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Tanturri de Horatio L, Shelmerdine SC, d'Angelo P, Di Paolo PL, Magni-Manzoni S, Malattia C, Damasio MB, Tomà P, Avenarius D, Rosendahl K. A novel magnetic resonance imaging scoring system for active and chronic changes in children and adolescents with juvenile idiopathic arthritis of the hip. Pediatr Radiol 2023; 53:426-437. [PMID: 36149477 PMCID: PMC9968695 DOI: 10.1007/s00247-022-05502-8] [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: 04/27/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Hip involvement predicts severe disease in juvenile idiopathic arthritis (JIA) and is accurately assessed by MRI. However, a child-specific hip MRI scoring system has not been validated. OBJECTIVE To test the intra- and interobserver agreement of several MRI markers for active and chronic hip changes in children and young adults with JIA and to examine the precision of measurements commonly used for the assessment of growth abnormalities. MATERIALS AND METHODS Hip MRIs from 60 consecutive children, adolescents and young adults with JIA were scored independently by two sets of radiologists. One set scored the same MRIs twice. Features of active and chronic changes, growth abnormalities and secondary post-inflammatory changes were scored. We used kappa statistics to analyze inter- and intraobserver agreement for categorical variables and a Bland-Altman approach to test the precision of continuous variables. RESULTS Among active changes, there was good intra- and interobserver agreement for grading overall inflammation (kappa 0.6-0.7). Synovial enhancement showed a good intraobserver agreement (kappa 0.7-0.8), while the interobserver agreement was moderate (kappa 0.4-0.5). Regarding acetabular erosions on a 0-3 scale, the intraobserver agreement was 0.6 for the right hip and 0.7 for the left hip, while the interobserver agreement was 0.6 for both hips. Measurements of joint space width, caput-collum-diaphyseal angle, femoral neck-head length, femoral width and trochanteric distance were imprecise. CONCLUSION We identified a set of MRI markers for active and chronic changes in JIA and suggest that the more robust markers be included in future studies addressing clinical validity and long-term patient outcomes.
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Affiliation(s)
- Laura Tanturri de Horatio
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy.
- Department of Clinical Medicine, the Artic University of Norway, Tromsø, Norway.
| | - Susan C Shelmerdine
- Department of Clinical Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, UK
- Great Ormond Street Hospital for Children, UCL Great Ormond Street Institute of Child Health, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, Bloomsbury, London, UK
- Department of Radiology, St. George's Hospital, London, UK
| | - Paola d'Angelo
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | - Pier Luigi Di Paolo
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | | | - Clara Malattia
- Clinica Pediatrica E Reumatologia, IRCCS Istituto Giannina Gaslini, Genoa, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genoa, Genoa, Italy
| | | | - Paolo Tomà
- Department of Imaging, IRCCS Bambino Gesù Children's Hospital, Piazza Di Sant'Onofrio 4, 00165, Rome, Italy
| | - Derk Avenarius
- Department of Clinical Medicine, the Artic University of Norway, Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
| | - Karen Rosendahl
- Department of Clinical Medicine, the Artic University of Norway, Tromsø, Norway
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
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van Dijkhuizen EP, Vanoni F, Magnano GM, Magnaguagno F, Rosendahl K, van Rossum MA, Martini A, Malattia C. Effect of the Inclusion of the Metacarpophalangeal Joints on the Wrist Magnetic Resonance Imaging Scoring System in Juvenile Idiopathic Arthritis. J Rheumatol 2018; 45:1581-1587. [DOI: 10.3899/jrheum.171246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2018] [Indexed: 12/27/2022]
Abstract
Objective.To extend the magnetic resonance imaging (MRI) score for assessment of wrist synovitis in juvenile idiopathic arthritis (JIA) by inclusion of the metacarpophalangeal (MCP) joints, and to compare the metric properties of the original and the extended score.Methods.Wrist MRI of 70 patients with JIA were scored by 3 independent readers according to (1) the wrist component of the rheumatoid arthritis MRI synovitis score (comprising distal radioulnar, radiocarpal, and combined midcarpal and carpometacarpal joints); and (2) an extended score including the MCP joints. Thirty-eight patients had a 1-year MRI followup. The concordance between the readers [intraclass correlation coefficient (ICC), 95% limits of agreement (LOA), and weighted Cohen’s κ], correlations with clinical variables (Spearman’s ϱ), and the sensitivity to change [standardized response mean (SRM)] were calculated for both scores.Results.The interreader agreement was moderate for the original score (ICC 0.77; 95% CI 0.68–0.84) and good for the extended score (ICC 0.86; 95% CI 0.80–0.91). Using 95% LOA, the aggregate score variability was less favorable with relatively wide LOA. Weighted Cohen’s κ of the individual joints indicated good agreement for the original score and good to excellent agreement for the extended score. Correlations with clinical variables reflecting disease activity improved for the extended score and its SRM was higher compared to that of the original score.Conclusion.The extended score showed better reliability, construct validity, and sensitivity to change than the original. Inclusion of the MCP joints should be considered for a more accurate assessment of disease activity and treatment efficacy in JIA.
