaard
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy; Servicio de Reumatología, Instituto Poal de Reumatologia Barcelona, Barcelona, Spain; Department of Rheumatology, AP-HP Ambroise Paré Hospital, Boulogne-Billancourt, Université Versailles Saint Quentin en Yvelines; Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP, Université Paris 6-UPMC, Paris, France.,M. Ammitzbøll-Danielsen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; E. Naredo, MD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, and Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz; A. Iagnocco, MD, Professor, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino; I. Möller, MD, Servicio de Reumatología, Instituto Poal de Reumatologia; M.A. D'Agostino, MD, PhD, Professor, Department of Rheumatology, AP-HP Ambroise Paré Hospital; F. Gandjbakhch, MD, Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP; L. Terslev, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet
| | - Esperanza Naredo
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy; Servicio de Reumatología, Instituto Poal de Reumatologia Barcelona, Barcelona, Spain; Department of Rheumatology, AP-HP Ambroise Paré Hospital, Boulogne-Billancourt, Université Versailles Saint Quentin en Yvelines; Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP, Université Paris 6-UPMC, Paris, France.,M. Ammitzbøll-Danielsen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; E. Naredo, MD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, and Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz; A. Iagnocco, MD, Professor, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino; I. Möller, MD, Servicio de Reumatología, Instituto Poal de Reumatologia; M.A. D'Agostino, MD, PhD, Professor, Department of Rheumatology, AP-HP Ambroise Paré Hospital; F. Gandjbakhch, MD, Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP; L. Terslev, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet
| | - Annamaria Iagnocco
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy; Servicio de Reumatología, Instituto Poal de Reumatologia Barcelona, Barcelona, Spain; Department of Rheumatology, AP-HP Ambroise Paré Hospital, Boulogne-Billancourt, Université Versailles Saint Quentin en Yvelines; Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP, Université Paris 6-UPMC, Paris, France.,M. Ammitzbøll-Danielsen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; E. Naredo, MD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, and Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz; A. Iagnocco, MD, Professor, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino; I. Möller, MD, Servicio de Reumatología, Instituto Poal de Reumatologia; M.A. D'Agostino, MD, PhD, Professor, Department of Rheumatology, AP-HP Ambroise Paré Hospital; F. Gandjbakhch, MD, Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP; L. Terslev, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet
| | - Ingrid Möller
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy; Servicio de Reumatología, Instituto Poal de Reumatologia Barcelona, Barcelona, Spain; Department of Rheumatology, AP-HP Ambroise Paré Hospital, Boulogne-Billancourt, Université Versailles Saint Quentin en Yvelines; Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP, Université Paris 6-UPMC, Paris, France.,M. Ammitzbøll-Danielsen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; E. Naredo, MD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, and Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz; A. Iagnocco, MD, Professor, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino; I. Möller, MD, Servicio de Reumatología, Instituto Poal de Reumatologia; M.A. D'Agostino, MD, PhD, Professor, Department of Rheumatology, AP-HP Ambroise Paré Hospital; F. Gandjbakhch, MD, Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP; L. Terslev, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet
| | - Maria-Antonietta D'Agostino
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy; Servicio de Reumatología, Instituto Poal de Reumatologia Barcelona, Barcelona, Spain; Department of Rheumatology, AP-HP Ambroise Paré Hospital, Boulogne-Billancourt, Université Versailles Saint Quentin en Yvelines; Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP, Université Paris 6-UPMC, Paris, France.,M. Ammitzbøll-Danielsen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; E. Naredo, MD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, and Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz; A. Iagnocco, MD, Professor, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino; I. Möller, MD, Servicio de Reumatología, Instituto Poal de Reumatologia; M.A. D'Agostino, MD, PhD, Professor, Department of Rheumatology, AP-HP Ambroise Paré Hospital; F. Gandjbakhch, MD, Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP; L. Terslev, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet
| | - Frédérique Gandjbakhch
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy; Servicio de Reumatología, Instituto Poal de Reumatologia Barcelona, Barcelona, Spain; Department of Rheumatology, AP-HP Ambroise Paré Hospital, Boulogne-Billancourt, Université Versailles Saint Quentin en Yvelines; Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP, Université Paris 6-UPMC, Paris, France.,M. Ammitzbøll-Danielsen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; E. Naredo, MD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, and Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz; A. Iagnocco, MD, Professor, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino; I. Möller, MD, Servicio de Reumatología, Instituto Poal de Reumatologia; M.A. D'Agostino, MD, PhD, Professor, Department of Rheumatology, AP-HP Ambroise Paré Hospital; F. Gandjbakhch, MD, Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP; L. Terslev, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet
| | - Lene Terslev
