1
|
Morales-Ivorra I, Taverner D, Codina O, Castell S, Fischer P, Onken D, Martínez-Osuna P, Battioui C, Marín-López MA. External Validation of the Machine Learning-Based Thermographic Indices for Rheumatoid Arthritis: A Prospective Longitudinal Study. Diagnostics (Basel) 2024; 14:1394. [PMID: 39001284 PMCID: PMC11241557 DOI: 10.3390/diagnostics14131394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/21/2024] [Accepted: 06/29/2024] [Indexed: 07/16/2024] Open
Abstract
External validation is crucial in developing reliable machine learning models. This study aimed to validate three novel indices-Thermographic Joint Inflammation Score (ThermoJIS), Thermographic Disease Activity Index (ThermoDAI), and Thermographic Disease Activity Index-C-reactive protein (ThermoDAI-CRP)-based on hand thermography and machine learning to assess joint inflammation and disease activity in rheumatoid arthritis (RA) patients. A 12-week prospective observational study was conducted with 77 RA patients recruited from rheumatology departments of three hospitals. During routine care visits, indices were obtained at baseline and week 12 visits using a pre-trained machine learning model. The performance of these indices was assessed cross-sectionally and longitudinally using correlation coefficients, the area under the receiver operating curve (AUROC), sensitivity, specificity, and positive and negative predictive values. ThermoDAI and ThermoDAI-CRP correlated with CDAI, SDAI, and DAS28-CRP cross-sectionally (ρ = 0.81; ρ = 0.83; ρ = 0.78) and longitudinally (ρ = 0.55; ρ = 0.61; ρ = 0.60), all p < 0.001. ThermoDAI and ThermoDAI-CRP also outperformed Patient Global Assessment (PGA) and PGA + C-reactive protein (CRP) in detecting changes in 28-swollen joint counts (SJC28). ThermoJIS had an AUROC of 0.67 (95% CI, 0.58 to 0.76) for detecting patients with swollen joints and effectively identified patients transitioning from SJC28 > 1 at baseline visit to SJC28 ≤ 1 at week 12 visit. These results support the effectiveness of ThermoJIS in assessing joint inflammation, as well as ThermoDAI and ThermoDAI-CRP in evaluating disease activity in RA patients.
Collapse
Affiliation(s)
| | - Delia Taverner
- Rheumatology Department, Hospital Universitari Sant Joan de Reus, 43204 Reus, Spain
| | - Oriol Codina
- Rheumatology Department, Hospital de Figueres, 17600 Figueres, Spain
| | - Sonia Castell
- Rheumatology Department, Hospital de Figueres, 17600 Figueres, Spain
| | - Peter Fischer
- Immunology, Eli Lilly and Company, Indianapolis, IN 46225, USA
| | - Derek Onken
- Advanced Analytics and Data Sciences, Eli Lilly and Company, Indianapolis, IN 46225, USA
| | | | - Chakib Battioui
- Advanced Analytics and Data Sciences, Eli Lilly and Company, Indianapolis, IN 46225, USA
| | | |
Collapse
|
2
|
Pezeshk P, Soldatos T, Ezzati F, Bhatnagar N, Chhabra A. Spectrum of Hand Arthritis. Magn Reson Imaging Clin N Am 2023; 31:239-253. [PMID: 37019548 DOI: 10.1016/j.mric.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Early diagnosis of arthritis is of paramount importance to slow the progression of disease and joint destruction. Because of temporal dissemination of the clinical and laboratory manifestations of the inflammatory arthritis and overlap of the findings, diagnosis can be challenging in early stages of the disease. This article highlights the utility of advanced cross-sectional imaging, including color-Doppler ultrasound, diffusion-weighted MR imaging, and perfusion MR imaging in the domain of arthropathy so that the reader can apply these principles and techniques in their practices for timely and accurate diagnosis and improved multidisciplinary communications for better management of such conditions.