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Recommendations for the use of ultrasound and magnetic resonance in patients with rheumatoid arthritis. ACTA ACUST UNITED AC 2016; 14:9-19. [PMID: 28029551 DOI: 10.1016/j.reuma.2016.08.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 08/10/2016] [Accepted: 08/13/2016] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To develop evidence-based recommendations on the use of ultrasound (US) and magnetic resonance imaging (MRI) in patients with rheumatoid arthritis (RA). METHODS Recommendations were generated following a nominal group technique. A panel of experts, consisting of 15 rheumatologists and 3 radiologists, was established in the first panel meeting to define the scope and purpose of the consensus document, as well as chapters, potential recommendations and systematic literature reviews (we used and updated those from previous EULAR documents). A first draft of recommendations and text was generated. Then, an electronic Delphi process (2 rounds) was carried out. Recommendations were voted from 1 (total disagreement) to 10 (total agreement). We defined agreement if at least 70% of experts voted ≥7. The level of evidence and grade or recommendation was assessed using the Oxford Centre for Evidence-based Medicine Levels of Evidence. The full text was circulated and reviewed by the panel. The consensus was coordinated by an expert methodologist. RESULTS A total of 20 recommendations were proposed. They include the validity of US and MRI regarding inflammation and damage detection, diagnosis, prediction (structural damage progression, flare, treatment response, etc.), monitoring and the use of US guided injections/biopsies. CONCLUSIONS These recommendations will help clinicians use US and MRI in RA patients.
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Dynamic contrast enhanced MRI of wrist as a useful diagnostic tool in early rheumatoid arthritis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2014. [DOI: 10.1016/j.ejrnm.2014.03.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Ogishima H, Tsuboi H, Umeda N, Horikoshi M, Kondo Y, Sugihara M, Suzuki T, Matsumoto I, Sumida T. Analysis of subclinical synovitis detected by ultrasonography and low-field magnetic resonance imaging in patients with rheumatoid arthritis. Mod Rheumatol 2014; 24:60-8. [PMID: 24261760 DOI: 10.3109/14397595.2013.854050] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To assess the utilities of ultrasonography (US) and low-field magnetic resonance imaging (compacTscan, cMRI) in the diagnosis of subclinical synovitis of hand joints of patients with rheumatoid arthritis (RA). METHODS A total of 1,540 joints of 77 RA patients were examined clinically, using US, using cMRI, and the baseline X-ray examination was performed. Clinical synovitis was defined as joint tenderness or swelling. Subclinical synovitis was diagnosed by US and by cMRI. The incidence of bone erosion and joint space narrowing was assessed by X-ray examination performed at approximately 40 weeks of follow-up. RESULTS Of the hand joints examined, 294 (19.1 %) were diagnosed with clinical synovitis, and 218 joints (14.1 %) were diagnosed with subclinical synovitis. The remaining 1,028 joints (66.8 %) were synovitis-free on clinical examination and imaging. For the diagnosis of subclinical synovitis, cMRI (11.4 %) was significantly more sensitive than power Doppler signals detected by US (US-PD; 6.8 %) (P < 0.01), and the combination of US-PD and cMRI was more useful (14.1 %) than US-PD or cMRI alone (P < 0.05). Follow-up X-ray examination of 600 joints showed a significantly higher incidence of bone erosion in joints with subclinical synovitis than in synovitis-free joints (P < 0.05). CONCLUSION US-PD and cMRI are useful for detecting subclinical synovitis in patients with RA. Subclinical synovitis of the small joints of the hand can progress to bone destruction.