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid; Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy; Servicio de Reumatología, Instituto Poal de Reumatologia Barcelona, Barcelona, Spain; Department of Rheumatology, AP-HP Ambroise Paré Hospital, Boulogne-Billancourt, Université Versailles Saint Quentin en Yvelines; Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP, Université Paris 6-UPMC, Paris, France.,M. Ammitzbøll-Danielsen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and Department of Clinical Medicine, University of Copenhagen; E. Naredo, MD, Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, and Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz; A. Iagnocco, MD, Professor, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino; I. Möller, MD, Servicio de Reumatología, Instituto Poal de Reumatologia; M.A. D'Agostino, MD, PhD, Professor, Department of Rheumatology, AP-HP Ambroise Paré Hospital; F. Gandjbakhch, MD, Department of Rheumatology, Pitie Salpetriere Hospital, AP-HP; L. Terslev, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet
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Chang EY, Chen KC, Huang BK, Kavanaugh A. Adult Inflammatory Arthritides: What the Radiologist Should Know. Radiographics 2017; 36:1849-1870. [PMID: 27726745 DOI: 10.1148/rg.2016160011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Developments and improvements in knowledge are rapid and ongoing in both the radiologic and rheumatologic fields. During the past decade, the roles of imaging and the radiologist in the assessment and management of many inflammatory rheumatologic diseases have undergone several changes. To remain effective in patient care, the radiologist needs to be aware of these changes when recommending and interpreting imaging examinations for the referring physician. The goal of contemporary rheumatoid arthritis (RA) management is to redefine RA as a disease that is no longer characterized by erosions, which reflect established or long-standing untreated disease. Most cases of RA are now diagnosed clinically, but imaging increases diagnostic confidence, is superior to clinical examination for the detection of joint inflammation, and plays an important role in patient management. The concept of the seronegative spondyloarthritides has recently been redefined by the Assessment of SpondyloArthritis International Society (ASAS). This new set of ASAS classification criteria divides the spectrum of spondyloarthritis on the basis of predominantly axial skeletal clinical manifestations or predominantly peripheral skeletal clinical manifestations. For axial spondyloarthritis, magnetic resonance imaging and radiography play crucial roles for classification and diagnosis. For both peripheral spondyloarthritis and psoriatic arthritis, the radiologist can provide important information that influences classification and diagnosis, including documenting radiologic evidence of juxta-articular new bone formation, diagnosing sacroiliitis, or delineating the presence and extent of enthesitis and dactylitis. The radiologist's familiarity with recent classification criteria, in addition to the traditional diagnostic characteristics of the individual inflammatory arthritides, maximizes the productive interface between the radiologist and the rheumatologist. ©RSNA, 2016.
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Affiliation(s)
- Eric Y Chang
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Karen C Chen
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Brady K Huang
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
| | - Arthur Kavanaugh
- From the Radiology Service, VA San Diego Healthcare System, 3350 La Jolla Village Dr, MC 114, San Diego, CA 92161 (E.Y.C., K.C.C.); and the Department of Radiology (E.Y.C., K.C.C., B.K.H.) and Division of Rheumatology, Allergy and Immunology, Department of Medicine (A.K.), University of California, San Diego Medical Center, San Diego, Calif
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Nieuwenhuis WP, van Steenbergen HW, Mangnus L, Newsum EC, Bloem JL, Huizinga TWJ, le Cessie S, Reijnierse M, van der Helm-van Mil AHM. Evaluation of the diagnostic accuracy of hand and foot MRI for early Rheumatoid Arthritis. Rheumatology (Oxford) 2017; 56:1367-1377. [PMID: 28460018 DOI: 10.1093/rheumatology/kex167] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Indexed: 11/14/2022] Open
Abstract
Objectives To assess the diagnostic value of MRI for early RA. In some RA patients, a classifiable diagnosis cannot be made at first presentation; these patients present with unclassified arthritis (UA). The use of MRI for early diagnosis of RA is recommended, yet the evidence for its reliability is limited. Methods MRI of hand and foot was performed in 589 early arthritis patients included in the Leiden Early Arthritis Clinic (229 presented with RA, 159 with other arthritides and 201 with UA). Symptom-free controls provided a reference for defining an abnormal MRI. In preliminary investigations, MRI of patients who presented with RA was compared with MRI of symptom-free controls and of patients with other arthritides. Thereafter, the value of MRI in early RA diagnosis was determined in UA patients using the 1-year follow-up on fulfilling the 1987 RA criteria and start of disease-modifying drugs as outcomes. Results Preliminary investigations were promising. Of the UA patients, 14% developed RA and 37% started disease-modifying treatment. MRI-detected tenosynovitis was associated with RA development independent of other types of MRI-detected inflammation [odds ratio (OR) = 7.5, 95% CI: 2.4, 23] and also independent of age and other inflammatory measures (swollen joints, CRP) (OR = 4.2, 95% CI: 1.4, 12.9). Within UA patients, the negative predictive value of abnormal tenosynovitis was 95% (95% CI: 89%, 98%) and the positive predictive value 25% (95% CI: 17%, 35%). The performance was best in the subgroup of UA patients presenting with oligoarthritis (18% developed RA): the positive predictive value was 36% (95% CI: 23%, 52%), the negative predictive value was 98% (95% CI: 88%, 100%), the sensitivity was 93% (95% CI: 70%, 99%) and the specificity was 63% (95% CI: 51%, 74%). Conclusion MRI contributes to the identification of UA patients who will develop RA, mostly in UA patients presenting with oligoarthritis.