Collapse
|
3
|
Curtis JR, Stolshek B, Emery P, Haraoui B, Karis E, Kricorian G, Collier DH, Yen PK, Bykerk VP. Effects of Disease-Worsening Following Withdrawal of Etanercept or Methotrexate on Patient-Reported Outcomes in Patients With Rheumatoid Arthritis: Results From the SEAM-RA Trial. J Clin Rheumatol 2023; 29:16-22. [PMID: 36459119 PMCID: PMC9803379 DOI: 10.1097/rhu.0000000000001893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND/OBJECTIVE The effect of treatment withdrawal on patient-reported outcomes (PROs) in patients with rheumatoid arthritis (RA) whose disease is in sustained remission has not been well described. This analysis aimed to compare PRO changes in patients with RA following medication withdrawal and disease worsening. METHODS SEAM-RA (Study of Etanercept and Methotrexate in Combination or as Monotherapy in Subjects With Rheumatoid Arthritis) was a phase 3, multicenter, randomized withdrawal, double-blind controlled study in patients with RA taking methotrexate plus etanercept and in remission (Simple Disease Activity Index ≤3.3). Patient's Global Assessment of Disease Activity, Patient's Assessment of Joint Pain, Health Assessment Questionnaire-Disability Index, and 36-Item Short-Form Health Survey were evaluated for 48 weeks following methotrexate or etanercept withdrawal. Treatment differences for patients with versus without disease worsening were evaluated using a 2-sample t test for continuous end points and log-rank test for time-to-event end points. RESULTS Of 253 patients, 121 experienced disease worsening and 132 did not. All PRO scores were similar to those of a general population at baseline and deteriorated over time across the study population. The PtGA and Patient's Assessment of Joint Pain values deteriorated less in those on etanercept monotherapy compared with methotrexate monotherapy. More patients with versus without disease worsening experienced deterioration that was greater than the minimal clinically important difference (MCID) for all PROs tested. In patients with disease worsening, PtGA deterioration more than the MCID preceded Simple Disease Activity Index disease worsening. CONCLUSIONS Etanercept monotherapy showed benefit over methotrexate in maintaining PRO scores. Patients with disease worsening experienced a more rapid worsening of PtGA beyond the MCID versus patients without disease worsening.Categories: autoinflammatory disease, biological therapy, DMARDs, rheumatoid arthritis.
Collapse
Affiliation(s)
- Jeffrey R. Curtis
- From the Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, United Kingdom
| | - Boulos Haraoui
- Centre Hospitalier de I'Université de Montréal, Montréal, Quebec, Canada
| | | | | | | | | | | |
Collapse
|
4
|
Harnden K, Di Matteo A, Mankia K. When and how should we use imaging in individuals at risk of rheumatoid arthritis? Front Med (Lausanne) 2022; 9:1058510. [PMID: 36507546 PMCID: PMC9726914 DOI: 10.3389/fmed.2022.1058510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022] Open
Abstract
In recent years rheumatologists have begun to shift focus from early rheumatoid arthritis (RA) to studying individuals at risk of developing the disease. It is now possible to use blood, clinical and imaging biomarkers to identify those at risk of progression before the onset of clinical synovitis. The use of imaging, in particular ultrasound (US) and magnetic resonance imaging (MRI), has become much more widespread in individuals at-risk of RA. Numerous studies have demonstrated that imaging can help us understand RA pathogenesis as well as identifying individuals at high risk of progression. In addition, imaging techniques are becoming more sophisticated with newer imaging modalities such as high-resolution peripheral quantitative computed tomography (HR-pQRCT), nuclear imaging and whole body-MRI (WB-MRI) starting to emerge. Imaging studies in at risk individuals are heterogeneous in nature due to the different at-risk populations, imaging modalities and protocols used. This review will explore the available imaging modalities and the rationale for their use in the main populations at risk of RA.