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Affiliation(s)
- Hiroshi Ogishima
- Department of Internal Medicine, University of Tsukuba , 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575 , Japan
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Ball EMA, Tan AL, Fukuba E, McGonagle D, Grey A, Steiner G, Bell AL, Rooney MR. A study of erosive phenotypes in lupus arthritis using magnetic resonance imaging and anti-citrullinated protein antibody, anti-RA33 and RF autoantibody status. Rheumatology (Oxford) 2014; 53:1835-43. [PMID: 24850876 DOI: 10.1093/rheumatology/keu215] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVES The aims of this study were to investigate the extent of MRI-determined joint disease (erosion and synovitis) in SLE and to link this to autoantibody profiles known to be relevant to SLE, including ACPA, RF and anti-RA33 antibodies. METHODS Contrast-enhanced MRI of the hand and wrist was performed in 34 symptomatic SLE patients and in 15 RA patients with similar disease duration. Images were scored by two observers using the OMERACT rheumatoid arthritis MRI scoring (RAMRIS) system. Findings were correlated with clinical examination and autoantibody status. RESULTS Erosions were present at the wrist in 93% of SLE patients and at the MCP joints in 61% of SLE patients. Despite the high prevalence of MRI-determined erosion, only 8.8% of SLE patients were ACPA positive, although these patients had a higher burden of erosive disease. There was no positive correlation with anti-RA33 titres and erosion scores in the SLE patients, but there was a negative correlation with anti-RA33 titres and total bone oedema scores in the SLE patients. Ninety-three per cent of SLE patients had at least grade 1 synovitis at one or more MCP joints, and wrist joint synovitis was present in all the SLE patients. CONCLUSION An MRI-determined joint erosive phenotype is common in SLE, even in ACPA-negative cases. The conventional radiographic observation that anti-RA33 is not positively associated with erosion in patients with RA was also found to be the case in SLE patients.
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Affiliation(s)
- Elisabeth M A Ball
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK. Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
| | - Ai Lyn Tan
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Eiji Fukuba
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Dennis McGonagle
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Arthur Grey
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Günter Steiner
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Aubrey L Bell
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
| | - Madeleine R Rooney
- Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK
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Sofka CM. Tracking rheumatic disease through imaging. Rheum Dis Clin North Am 2013; 39:633-44. [PMID: 23719079 DOI: 10.1016/j.rdc.2013.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This review recounts the historical, current, and future involvement of radiology and imaging in the diagnosis, management, and follow-up of patients with various rheumatic conditions. Radiographs are the mainstay of imaging patients with rheumatic conditions, although magnetic resonance imaging and ultrasonography are routinely used for early diagnosis of disease. Computed tomography remains useful in evaluating the extent of involvement of inflammatory spondyloarthropathies that classically involve the axial skeleton and sacroiliac joints. Molecular imaging has begun to play an innovative role in evaluating patients with arthritis, aiming to identify disease earlier and provide greater specificity.
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Affiliation(s)
- Carolyn M Sofka
- Department of Radiology and Imaging, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA.
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Analysis of subclinical synovitis detected by ultrasonography and low-field magnetic resonance imaging in patients with rheumatoid arthritis. Mod Rheumatol 2013. [DOI: 10.1007/s10165-013-0849-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abdel-Magied RA, Lotfi A, AbdelGawad EA. Magnetic resonance imaging versus musculoskeletal ultrasonography in detecting inflammatory arthropathy in systemic sclerosis patients with hand arthralgia. Rheumatol Int 2013; 33:1961-6. [PMID: 23354165 PMCID: PMC3719002 DOI: 10.1007/s00296-013-2665-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Accepted: 01/04/2013] [Indexed: 11/30/2022]
Abstract
The aim of the study was the detection of inflammatory arthropathy in patients with systemic sclerosis (SSc) with arthralgia using musculoskeletal ultrasonography (MSUS) and magnetic resonance imaging (MRI) and to compare between MRI versus MSUS detecting musculoskeletal abnormalities and find out its relation with other clinical and laboratory parameters. Sixteen SSc patients with hand arthralgia had a baseline MSUS for their hands. Six months later, patients had a second MSUS and MRI with gadolinium of their most symptomatic hand. Of the 16 patients examined by MSUS, it was found that on baseline and second examination, tenosynovitis was seen in 8 (50 %) and 7 (43.7 %) patients and synovitis was seen in 4 (25 %) and 5 (31 %) patients, respectively, indicating persistence synovial inflammation, and erosion was seen in only 1 (6.3 %) patient on baseline and second examination. Regarding MRI, 81.3 % (13) patients had tenosynovitis, 87.5 % (14) patients had synovitis, and 62.5 % (10) patients had erosions. Applying the RAMRIS system (a semiquantitative MRI scoring system used in RA), the mean values for synovitis, bone marrow edema, and erosions fell within the range seen in RA. Systemic sclerosis patients with arthralgia that have no obvious clinical inflammatory arthritis were found to have persistent inflammatory erosive arthropathy in their hands and wrists using MSUS and MRI. While both MRI and MSUS are useful in characterizing synovial inflammation in SSc, MRI is clearly more sensitive than MSUS in this setting. Further studies on larger number of SSc patients with arthralgia and a control group consisting of SSc patients without arthralgia to better establish the clinical and radiological findings in SSc.