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Affiliation(s)
| | | | | | | | | | | | - Saskia le Cessie
- Department of Clinical Epidemiology.,Department of Medical Statistics, Leiden University Medical Center, Leiden, The Netherlands
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Woodworth TG, Morgacheva O, Pimienta OL, Troum OM, Ranganath VK, Furst DE. Examining the validity of the rheumatoid arthritis magnetic resonance imaging score according to the OMERACT filter-a systematic literature review. Rheumatology (Oxford) 2017; 56:1177-1188. [PMID: 28398508 PMCID: PMC5850856 DOI: 10.1093/rheumatology/kew445] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 11/01/2016] [Indexed: 02/05/2023] Open
Abstract
Objective To examine whether the RA MRI score (RAMRIS) for RA of the wrist/hand meets the OMERACT filter criteria-truth (validity), discrimination and feasibility. Methods We conducted a systematic literature review in PubMed and Scopus, from 1970 through June 2014, focused on MRI measures of synovitis, osteitis/bone marrow oedema, erosions and/or joint space narrowing in RA randomized controlled trials and observational studies with cohort size ⩾10. Strength of evidence was assessed using the Cochrane Handbook criteria. Results Of 634 MRI titles/abstracts, 202 met the review criteria, with 92 providing at least 1 type of validity. Four articles provided criterion validity, and 26 articles utilized RAMRIS to assess 1.5 T MRI images. Histopathology data showed inflammation corresponding to MRI of synovitis and osteitis. MRI erosions corresponded to those identified with CT. Content and construct validity for RAMRIS synovitis, osteitis and erosions were documented by correlations with clinical, laboratory and/or radiographic data. Each measure was sensitive to change and responsive to therapy. RAMRIS synovitis and osteitis were able to discriminate between the efficacy of treatments vs placebo in 12-week studies, whereas RAMRIS erosions required studies of ⩾24 weeks. Conclusion RAMRIS synovitis, osteitis and erosions imaged with 1.5 T MRI are valid and useful for evaluating joint inflammation and damage for RA of the wrist/hand, according to the OMERACT filter.
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Affiliation(s)
- Thasia G. Woodworth
- Department of Medicine, Division of Rheumatology, David Geffen School of
Medicine, UCLA, Los Angeles
| | - Olga Morgacheva
- Department of Medicine, Division of Rheumatology, David Geffen School of
Medicine, UCLA, Los Angeles
| | - Olga L. Pimienta
- Keck School of Medicine, University of Southern California, Santa Monica,
CA, USA
| | - Orrin M. Troum
- Keck School of Medicine, University of Southern California, Santa Monica,
CA, USA
| | - Veena K. Ranganath
- Department of Medicine, Division of Rheumatology, David Geffen School of
Medicine, UCLA, Los Angeles
| | - Daniel E. Furst
- Department of Medicine, Division of Rheumatology, David Geffen School of
Medicine, UCLA, Los Angeles
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Ramrattan LA, Kaeley GS. Sonographic Characteristics of Extensor Tendon Abnormalities and Relationship With Joint Disease Activity in Rheumatoid Arthritis: A Pilot Study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:985-992. [PMID: 28258622 DOI: 10.7863/ultra.16.05024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 07/29/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To characterize abnormalities in the dorsal extensor tendons of the hand and determine the importance of these findings in rheumatoid arthritis. METHODS A retrospective cross-sectional study was done on 26 patients with rheumatoid arthritis who had sonography of their hands. B-mode and power Doppler joint activity were scored, and the extensor tendons were examined for B-mode changes and power Doppler signals. B-mode changes included anechoic fluid around tendons, hypoechoic tissue around tendons, paratendon tissue and tendon thickening, as well as vascularity around the tendon, for which peritendon power Doppler signals were recorded. RESULTS Forty-one hands and 205 joints were reviewed. Anechoic fluid around the tendons and peritendon power Doppler signals were observed in 41% and 39%, respectively; 44% and 28% of patients had B-mode and power Doppler scores in the upper tertile, respectively. For both B-mode and power Doppler scores, 3 categories or tertiles were created, 0 to 0.9, 1 to 1.9, and 2 to 3. We reported the percentage of patients with power Doppler and B-mode scores in this category. The severity of synovitis was associated with anechoic fluid around the tendons and peritendon power Doppler signals according to the Cochran-Mantel-Haenszel test. The common odds ratio was 3.52 (95% confidence interval, 1.45- 8.53) for anechoic fluid around the tendons and severe synovitis. The common odds ratio was 2.52 (95% confidence interval, 1.13-5.63) for peritendon power Doppler signals and severe synovitis. CONCLUSIONS Findings at the dorsal extensor tendons were anechoic fluid around tendons, hypoechoic tissue around tendons, peritendon power Doppler signals, and tendon thickening. Patients with anechoic fluid and power Doppler signals were found to have more severe disease activity at the joints based on B-mode and power Doppler scores.