Collapse
|
5
|
Podewski AF, Glimm AM, Fischer I, Bruyn GAW, Hanova P, Hammer HB, Aga AB, Haavardsholm EA, Ramiro S, Burmester GR, Backhaus M, Ohrndorf S. The MCP2 and the wrist plus two extensor compartments are the most affected and responsive joints/tendons out of the US7 score in patients with rheumatoid arthritis-an observational study. Arthritis Res Ther 2022; 24:183. [PMID: 35932087 PMCID: PMC9354335 DOI: 10.1186/s13075-022-02874-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/18/2022] [Indexed: 11/25/2022] Open
Abstract
Background There is no international consensus on an optimal ultrasound score for monitoring of rheumatoid arthritis (RA) on patient-level yet. Our aim was to reassess the US7 score for the identification of the most frequently pathologic and responsive joint/tendon regions, to optimize it and contribute to an international consensus. Furthermore, we aimed to evaluate the impact of disease duration on the performance of the score. Methods RA patients were assessed at baseline and after 3 and 6 months of starting/changing DMARD therapy by the US7 score in greyscale (GS) and power Doppler (PD). The frequency of pathologic joint/tendon regions and their responsiveness to therapy were analyzed by Friedman test and Cochrane-Q test respectively, including the comparison of palmar vs. dorsal regions (chi-square test). The responsiveness of different reduced scores and the amount of information retained from the original US7 score were assessed by standardized response means (SRM)/linear regression. Analyses were also performed separately for early and established RA. Results A total of 435 patients (N = 138 early RA) were included (56.5 (SD 13.1) years old, 8.2 (9.1) years disease duration, 80% female). The dorsal wrist, palmar MCP2, extensor digitorum communis (EDC) and carpi ulnaris (ECU) tendons were most frequently affected by GS/PD synovitis/tenosynovitis (wrist: 45%/43%; MCP2: 35%/28%; EDC: 30%/11% and ECU: 25%/11%) and significantly changed within 6 months of therapy (all p ≤0.003 by GS/PD). The dorsal vs. palmar side of the wrist by GS/PD (p < 0.001) and the palmar side of the finger joints by PD (p < 0.001) were more frequently pathologic. The reduced US7 score (GS/PD: palmar MCP2, dorsal wrist, EDC and ECU, only PD: dorsal MCP2) showed therapy response (SRM 0.433) after 6 months and retained 76% of the full US7 score’s information. No major differences between the groups of early and established RA could be detected. Conclusions The wrist, MCP2, EDC, and ECU tendons were most frequently pathologic and responsive to therapy in both early and established RA and should therefore be included in a comprehensive score for monitoring RA patients on patient-level. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02874-y.
Collapse
Affiliation(s)
- A F Podewski
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany. .,Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany.
| | - A M Glimm
- Department of Endocrinology, Nephrology, Rheumatology, Division Rheumatology, Universitätsklinikum Leipzig, Leipzig, Germany
| | - I Fischer
- Biostatistics Tubingen, Tubingen, Germany
| | - G A W Bruyn
- Department of Rheumatology, MC Groep Hospitals, Lelystad, Netherlands
| | - P Hanova
- Department of Rheumatology, First Faculty of Medicine, Charles University of Prague, Prague, Czech Republic
| | - H B Hammer
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - A B Aga
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - E A Haavardsholm
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - S Ramiro
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Zuyderland Medical Center, Heerlen, The Netherlands
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Backhaus
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany
| | - S Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
6
|
Morales-Ivorra I, Narváez J, Gómez-Vaquero C, Moragues C, Nolla JM, Narváez JA, Marín-López MA. Assessment of inflammation in patients with rheumatoid arthritis using thermography and machine learning: a fast and automated technique. RMD Open 2022; 8:rmdopen-2022-002458. [PMID: 35840312 PMCID: PMC9295660 DOI: 10.1136/rmdopen-2022-002458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/30/2022] [Indexed: 11/28/2022] Open
Abstract
Objectives Sensitive detection of joint inflammation in rheumatoid arthritis (RA) is crucial to the success of the treat-to-target strategy. In this study, we characterise a novel machine learning-based computational method to automatically assess joint inflammation in RA using thermography of the hands, a fast and non-invasive imaging technique. Methods We recruited 595 patients with arthritis and osteoarthritis, as well as healthy subjects at two hospitals over 4 years. Machine learning was used to assess joint inflammation from the thermal images of the hands using ultrasound as the reference standard, obtaining a Thermographic Joint Inflammation Score (ThermoJIS). The machine learning model was trained and tuned using data from 449 participants with different types of arthritis, osteoarthritis or without rheumatic disease (development set). The performance of the method was evaluated based on 146 patients with RA (validation set) using Spearman’s rank correlation coefficient, area under the receiver-operating curve (AUROC), average precision, sensitivity, specificity, positive and negative predictive value and F1-score. Results ThermoJIS correlated moderately with ultrasound scores (grey-scale synovial hypertrophy=0.49, p<0.001; and power Doppler=0.51, p<0.001). The AUROC for ThermoJIS for detecting active synovitis was 0.78 (95% CI, 0.71 to 0.86; p<0.001). In patients with RA in clinical remission, ThermoJIS values were significantly higher when active synovitis was detected by ultrasound. Conclusions ThermoJIS was able to detect joint inflammation in patients with RA, even in those in clinical remission. These results open an opportunity to develop new tools for routine detection of joint inflammation.