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Akbayrak E, Dinser R, Müller-Ladner U, Tarner IH. Low-field magnetic resonance imaging study on carpal arthritis in systemic sclerosis--low-grade erosive arthritis of carpal bones is an unexpected and frequent disease manifestation. Arthritis Res Ther 2013; 15:R2. [PMID: 23289906 PMCID: PMC3672762 DOI: 10.1186/ar4128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 01/02/2013] [Indexed: 11/10/2022] Open
Abstract
Introduction The aim of the present study was to assess the prevalence and characteristics of subclinical arthritis of carpal and metacarpophalangeal joints in patients with systemic sclerosis (SSc). Methods Low-field (0.2 T) magnetic resonance imaging (MRI) was performed in consecutive patients with SSc attending our center between January 2010 and March 2011. Results were assessed in a standardized manner using the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) and standardized assessments of all hand joints. Patients with arthritis due to overlap syndromes were excluded. Results Of 38 inpatients and eight outpatients who were screened for inclusion, 30 patients participated in the study and 26 patients could be evaluated. Erosions, bone marrow edema, synovitis, and joint effusions were found in 87%, 37%, 68%, and 58%, respectively, and 24% of patients had additional tenovaginitis. Arthritis affected only a low number of joints per analyzed hand. All bones and joints could be affected, but synovitis and bone marrow edema occurred predominantly in the proximal row of carpal bones, most frequently affecting the lunate bone. The extent of inflammatory changes measured with the RAMRIS correlated significantly with the functional status assessed with the validated German functional score questionnaire Funktionsfragebogen Hannover. Conclusion Low-grade arthritic changes on low-field MRI are frequent in patients with pure SSc. The features of arthritis in SSc differ from rheumatoid arthritis. The distribution, the MRI pattern and the predilection for the lunate bone raise the hypothesis that arthritis in SSc may be caused not only by immunological inflammation but also by ischemic mechanisms.
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The impact of MRI on the clinical management of inflammatory arthritides. Skeletal Radiol 2011; 40:1153-73. [PMID: 21847747 DOI: 10.1007/s00256-011-1204-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 05/09/2011] [Accepted: 05/10/2011] [Indexed: 02/02/2023]
Abstract
In the past two decades, MRI has gained a major role in research and clinical management of patients with inflammatory arthritides, particularly in spondyloarthritis (SpA), rheumatoid arthritis (RA), and osteoarthritis (OA). MRI is regarded as the most sensitive imaging modality for detecting early SpA in young patients with inflammatory back pain and normal radiographs of the sacroiliac joints. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA. Recent data show that systematic assessment of sacroiliitis displayed on MRI has much greater diagnostic utility than previously reported and highlight the diagnostic relevance of structural lesions. In RA, MRI has predictive value for the development of disease in new onset undifferentiated arthritis, and MR pathology at disease onset is a highly significant predictor of radiographic erosions. Consequently MRI has been credited with an important role in the new ACR/EULAR 2010 classification criteria for RA. In OA, bone marrow edema (BME) and synovitis may serve as biomarkers in interventional trials. Treatment interventions targeting BME and synovitis observed on MRI in inflammatory arthritides may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Research should focus on the prognostic significance of MRI lesions in larger cohorts and whether adding MRI to routine care improves clinical and radiographic outcome in patients with inflammatory arthritides.