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Glinatsi D, Bird P, Gandjbakhch F, Haavardsholm EA, Peterfy CG, Vital EM, Emery P, Conaghan PG, Østergaard M. Development and Validation of the OMERACT Rheumatoid Arthritis Magnetic Resonance Tenosynovitis Scoring System in a Multireader Exercise. J Rheumatol 2017; 44:1688-1693. [PMID: 28461643 DOI: 10.3899/jrheum.161097] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2017] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To develop and validate a magnetic resonance imaging (MRI) tenosynovitis (TS) score for tendons at the wrist and metacarpophalangeal (MCP) joint levels in patients with rheumatoid arthritis (RA). METHODS Axial T1-weighted precontrast and postcontrast fat-saturated MR image sets of the hands of 43 patients with RA initiating rituximab therapy were obtained at baseline and after 14, 26, 38, or 52 weeks. The MR images were scored twice by 4 readers. Nine tendon compartments of the wrist and 4 flexor tendon compartments at the MCP joints were assessed. Tenosynovitis was scored as follows: 0: No; 1: < 1.5 mm; 2: ≥ 1.5 mm but < 3 mm; 3: ≥ 3 mm peritendinous effusion and/or postcontrast enhancement. Intrareader and interreader intraclass correlation coefficients (ICC), smallest detectable change (SDC), percentage of exact and close agreement (PEA/PCA), and standardized response mean (SRM) were calculated. RESULTS Intrareader and interreader ICC for status and change scores were very good (≥ 0.80) for total scores for all readers. Intrareader SDC was ≤ 3.0 and interreader SDC was < 2.0. The overall PEA/PCA intrareader and interreader agreements for change scores in all tendons were 73.8%/97.6% and 47.9%/85.0%, respectively. Average SRM was moderate for total scores and 60.5% of the patients had a tenosynovitis change score ≥ SDC. CONCLUSION The TS score showed high intrareader and interreader agreement for wrist and finger tendons, with moderate responsiveness, and the majority of the patients showed a change above the SDC. This scoring system may be included as a component of the RAMRIS.
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Affiliation(s)
- Daniel Glinatsi
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit; Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences Inc., Boca Raton, Florida, USA. .,D. Glinatsi, MD, research fellow, COPECARE, Center for Rheumatology and Spine Diseases; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; E.M. Vital, MRCP, PhD, Associate Professor and Honorary Consultant, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen.