Collapse
Affiliation(s)
| | - Javier Narváez
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Gómez-Vaquero
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Carmen Moragues
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Joan M Nolla
- Rheumatology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - José A Narváez
- Radiodiagnosis Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | | |
Collapse
|
7
|
Fattah SA, Abdel Fattah MA, Mesbah NM, Saleh SM, Abo-Elmatty DM, Mehanna ET. The expression of zinc finger 804a (ZNF804a) and cyclin-dependent kinase 1 (CDK1) genes is related to the pathogenesis of rheumatoid arthritis. Arch Physiol Biochem 2022; 128:688-693. [PMID: 31994908 DOI: 10.1080/13813455.2020.1716810] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT ZNF804a and CDK1 genes code for proteins involved in inflammatory pathways. OBJECTIVE This study aimed to investigate the correlation of ZNF804a and CDK1 expression profiles in RA with the activity and the severity of the disease and to assess their association with inflammatory reactions in the Egyptian RA patients. METHODS ZNF804a and CDK1 expression profiles were assessed using quantitative PCR (qRT-PCR). Clinical and laboratory parameters were evaluated. RESULTS ZNF804a expression was down-regulated by 0.177-fold while CDK1 expression was up-regulated to 3.29-fold in RA patients compared with healthy controls (p < .001). ZNF804a down-regulation was negatively correlated with CRP, RF, disease activity score of 28 joints (DAS) using CRP (DAS-CRP) and TNF-α. CDK1 overexpression was correlated with IFN-1 and ACPA in RA patients. CONCLUSION ZNF804a and CDK1 genes are implicated in RA pathogenesis due to their influences on TNF-α and IFN-1 which contribute to inflammation in RA patients.
Collapse
Affiliation(s)
- Shaimaa A Fattah
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Maha A Abdel Fattah
- Department of Physical Medicine, Rheumatology and Rehabilitation, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Noha M Mesbah
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Samy M Saleh
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Dina M Abo-Elmatty
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| | - Eman T Mehanna
- Department of Biochemistry, Faculty of Pharmacy, Suez Canal University, Ismailia, Egypt
| |
Collapse
|
8
|
Performance of a Handheld Ultrasound Device to Assess Articular and Periarticular Pathologies in Patients with Inflammatory Arthritis. Diagnostics (Basel) 2021; 11:diagnostics11071139. [PMID: 34206675 PMCID: PMC8305786 DOI: 10.3390/diagnostics11071139] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 12/27/2022] Open
Abstract
The purpose of this study was to assess the accuracy and performance of a new handheld ultrasound (HHUS) machine in comparison to a conventional cart-based sonographic machine in patients with inflammatory arthritis (IA). IA patients with at least one tender and swollen joint count were enrolled. US was performed on the clinically affected joints using a cart-based sonographic device (Samsung HS40) and a HHUS device (Butterfly iQ). One blinded reader scored all images for the presence of erosions, bony enlargement, synovial hypertrophy, joint effusion, bursitis, tenosynovitis, and enthesitis. Synovitis was graded (B mode and power Doppler (PD)) by the 4-level EULAR-OMERACT scale. To avoid bias by the blinded reader, we included 67 joints of two healthy volunteers in the evaluation. We calculated the overall concordance and the concordance by type of joint and pathological finding. We also measured the time required for the US examination per joint with both devices. Thirty-two patients (20 with RA, 10 with PsA, and one each with gout and SLE-associated arthritis) were included, and 186 joints were examined. The overall raw concordance in B mode was 97% (κappa 0.90, 95% CI (0.89, 0.94)). In B mode, no significant differences were found in relation to type of joint or pathological finding examined. The PD mode of the HHUS device did not detect any PD signal, whereas the cart-based device detected a PD signal in 61 joints (33%). The portable device did not offer any time savings compared to the cart-based device (47.0 versus 46.3 s). The HHUS device was accurate in the assessment of structural damage and inflammation in patients with IA, but only in the B mode. Significant improvements are still needed for HHUS to reliably demonstrate blood flow detection in PD mode.