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Kamishima T, Tanimura K, Shimizu M, Matsuhashi M, Fukae J, Kon Y, Hagiwara H, Narita A, Aoki Y, Kosaka N, Atsumi T, Shirato H, Terae S. Monitoring anti-interleukin 6 receptor antibody treatment for rheumatoid arthritis by quantitative magnetic resonance imaging of the hand and power Doppler ultrasonography of the finger. Skeletal Radiol 2011; 40:745-55. [PMID: 21076827 DOI: 10.1007/s00256-010-1064-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 10/23/2010] [Accepted: 10/27/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare quantitative magnetic resonance imaging (MRI) and power Doppler ultrasonography (PDUS) with conventional measures of disease activity in rheumatoid arthritis (RA) patients treated with the anti-interleukin 6 (anti-IL 6) receptor antibody tocilizumab in terms of responsiveness at a few months to disease activity and ability to predict structural damage at 1 year. METHODS A cohort of patients with RA (n = 29) was evaluated clinically including disease activity score 28 (DAS28) and by semiquantitative (SQ-) and quantitative (Q-) PDUS (bilateral metacarpophalangeal joints) and MRI (one hand and wrist) at initiation of treatment with anti-IL 6 receptor antibody agents and after 2 and 5 months. Conventional radiography for both hands and wrists was performed at baseline and at 12 months. Responsiveness was assessed by standardized response means (SRM). Areas under the curve (AUC) for measures at baseline, 2 and 5 months were correlated with structural damage at 1 year. RESULTS Among the laboratory and clinical parameters, DAS28-ESR was the most responsive with a large effect size of SRM. Structural damage progressions for radiography and MR erosion were correlated with AUC of MR bone erosion and Q-PDUS, respectively. CONCLUSIONS In the evaluation of disease activity in RA patients in the first few months after starting anti-IL 6 receptor antibody tocilizumab treatment, the semiquantitative MR bone erosion score of the hand and quantitative value for power Doppler signal in the finger joint were both responsive and predictive of structural damage progression at 1 year.
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Affiliation(s)
- Tamotsu Kamishima
- Department of Radiology, Hokkaido University Hospital, N15 W7, Kita-Ku, Sapporo, 0600815, Japan.
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Chitale S, Ciapetti A, Hodgson R, Grainger A, O'Connor P, Goodson NJ, Thompson RN, Estrach C, Moots RJ, Grassi W, Anderson ME. Magnetic resonance imaging and musculoskeletal ultrasonography detect and characterize covert inflammatory arthropathy in systemic sclerosis patients with arthralgia. Rheumatology (Oxford) 2010; 49:2357-61. [DOI: 10.1093/rheumatology/keq268] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Longitudinal changes in rheumatoid arthritis after rituximab administration assessed by quantitative and dynamic contrast-enhanced 3-T MR imaging: preliminary findings. Eur Radiol 2009; 19:2217-24. [PMID: 19396446 DOI: 10.1007/s00330-009-1401-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Accepted: 02/01/2009] [Indexed: 10/20/2022]
Abstract
We retrospectively assessed the longitudinal changes of rheumatoid arthritis under rituximab therapy by use of quantitative and dynamic contrast-enhanced 3-T magnetic resonance (MR) imaging of the metacarpophalangeal joints of 10 patients at baseline and 26 weeks (n = 10). Additional studies were available at 12 weeks (n = 9) and at 52 weeks (n = 5). Clinical activity was assessed by use of the 28-joint disease activity score (DAS28). MR imaging was used to assess volumes of synovial enhancement, osseous enhancement, and erosions and early rapid enhancement. DAS28 and serum C-reactive protein trended down over time and were significantly lower at 26 weeks. Volume of synovial enhancement and early rapid enhancement showed a significant minimum at 26 weeks and increased thereafter. The erythrocyte sedimentation rate paralleled these two trends. Osseous enhancement did not significantly change over time. Erosions showed a significant progression. Trends of DAS28 and erosions were significantly different (P = 0.0075). In conclusion, our preliminary results suggest that rituximab is associated with a decrease of the inflammatory activity of synovitis with a minimum at 26 weeks and increasing activity thereafter suggesting recurrence. Our results further suggest subclinical progression of erosions with an inverse relationship to decreasing disease activity scores. Further studies are needed to confirm these results.
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McQueen FM. The MRI view of synovitis and tenosynovitis in inflammatory arthritis: implications for diagnosis and management. Ann N Y Acad Sci 2009; 1154:21-34. [PMID: 19250228 DOI: 10.1111/j.1749-6632.2009.04382.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
MRI scanning is the current gold standard modality for imaging synovitis and tenosynovitis in patients with inflammatory arthritis. Inflamed synovial membrane within the joints and investing tendon sheaths appears thickened on T1-weighted sequences and enhances postcontrast. On T2-weighted sequences, synovitis and synovial effusions typically show a high signal. Studies have shown correlations between the degree of inflammation and vascularity of synovium obtained at biopsy and postcontrast enhancement on matching dynamic MRI scans. Scoring systems have been devised that are based on quantifying synovial membrane thickening and signal intensity on static postcontrast scans and have been validated in multireader settings. Moderate to high reliability has been demonstrated with trained readers and quantification of synovitis in this way is being used increasingly as an outcome measure in clinical trials to assess response to therapy. MRI-observed synovitis is almost invariable in those with active rheumatoid arthritis, but recent studies have also demonstrated its presence in patients in clinical remission, emphasizing the sensitivity of this technique and the importance of subclinical joint inflammation. MRI-observed synovitis has been validated against other imaging modalities, including power Doppler ultrasound, and has also been investigated in normal subjects (where mild enhancement can rarely occur). Studies over 1-2 years have suggested that MRI synovial membrane volume and postcontrast enhancement on dynamic imaging can predict the development of erosions. In the long term, an overall score of inflammation incorporating synovitis, tenosynovitis, and bone edema may be a more useful MRI predictor of aggressive erosive disease.