| | - Paul Bird
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit; Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences Inc., Boca Raton, Florida, USA.,D. Glinatsi, MD, research fellow, COPECARE, Center for Rheumatology and Spine Diseases; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; E.M. Vital, MRCP, PhD, Associate Professor and Honorary Consultant, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen
| | - Frédérique Gandjbakhch
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit; Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences Inc., Boca Raton, Florida, USA.,D. Glinatsi, MD, research fellow, COPECARE, Center for Rheumatology and Spine Diseases; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; E.M. Vital, MRCP, PhD, Associate Professor and Honorary Consultant, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen
| | - Espen A Haavardsholm
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit; Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences Inc., Boca Raton, Florida, USA.,D. Glinatsi, MD, research fellow, COPECARE, Center for Rheumatology and Spine Diseases; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; E.M. Vital, MRCP, PhD, Associate Professor and Honorary Consultant, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen
| | - Charles G Peterfy
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit; Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences Inc., Boca Raton, Florida, USA.,D. Glinatsi, MD, research fellow, COPECARE, Center for Rheumatology and Spine Diseases; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; E.M. Vital, MRCP, PhD, Associate Professor and Honorary Consultant, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen
| | - Edward M Vital
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit; Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences Inc., Boca Raton, Florida, USA.,D. Glinatsi, MD, research fellow, COPECARE, Center for Rheumatology and Spine Diseases; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; E.M. Vital, MRCP, PhD, Associate Professor and Honorary Consultant, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen
| | - Paul Emery
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit; Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences Inc., Boca Raton, Florida, USA.,D. Glinatsi, MD, research fellow, COPECARE, Center for Rheumatology and Spine Diseases; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; E.M. Vital, MRCP, PhD, Associate Professor and Honorary Consultant, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen
| | - Philip G Conaghan
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit; Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences Inc., Boca Raton, Florida, USA.,D. Glinatsi, MD, research fellow, COPECARE, Center for Rheumatology and Spine Diseases; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; E.M. Vital, MRCP, PhD, Associate Professor and Honorary Consultant, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen
| | - Mikkel Østergaard
- From the Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit; Leeds Teaching Hospitals National Health Service (NHS) Trust, Leeds, UK; University of New South Wales (NSW), Sydney, Australia; Hôpital Pitié-Salpétrière, APHP, Université Paris VI, Paris, France; Diakonhjemmet Hospital, Oslo, Norway; Spire Sciences Inc., Boca Raton, Florida, USA.,D. Glinatsi, MD, research fellow, COPECARE, Center for Rheumatology and Spine Diseases; P. Bird, BMed (Hons), FRACP, PhD, Grad Dip MRI, Associate Professor, University of NSW; F. Gandjbakhch, MD, Practicing Rheumatologist, Hôpital Pitié-Salpétrière, APHP, Université Paris VI; E.A. Haavardsholm, MD, PhD, Postdoctoral Researcher, Department of Rheumatology, Diakonhjemmet Hospital; C.G. Peterfy, MD, PhD, FRCP, Chief Executive Officer, Spire Sciences Inc.; E.M. Vital, MRCP, PhD, Associate Professor and Honorary Consultant, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P. Emery, MA, MD, FRCP, ARC Professor in Rheumatology, Leeds Institute for Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; P.G. Conaghan, MB, BS, PhD, FRACP, FRCP, Professor of Musculoskeletal Medicine, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Musculoskeletal Biomedical Research Unit; M. Østergaard, MD, PhD, DMSc, Professor, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet, and the Department of Clinical Medicine, University of Copenhagen
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Takase-Minegishi K, Horita N, Kobayashi K, Yoshimi R, Kirino Y, Ohno S, Kaneko T, Nakajima H, Wakefield RJ, Emery P. Diagnostic test accuracy of ultrasound for synovitis in rheumatoid arthritis: systematic review and meta-analysis. Rheumatology (Oxford) 2017; 57:49-58. [DOI: 10.1093/rheumatology/kex036] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Indexed: 11/14/2022] Open
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Ammitzbøll-Danielsen M, Østergaard M, Naredo E, Terslev L. Validity and sensitivity to change of the semi-quantitative OMERACT ultrasound scoring system for tenosynovitis in patients with rheumatoid arthritis. Rheumatology (Oxford) 2016; 55:2156-2166. [PMID: 27616145 DOI: 10.1093/rheumatology/kew317] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 07/22/2016] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES The aim was to evaluate the metric properties of the semi-quantitative OMERACT US scoring system vs a novel quantitative US scoring system for tenosynovitis, by testing its intra- and inter-reader reliability, sensitivity to change and comparison with clinical tenosynovitis scoring in a 6-month follow-up study. METHODS US and clinical assessments of the tendon sheaths of the clinically most affected hand and foot were performed at baseline, 3 and 6 months in 51 patients with RA. Tenosynovitis was assessed using the semi-quantitative scoring system (0-3) proposed by the OMERACT US group and a new quantitative US evaluation (0-100). A sum for US grey scale (GS), colour Doppler (CD) and pixel index (PI), respectively, was calculated for each patient. In 20 patients, intra- and inter-observer agreement was established between two independent investigators. A binary clinical tenosynovitis score was performed, calculating a sum score per patient. RESULTS The intra- and inter-observer agreements for US tenosynovitis assessments were very good at baseline and for change for GS and CD, but less good for PI. The smallest detectable change was 0.97 for GS, 0.93 for CD and 30.1 for PI. The sensitivity to change from month 0 to 6 was high for GS and CD, and slightly higher than for clinical tenosynovitis score and PI. CONCLUSION This study demonstrated an excellent intra- and inter-reader agreement between two investigators for the OMERACT US scoring system for tenosynovitis and a high ability to detect changes over time. Quantitative assessment by PI did not add further information.