Collapse
|
9
|
Ziegelasch M, Eloff E, Hammer HB, Cedergren J, Martinsson K, Reckner Å, Skogh T, Magnusson M, Kastbom A. Bone Erosions Detected by Ultrasound Are Prognostic for Clinical Arthritis Development in Patients With ACPA and Musculoskeletal Pain. Front Med (Lausanne) 2021; 8:653994. [PMID: 33834034 PMCID: PMC8021704 DOI: 10.3389/fmed.2021.653994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/01/2021] [Indexed: 11/14/2022] Open
Abstract
Anti-citrullinated protein antibodies (ACPA) often precede onset of rheumatoid arthritis (RA) by years, and there is an urgent clinical need for predictors of arthritis development among such at-risk patients. This study assesses the prognostic value of ultrasound for arthritis development among ACPA-positive patients with musculoskeletal pain. We prospectively followed 82 ACPA-positive patients without clinical signs of arthritis at baseline. Ultrasound at baseline assessed synovial hypertrophy, inflammatory activity by power Doppler, and erosions in small joints of hands and feet. We applied Cox regression analyses to examine associations with clinical arthritis development during follow-up (median, 69 months; range, 24–90 months). We also compared the ultrasound findings among the patients to a control group of 100 blood donors without musculoskeletal pain. Clinical arthritis developed in 39/82 patients (48%) after a median of 6 months (range, 1–71 months). One or more ultrasound erosions occurred in 13/82 patients (16%), with none in control subjects (p < 0.001). Clinical arthritis development was more common among patients with baseline ultrasound erosions than those without (77 vs. 42%, p = 0.032), and remained significant in a multivariable Cox regression analysis that included previously described prognostic factors (HR 3.9, 95% CI 1.6–9.4, p = 0.003). Ultrasound-detected tenosynovitis was more frequent among the patients and associated with clinical arthritis development in a univariable analysis (HR 2.5, 95% CI 1.1–5.7, p = 0.031), but did not remain statistically significant in multivariable analysis. Thus, bone erosions detected by ultrasound are independent predictors of clinical arthritis development in an ACPA-positive at-risk population. Trial Registration: Regional Ethics Committee in Linköping, Sweden, Dnr M220-09. Registered 16 December 2009, https://etikprovningsmyndigheten.se/.
Collapse
Affiliation(s)
- Michael Ziegelasch
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Emma Eloff
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Jan Cedergren
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Klara Martinsson
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Åsa Reckner
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Thomas Skogh
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Mattias Magnusson
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Alf Kastbom
- Department of Rheumatology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| |
Collapse
|
10
|
Gessl I, Balint PV, Filippucci E, Keen HI, Pineda C, Terslev L, Wildner B, D'Agostino MA, Mandl P. Structural damage in rheumatoid arthritis assessed by musculoskeletal ultrasound: A systematic literature review by the Structural Joint Damage Task Force of the OMERACT Ultrasound Working Group. Semin Arthritis Rheum 2021; 51:627-639. [PMID: 33810864 DOI: 10.1016/j.semarthrit.2021.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/05/2021] [Accepted: 02/15/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To identify and synthesize the evidence for the use and measurement properties of musculoskeletal ultrasound in assessing structural joint damage in patients with rheumatoid arthritis (RA). METHODS A systematic literature search (SLR) of the PubMed, Embase and Cochrane Library was performed. Original articles were included published in English reporting on ultrasound of bone erosion, cartilage damage and the measurement properties of ultrasound according to the OMERACT filter 2.1. RESULTS Of the 1.495 identified articles 149 were included in the final review, most of which reported on cross-sectional studies and used the OMERACT definitions for ultrasonographic pathology. Among these, bone erosions were assessed in 139 (93.3%), cartilage damage in 24 (16.1%), enthesophytes in 8 (5.4%), osteophytes in 15 (10.1%) and malalignment and ankylosis in a single (0.9%) study, respectively. Most studies (126/149, 84.6%) assessed the joints of the hands. The overwhelming majority of studies (127/149, 85.2%) assessed structural joint damage bilaterally. Validity, reliability and responsiveness were assessed in 21 (14.1%), 34 (22.8%) and 17 (11.4%) studies, respectively. CONCLUSION While the results of this SLR suggest that ultrasound is a sensitive, reliable and feasible tool to detect damage in RA, they also highlight the need for further research and validation. Findings of this SLR will inform the next steps of the OMERACT Ultrasound Working Group in developing an ultrasound score for assessing structural joint damage in patients with RA.