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Affiliation(s)
- Fiona M McQueen
- Department of Molecular Medicine and Pathology, University of Auckland, Auckland, New Zealand.
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Kubassova O, Boesen M, Peloschek P, Langs G, Cimmino MA, Bliddal H, Torp-Pedersen S. Quantifying Disease Activity and Damage by Imaging in Rheumatoid Arthritis and Osteoarthritis. Ann N Y Acad Sci 2009; 1154:207-38. [DOI: 10.1111/j.1749-6632.2009.04392.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Østergaard M, Pedersen SJ, Døhn UM. Imaging in rheumatoid arthritis--status and recent advances for magnetic resonance imaging, ultrasonography, computed tomography and conventional radiography. Best Pract Res Clin Rheumatol 2009; 22:1019-44. [PMID: 19041075 DOI: 10.1016/j.berh.2008.09.014] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Sensitive and reproducible tools for diagnosis, monitoring of disease activity and damage, and prognostication are essential in the management of patients with rheumatoid arthritis (RA). Conventional radiography (X-ray), the traditional gold standard for imaging in RA, is not able to detect early disease manifestations such as inflammatory changes in the soft tissues (synovitis, tensynovitis, enthesitis etc.) and the earliest stages of bone erosion. In contrast, magnetic resonance imaging (MRI) and ultrasonography (US) allow direct visualization of early inflammatory and destructive joint changes, and have several documented and potential applications in RA patients. This chapter will review key aspects of the current status and recent important advances in imaging in RA, briefly discussing X-ray and computed tomography, and particularly focusing on MRI and US. Suggestions for use in clinical trials and practice are provided.
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Affiliation(s)
- Mikkel Østergaard
- Department of Rheumatology, Copenhagen University Hospitals at Herlev and Hvidovre, Copenhagen, Denmark.
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McQueen FM, Ostergaard M. Established rheumatoid arthritis – new imaging modalities. Best Pract Res Clin Rheumatol 2007; 21:841-56. [PMID: 17870031 DOI: 10.1016/j.berh.2007.05.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
New imaging modalities are assuming an increasingly important role in the investigation and management of rheumatoid arthritis. It is now possible to obtain information about all tissues within the joint in three dimensions using tomographic techniques such as magnetic resonance imaging (MRI) and high-resolution computerized tomography. Erosions are very clearly depicted using these modalities and MRI also allows imaging of soft tissues with assessment of joint inflammation. High-resolution ultrasound is a convenient clinical technique for the assessment of erosions, synovitis and tenosynovitis in real-time and facilitates diagnostic and therapeutic interventions such as joint aspiration and injection. Exciting experimental modalities are also being developed with the potential to provide not just morphological but functional imaging. Techniques such as positron emission tomography (PET) and single photon emission tomography (SPECT) can reveal actively metabolizing bone and the proliferation of synovial cells via radioactive labeling. Bioluminescence and fluorescence reflectance imaging are other approaches that allow imaging, and potentially the delivery of therapeutic agents, at a molecular level.
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Affiliation(s)
- Fiona M McQueen
- Department of Molecular Medicine and Pathology, University of Auckland, New Zealand.
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Schett G, Landewé R, van der Heijde D. Tumour necrosis factor blockers and structural remodelling in ankylosing spondylitis: what is reality and what is fiction? Ann Rheum Dis 2007; 66:709-11. [PMID: 17513569 PMCID: PMC1954668 DOI: 10.1136/ard.2007.071159] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2007] [Indexed: 11/03/2022]
Abstract
A delineation of the differences in pathology between AS and RA
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Pilar Lisbona M, Maymó J, Carbonell J. [Magnetic resonance of the hand in rheumatoid arthritis. Review of methodology, and its use in diagnosis, monitoring and prognosis]. REUMATOLOGIA CLINICA 2007; 3:126-136. [PMID: 21794414 DOI: 10.1016/s1699-258x(07)73679-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2005] [Accepted: 04/10/2006] [Indexed: 05/31/2023]
Abstract
The ideal aim of treatment in rheumatoid arthritis (RA) is to suppress synovial inflammation and to stop or reduce structural joint damage progression. To evaluate joint damage in RA, radiographic assessment of hands and feet is the traditional method. Nevertheless, plain film radiography can only evaluate bone damage (erosion) and, indirectly, joint cartilage. Magnetic resonance imaging presents important advantages since allows to study, not only the cortical bone and the marrow, but also the synovial membrane, tendon and ligament structures,and adjacent soft tissue that usually are involved in early disease. Moreover, hand-magnetic resonance (h-MRI) has shown to be more sensitive than plain radiography in detecting early erosions and predicting progression of bone damage, allowing a rapid diagnosis and to start the most efficient therapy as well as to achieve better outcomes for this disease.