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Affiliation(s)
- Mads Ammitzbøll-Danielsen
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Esperanza Naredo
- Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid, Spain
| | - Lene Terslev
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup
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Bellis E, Scirè CA, Carrara G, Adinolfi A, Batticciotto A, Bortoluzzi A, Cagnotto G, Caprioli M, Canzoni M, Cavatorta FP, De Lucia O, Di Sabatino V, Draghessi A, Filippou G, Farina I, Focherini MC, Gabba A, Gutierrez M, Idolazzi L, Luccioli F, Macchioni P, Massarotti MS, Mastaglio C, Menza L, Muratore M, Parisi S, Picerno V, Piga M, Ramonda R, Raffeiner B, Rossi D, Rossi S, Rossini P, Sakellariou G, Scioscia C, Venditti C, Volpe A, Matucci-Cerinic M, Iagnocco A. Ultrasound-detected tenosynovitis independently associates with patient-reported flare in patients with rheumatoid arthritis in clinical remission: results from the observational study STARTER of the Italian Society for Rheumatology. Rheumatology (Oxford) 2016; 55:1826-36. [PMID: 27354688 DOI: 10.1093/rheumatology/kew258] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES This study aimed to estimate the prevalence of US-detected tenosynovitis in RA patients in clinical remission and to explore its clinical correlates. METHODS A total of 427 RA patients in clinical remission were consecutively enrolled from 25 Italian rheumatology centres. Tenosynovitis and synovitis were scored by US grey scale (GS) and power Doppler (PD) semi-quantitative scoring systems at wrist and hand joints. Complete clinical assessment was performed by rheumatologists blinded to the US results. A flare questionnaire was used to assess unstable remission (primary outcome), HAQ for functional disability and radiographic erosions for damage (secondary outcomes). Cross-sectional relationships between the presence of each US finding and outcome variables are presented as odds ratios (ORs) and 95% CIs, both crude and adjusted for pre-specified confounders. RESULTS The prevalence of tenosynovitis in clinical remission was 52.5% (95% CI 0.48, 0.57) for GS and 22.7% (95% CI 0.19, 0.27) for PD, while the prevalence of synovitis was 71.6% (95% CI 0.67, 0.76) for GS and 42% (95% CI 0.37, 0.47) for PD. Among clinical correlates, PD tenosynovitis associated with lower remission duration and morning stiffness while PD synovitis did not. Only PD tenosynovitis showed a significant association with the flare questionnaire [OR 1.95 (95% CI 1.17, 3.26)]. No cross-sectional associations were found with the HAQ. The presence of radiographic erosions associated with GS and PD synovitis but not with tenosynovitis. CONCLUSIONS US-detected tenosynovitis is a frequent finding in RA patients in clinical remission and associates with unstable remission.
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Affiliation(s)
| | | | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan
| | - Antonella Adinolfi
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena
| | | | | | - Giovanni Cagnotto
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo
| | - Marta Caprioli
- Medicine Department, Istituti Clinici di Pavia e Vigevano, Pavia
| | | | | | - Orazio De Lucia
- Division and Chair of Rheumatology, Gaetano Pini Orthopaedic Institute, Milan
| | - Valentina Di Sabatino
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena
| | - Antonella Draghessi
- Rheumatology Department, Clinica Reumatologica, Università Policlinica delle Marche, Jesi
| | - Georgios Filippou
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena
| | - Ilaria Farina
- Rheumatology Department, S. Anna di Cona University Hospital, Ferrara
| | | | - Alessandra Gabba
- Rheumatology Unit, A.O.U. University Clinic Cagliari, Monserrato
| | - Marwin Gutierrez
- Rheumatology Department, Clinica Reumatologica, Università Policlinica delle Marche, Jesi
| | | | | | | | | | | | - Luana Menza
- Rheumatology Unit, Moriggia-Pelascini Hospital, Gravedona
| | | | - Simone Parisi
- SC Reumatologia, A.O.U. Città della Salute e della Scienza di Torino, Turin
| | - Valentina Picerno
- Department of Medicine, Surgery and Neurosciences, Rheumatology Section, University of Siena, Siena
| | - Matteo Piga
- Rheumatology Unit, A.O.U. University Clinic Cagliari, Monserrato
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine, DIMED, University of Padova, Padova
| | | | | | - Silvia Rossi
- Division of Rheumatology, University of Pavia, IRCCS Policlinico San Matteo
| | - Paola Rossini
- Rheumatology Unit, P.O. Destra Secchia, Pieve di Coriano
| | | | | | | | | | | | - Annamaria Iagnocco
- Rheumatology Unit, Dipartimento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy
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Janta I, Morán J, Naredo E, Nieto JC, Uson J, Möller I, Bong D, Bruyn GAW, D Agostino MA, Filippucci E, Hammer HB, Iagnocco A, Terslev L, González JM, Mérida JR, Carreño L. How does a cadaver model work for testing ultrasound diagnostic capability for rheumatic-like tendon damage? Rheumatol Int 2016; 36:863-9. [PMID: 26995000 DOI: 10.1007/s00296-016-3460-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 03/07/2016] [Indexed: 12/28/2022]