Collapse
Affiliation(s)
- I Gessl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, 18-20 Währinger Gürtel, Vienna, Austria
| | - P V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - E Filippucci
- Department of Rheumatology, Universita` Politecnica delle Marche, Jesi, Ancona, Italy
| | - H I Keen
- Medical School, University of Western Australia, Perth, Australia
| | - C Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - L Terslev
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Copenhagen, Denmark
| | - B Wildner
- University Library, Medical University of Vienna, Vienna, Austria
| | - M A D'Agostino
- Department of Rheumatology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy; UFR Simone Veil, Versailles-Saint-Quentin-Paris Saclay University, Versailles, France
| | - P Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, 18-20 Währinger Gürtel, Vienna, Austria.
| |
Collapse
|
11
|
Polachek A, Furer V, Zureik M, Nevo S, Mendel L, Levartovsky D, Wollman J, Aloush V, Tzemah R, Elalouf O, Anouk M, Berman M, Kaufman I, Lahat Y, Sarbagil-Maman H, Borok S, Broyde A, Eder L, Paran D, Iluz M, Eshed I, Elkayam O. Ultrasound, magnetic resonance imaging and radiography of the finger joints in psoriatic arthritis patients. Rheumatology (Oxford) 2021; 61:563-571. [PMID: 33734348 DOI: 10.1093/rheumatology/keab272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 02/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To report the discrepancies and agreements between ultrasound (US), magnetic resonance imaging (MRI) and radiography of the hand in psoriatic arthritis (PsA), and to compare the sensitivity and specificity of US and radiography to MRI as the gold standard imaging study in PsA. METHODS All of the 100 prospectively recruited consecutive PsA patients underwent clinical assessment and concomitant radiographic, US and MRI studies of the metacarpophalangeal, proximal interphalangeal and distal interphalangeal joints of one hand. Synovitis, flexor tenosynovitis, extensor paratenonitis, erosions and bone proliferations were identified and scored. All readers were blinded to clinical data, and agreement was calculated based on prevalence-adjusted bias-adjusted kappa (PABAK). RESULTS The prevalence of synovitis, flexor tenosynovitis, extensor paratenonitis and erosions was similar for US and MRI, while that of bone proliferation was significantly increased in US and radiography compared to MRI (P < 0.001). The absolute agreement between US and MRI was good-to-very good for synovitis (85%-96%, PABAK=0.70-0.92), flexor tenosynovitis (93%-98%, PABAK=0.87-0.96), and extensor paratenonitis (95%-98%, PABAK=0.90-0.97). Agreement between US, MRI and radiography was 96%-98% (PABAK=0.92-0.97) for erosions and 71%-93% (PABAK=0.47-0.87) for bone proliferations. Sensitivity of US with MRI as gold standard was higher for synovitis (0.5-0.86) and extensor paratenonitis (0.63-0.85) than for flexor tenosynovitis (0.1-0.75), while the specificity was high for each pathology (0.89-0.98). CONCLUSION There is very good agreement between US and MRI for the detection of inflammatory changes in finger joints in PsA. US, radiography and MRI have a good-to-very good agreement for destructive changes.
Collapse
Affiliation(s)
- Ari Polachek
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victoria Furer
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mirna Zureik
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharon Nevo
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Mendel
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Levartovsky
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Wollman
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Valerie Aloush
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Reut Tzemah
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Elalouf
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marina Anouk
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark Berman
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ilana Kaufman
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lahat
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Sarbagil-Maman
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Borok
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Broyde
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lihi Eder
- Women's College Research Institute, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Daphna Paran
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moshe Iluz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Radiology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Iris Eshed
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Radiology Department, Sheba Medical Center, Tel Hashomer, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
12
|
[Rheumatoid arthritis of the hand : Part 2: Imaging]. Radiologe 2021; 61:362-374. [PMID: 33728480 DOI: 10.1007/s00117-021-00833-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Rheumatoid arthritis can cause joint destruction, especially joints of the hands. Diagnosed at an early stage, which often includes imaging methods, can minimize structural joint damage and resulting disabilities as well as avoid systemic manifestations such as cardiovascular damage through rapid and continuous so-called targeted treatment approaches. OBJECTIVE The aim of this work is the systematic description and report of imaging findings in rheumatoid arthritis as the most common autoimmunologic rheumatologic disease, which is characterized by a typical pattern of synovitis of the hands. MATERIALS AND METHODS Narrative review based on the current literature on the subject from the radiological and rheumatological point of view. RESULTS Inflammation of the hands represents the most frequently affected area of the body in rheumatoid arthritis. Taking into consideration the topology and typical synovitis patterns of the hands, differences between early and late stages are described. Knowledge regarding image-based morphological changes associated with this complex disease, especially in the hands, is important in the differential diagnosis, especially in early stages of the disease. CONCLUSIONS For the diagnosis of rheumatoid arthritis of the hands, the radiologist must be familiar with basic knowledge of arthritis in the hands to confidently analyze the typical patterns present in the diagnostic imaging at initial diagnosis and during the course of the disease, which serve as a guide for therapy decisions.