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Affiliation(s)
- M Pilar Lisbona
- Hospitales del Mar y de la Esperanza. Institut Municipal d'Assistència Sanitària (IMAS). Universidad Autónoma de Barcelona. Barcelona. España
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Døhn UM, Skjødt H, Hetland ML, Vestergaard A, Møller JM, Knudsen LS, Ejbjerg BJ, Thomsen HS, Ostergaard M. No erosive progression revealed by MRI in rheumatoid arthritis patients treated with etanercept, even in patients with persistent MRI and clinical signs of joint inflammation. Clin Rheumatol 2007; 26:1857-61. [PMID: 17332974 DOI: 10.1007/s10067-007-0589-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2006] [Revised: 02/05/2007] [Accepted: 02/06/2007] [Indexed: 10/23/2022]
Abstract
The aim of this study is to investigate the course of magnetic resonance imaging (MRI) signs of inflammatory and destructive changes in rheumatoid arthritis (RA) wrist and metacarpophalangeal (MCP) joints during etanercept treatment. MRI of the non-dominant wrist and second to fifth MCP joints was performed in five clinical active RA patients before and 4 and 16 weeks after initiation of etanercept treatment. MRI was evaluated according to the EULAR-OMERACT RA MRI reference image atlas. The median 28-joint count disease activity score (DAS28; erythrocyte sedimentation rate based) was 5.6 (range 5.0-6.8) at baseline and 3.5 (1.5-4.1) at week 16 (decreased in all patients compared to baseline, Wilcoxon-Pratt, p < 0.05). The median MRI synovitis score was 18 (14-21), 18 (10-20) and 16 (10-20) at baseline, week 4 and 16, respectively (decreased in all patients compared to baseline, Wilcoxon-Pratt, p < 0.05), while corresponding MRI bone oedema scores were 4 (0-13), 3 (0-9) and 1 (0-3; NS). The median MRI bone erosion score was 27 (11-111; NS) at all time points. Four patients had identical total bone erosion scores at baseline and week 16, whereas one patient showed a reduced score. In conclusion, one patient showed erosive regression, while no patient showed erosive progression on MRI during 16 weeks of etanercept therapy; even though clinical and MRI signs of joint inflammation remained. This small study supports that erosive progression judged by MRI is minimal in RA patients treated with etanercept, even in joints with persistent inflammation.
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Affiliation(s)
- Uffe Møller Døhn
- Department of Rheumatology, Copenhagen University Hospital at Hvidovre, Kettegaard Allé 30, 2650, Hvidovre, Denmark.
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Østergaard M, Døhn UM, Ejbjerg BJ, McQueen FM. Ultrasonography and magnetic resonance imaging in early rheumatoid arthritis: Recent advances. Curr Rheumatol Rep 2006; 8:378-85. [PMID: 16973112 DOI: 10.1007/s11926-006-0069-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Efficient methods for diagnosis, monitoring, and prognostication are essential in early rheumatoid arthritis. Data on the value of ultrasonography and MRI are accumulating rapidly, fueling their increasing use in early rheumatoid arthritis. This review focuses on recent advances in the clinical applications of these imaging modalities.
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Affiliation(s)
- Mikkel Østergaard
- Departments of Rheumatology, Copenhagen University Hospitals at Hvidovre and Herlev, Kettegaard Alle 30, DK-2650 Hvidovre, Denmark.