Abstract
To establish whether a cadaver model can serve as an effective surrogate for the detection of tendon damage characteristic of rheumatoid arthritis (RA). In addition, we evaluated intraobserver and interobserver agreement in the grading of RA-like tendon tears shown by US, as well as the concordance between the US findings and the surgically induced lesions in the cadaver model. RA-like tendon damage was surgically induced in the tibialis anterior tendon (TAT) and tibialis posterior tendon (TPT) of ten ankle/foot fresh-frozen cadaveric specimens. Of the 20 tendons examined, six were randomly assigned a surgically induced partial tear; six a complete tear; and eight left undamaged. Three rheumatologists, experts in musculoskeletal US, assessed from 1 to 5 the quality of US imaging of the cadaveric models on a Likert scale. Tendons were then categorized as having either no damage, (0); partial tear, (1); or complete tear (2). All 20 tendons were blindly and independently evaluated twice, over two rounds, by each of the three observers. Overall, technical performance was satisfactory for all items in the two rounds (all values over 2.9 in a Likert scale 1-5). Intraobserver and interobserver agreement for US grading of tendon damage was good (mean κ values 0.62 and 0.71, respectively), with greater reliability found in the TAT than the TPT. Concordance between US findings and experimental tendon lesions was acceptable (70-100 %), again greater for the TAT than for the TPT. A cadaver model with surgically created tendon damage can be useful in evaluating US metric properties of RA tendon lesions.
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Affiliation(s)
- Iustina Janta
- Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Doctor Esquerdo 46, 28007, Madrid, Spain.
| | - Julio Morán
- Department of Traumatology and Orthopaedic Surgery, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Juan Carlos Nieto
- Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Doctor Esquerdo 46, 28007, Madrid, Spain
| | - Jacqueline Uson
- Department of Rheumatology, Hospital Universitario de Móstoles, Madrid, Spain
| | - Ingrid Möller
- Department of Rheumatology, Instituto Poal, Barcelona, Spain
| | - David Bong
- Department of Rheumatology, Instituto Poal, Barcelona, Spain
| | | | - Maria Antonietta D Agostino
- Department of Rheumatology, Hôpital Ambroise Paré, APHP, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Boulogne-Billancourt, France
| | - Emilio Filippucci
- Department of Rheumatology, Clinica Reumatologica, Universitá Politecnica delle Marche, Jesi, Ancona, Italy
| | | | | | - Lene Terslev
- Department of Rheumatology, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Copenhagen, Denmark
| | - Jorge Murillo González
- Department of Human Anatomy and Embryology, Faculty of Medicine, Universidad Complutense, Madrid, Spain
| | - José Ramón Mérida
- Department of Human Anatomy and Embryology, Faculty of Medicine, Universidad Complutense, Madrid, Spain
| | - Luis Carreño
- Department of Rheumatology, Faculty of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Doctor Esquerdo 46, 28007, Madrid, Spain
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Ultrasound-detected activity in rheumatoid arthritis on methotrexate therapy: Which joints and tendons should be assessed to predict unstable remission? Rheumatol Int 2015; 36:387-96. [DOI: 10.1007/s00296-015-3409-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 12/12/2015] [Indexed: 10/22/2022]
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Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol 2015; 11:1131-46. [DOI: 10.1586/1744666x.2015.1075395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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45
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Mathew AJ, Bird P. Utility of in-office extremity magnetic resonance imaging in rheumatology. INDIAN JOURNAL OF RHEUMATOLOGY 2015. [DOI: 10.1016/j.injr.2015.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Nieuwenhuis WP, Krabben A, Stomp W, Huizinga TWJ, van der Heijde D, Bloem JL, van der Helm-van Mil AHM, Reijnierse M. Evaluation of Magnetic Resonance Imaging-Detected Tenosynovitis in the Hand and Wrist in Early Arthritis. Arthritis Rheumatol 2015; 67:869-76. [DOI: 10.1002/art.39000] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 12/11/2014] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Wouter Stomp
- Leiden University Medical Center; Leiden The Netherlands
| | | | | | - Johan L. Bloem
- Leiden University Medical Center; Leiden The Netherlands