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Tam LS, Griffith JF, Yu AB, Li TK, Li EK. Rapid improvement in rheumatoid arthritis patients on combination of methotrexate and infliximab: clinical and magnetic resonance imaging evaluation. Clin Rheumatol 2006; 26:941-6. [PMID: 16868816 DOI: 10.1007/s10067-006-0372-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Revised: 06/05/2006] [Accepted: 06/07/2006] [Indexed: 10/24/2022]
Abstract
The objectives of this study was to assess, using clinical and magnetic resonance imaging (MRI) criteria, the efficacy of combination infliximab therapy in patients with active rheumatoid arthritis (RA) refractory to methotrexate (MTX) treatment and to ascertain whether the changes in MRI parameters correlate with the clinical response. Four infusions of infliximab (3 mg/kg) at weeks 0, 2, 6, and 14 were added to a stable background dose of MTX in 19 patients with active disease. Clinical parameters were assessed before each infusion and at week 14. Dynamic contrast-enhanced MRI examination of the most severely affected wrist was performed at baseline and week 14. Synovitis severity, volume of synovitis, and synovial perfusion indices were evaluated. Significant improvement in all clinical disease activity parameters was seen at week 14 with reduction in C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and DAS28. Sixty-eight percent of patients achieved ACR20. MRI disease activity parameters also significantly decreased after treatment with reduction in grading of synovitis, volume of active synovitis, and perfusion enhancement slope. Significant positive correlations were seen between the baseline volume of synovitis and the pain score (r=0.65), patient global score (r=0.68), and health assessment questionnaire (HAQ) score (r=0.46). In conclusion, addition of infliximab to methotrexate rapidly reduces inflammation in longstanding patients with RA. Assessment of enhancing synovial volume and perfusion indices on serial MRI examination was helpful in documenting the effect of treatment over this short period.
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Affiliation(s)
- Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hongkong, People's Republic of China.
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Abstract
Recent advances in the understanding of the pathophysiology and aggressive treatment of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis have dramatically changed the outcomes of patients with these diseases over the past 7 years. Much of the progress in therapy is due to the change in the treatment paradigm in which early, aggressive therapy has become the norm and the introduction of therapies that target the disease processes, specifically the overproduction of tumor necrosis factor-α. Etanercept was the first anti-tumor necrosis factor-α therapy approved for use in rheumatoid arthritis, juvenile rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. It has been shown to have an excellent risk:benefit ratio in clinical trials as well as postmarketing surveillance. However, there has been limited information regarding the safety and efficacy of etanercept in patients aged 65 years or over, which is the focus of this review.
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Affiliation(s)
- Roy Fleischmann
- University of Texas Southwestern Medical Center at Dallas, Co-Medical Director Radiant Research – Dallas, 5939 Harry Hines Boulevard, Suite 400, Dallas, TX 75235-5360 USA
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Guías y recomendaciones del Colegio Mexicano de Reumatología para el uso de agentes biológicos en enfermos reumáticos. ACTA ACUST UNITED AC 2006; 2:78-89. [DOI: 10.1016/s1699-258x(06)73026-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Accepted: 01/11/2006] [Indexed: 01/20/2023]
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Hunter DJ, Conaghan PG. Imaging outcomes and their role in determining outcomes in osteoarthritis and rheumatoid arthritis. Curr Opin Rheumatol 2006; 18:157-62. [PMID: 16462521 DOI: 10.1097/01.bor.0000209427.61904.66] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review describes the advances in knowledge of outcomes that have occurred recently as a result of imaging research in both osteoarthritis and rheumatoid arthritis. RECENT FINDINGS Recent imaging advances in osteoarthritis have offered insights into fundamental questions including the cause of pain and reasons for disease progression. Although ongoing disease modification clinical drug trials in osteoarthritis mostly use standardized plain radiographs to monitor structural changes in the joint, magnetic resonance imaging is rapidly evolving as a method of monitoring joint structure and with time may become the preferred method of monitoring this feature in osteoarthritis clinical trials. The past decade has seen major advances in the treatment of rheumatoid arthritis in which imaging determines whether individual agents or therapeutic regimens are structure modifying. Although conventional radiography remains the gold standard for assessing structural progression in rheumatoid arthritis, growing work on the performance metrics of magnetic resonance imaging has resulted in its increasing use in trials. Ultrasonography shows preliminary promise as a useful outcome measure. SUMMARY Recent advances in imaging are improving our understanding of the etiopathogenesis and treatment of persons with osteoarthritis and rheumatoid arthritis. Complex challenges face us over the coming years as clinicians and researchers grapple with the use of these new techniques, the insights they may provide, and their clinical application.
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Affiliation(s)
- David J Hunter
- Boston University Clinical Epidemiology Research and Training Unit, and the Department of Medicine at Boston Medical Center, Boston, Massachussetts 02118, USA.
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Westhovens R. Abatacept: the first-in-class costimulation blocker for the treatment of rheumatoid arthritis. ACTA ACUST UNITED AC 2006. [DOI: 10.2217/17460816.1.1.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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