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Aiming for a simpler early arthritis MRI protocol: can Gd contrast administration be eliminated? Eur Radiol 2015; 25:1520-7. [PMID: 25636414 DOI: 10.1007/s00330-014-3522-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 09/28/2014] [Accepted: 11/18/2014] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate whether intravenous gadolinium (Gd) contrast administration can be eliminated when evaluating synovitis and tenosynovitis in early arthritis patients, thereby decreasing imaging time, cost, and invasiveness. MATERIALS AND METHODS Wrist MRIs of 93 early arthritis patients were evaluated by two readers for synovitis of the radioulnar, radiocarpal, and intercarpal joints, according to the Rheumatoid Arthritis MRI Scoring method (RAMRIS), and for tenosynovitis in ten compartments. Scores of MRI images without Gd contrast enhancement were compared to scores obtained when evaluating all, including contrast-enhanced, MRI images as reference. Subsequently, a literature review and pooled analysis of data from the present and two previous studies were performed. RESULTS At the individual joint/tendon level, sensitivity to detect synovitis without Gd contrast was 91 % and 72 % for the two readers, respectively, with a specificity of 51 % and 81 %. For tenosynovitis, the sensitivity was 67 % and 54 %, respectively, with a specificity of 87 % and 91 %. Pooled data analysis revealed an overall sensitivity of 81 % and specificity of 50 % for evaluation of synovitis. Variations in tenosynovitis scoring systems hindered pooled analyses. CONCLUSION Eliminating Gd contrast administration resulted in low specificity for synovitis and low sensitivity for tenosynovitis, indicating that Gd contrast administration remains essential for an optimal assessment. KEY POINTS • Eliminating gadolinium contrast administration results in low specificity for synovitis • For tenosynovitis, sensitivity is low without gadolinium contrast administration • Gadolinium contrast administration remains essential for evaluating synovitis and tenosynovitis in early arthritis.
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Lee CH, Tandon A. Focal hand lesions: review and radiological approach. Insights Imaging 2014; 5:301-19. [PMID: 24838840 PMCID: PMC4035494 DOI: 10.1007/s13244-014-0334-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 04/09/2014] [Accepted: 04/15/2014] [Indexed: 12/12/2022] Open
Abstract
Focal hand lesions are commonly encountered in clinical practice and are often benign. Magnetic resonance (MR) imaging is the imaging modality of choice in evaluating these lesions as it can accurately determine the nature of the lesion, enhancement pattern and exact location in relation to surrounding tissues. However, while MR features of various soft tissue lesions in the hand have been well described, it is often still difficult to differentiate between benign and malignant lesions. We review the MR imaging features of a variety of focal hand lesions presenting at our institution and propose a classification into "benign", "intermediate grade" (histologically benign but locally aggressive with potential for recurrence) and frankly "malignant" lesions based on MR findings. This aims to narrow down differential diagnoses and helps in further management of the lesion, preoperative planning and, in cases of primary malignancy, local staging. Teaching Points • Hand lesions are often benign and MR is essential as part of the workup. • MR features of various hand lesions are well described but are often non-specific. • Certain MR features may help for the diagnosis but histological examination is usually required. • We aim to classify hand lesions based on MR features such as margin, enhancement and bony involvement. • Classifying these lesions can help narrow down differential diagnoses and aid management.
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Affiliation(s)
- Chau Hung Lee
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
| | - Ankit Tandon
- Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433 Singapore
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Suzuki T, Ishihara K. Achilles paratendonitis as the initial manifestation of rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-010-0369-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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50
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Werner SG, Langer HE, Schott P, Bahner M, Schwenke C, Lind-Albrecht G, Spiecker F, Kurtz B, Burmester GR, Backhaus M. Indocyanine Green-Enhanced Fluorescence Optical Imaging in Patients With Early and Very Early Arthritis: A Comparative Study With Magnetic Resonance Imaging. ACTA ACUST UNITED AC 2013; 65:3036-44. [DOI: 10.1002/art.38175] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Accepted: 08/22/2013] [Indexed: 01/18/2023]
Affiliation(s)
- Stephanie G. Werner
- Charité University Medicine Berlin; Berlin Germany
- RHIO Center Dusseldorf and RHIO Research Institute; Dusseldorf Germany
| | | | - Peter Schott
- Evangelisches Krankenhaus Dusseldorf; Dusseldorf Germany
| | | | | | | | | | - Bernward Kurtz
- Evangelisches Krankenhaus Dusseldorf; Dusseldorf Germany
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