Collapse
|
13
|
Finzel S, Aegerter P, Schett G, D'Agostino MA. Identification, localization and differentiation of erosions and physiological bone channels by ultrasound in rheumatoid arthritis patients. Rheumatology (Oxford) 2021; 59:3784-3792. [PMID: 32417898 DOI: 10.1093/rheumatology/keaa183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Ultrasound (US) can detect cortical bone lesions in RA. However, not all cortical bone lesions are erosions. Herein, we aimed to define whether US can differentiate between physiological bone channels and pathological erosions in RA and to provide topographic description of their differential localization. METHODS RA patients and healthy controls (HC) received US examination of the metacarpophalangeal (MCPJ) and proximal inter-phalangeal (PIPJ) joints adjudicating cortical bone lesions as physiological bone channels or pathological erosions. In a subset of RA patients and HC, high-resolution peripheral quantitative computed tomography (HR-pQCT) of the hand was performed to validate the classification of lesions. RESULTS A total of 40 RA patients and 43 HC were enrolled and totally 771 MCPJ and 638 PIPJ were examined by US, and 94 and 51, respectively, by HR-pQCT. US-defined cortical bone lesions clustered in the lateral part of the MCP (50%) and the dorsal part of the PIPJ (66.7%) in RA. US-defined physiological bone channels clustered in the palmar parts of the MCPJ and PIPJ in both RA (78.8% and 100%, respectively) and HC (51.8% and 80%, respectively). HR-pQCT data confirmed US data with respect to adjudication of physiological bone channels and pathological erosions. Erosions were significantly (all P <0.000001) larger than physiological channels and preferentially localized at radial and ulnar sites, while physiological channels were clustered at palmar sites. Specificity of US was excellent for erosions in RA and for physiological bone channels in HC and RA. CONCLUSION US allows differentiation between physiological channels and bone erosions in RA.
Collapse
Affiliation(s)
- Stephanie Finzel
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich Alexander University of Erlangen-Nurnberg and Universitaetsklinikum Erlangen, Erlangen.,Department of Rheumatology and Clinical Immunology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philippe Aegerter
- Laboratoire Vieillissement et Maladies Chroniques, Approches Epidémiologique et de Santé Publiques, Université Paris-Saclay, UVSQ, Inserm U1168, Montigny-Le-Bretonneux
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich Alexander University of Erlangen-Nurnberg and Universitaetsklinikum Erlangen, Erlangen
| | - Maria-Antonietta D'Agostino
- Department of Rheumatology, Université de Versailles St-Quentin-en Yvelines-Paris Saclay, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
| |
Collapse
|
14
|
Hirano F, Yokoyama-Kokuryo W, Yamazaki H, Tsutsumino M, Sakai R, Satoh S, Kimura T, Tojo N, Kohsaka H, Harigai M. Comparison of fluorescence optical imaging, ultrasonography and clinical examination with magnetic resonance imaging as a reference in active rheumatoid arthritis patients. Immunol Med 2018; 41:75-81. [PMID: 30938268 DOI: 10.1080/13497413.2018.1481578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Fluorescence optical imaging with indocyanine-green enhancement (FOI) is a new imaging modality for the assessment of hand arthritis. The objective of this study was to compare performance profiles of clinical examination (CE), US and FOI using MRI as a reference in the same active rheumatoid arthritis (RA) patients. METHODS CE, US, FOI and MRI were performed on six subjects with active RA. Each sequence of FOI was divided into three phases based on indocyanine-green dynamics and the joints were graded semi-quantitatively. Sensitivities and specificities of CE, US and FOI were calculated using the RAMRIS synovitis score >0 as a reference in a total of 30 joints (the second to fifth metacarpophalangeal (MCP) joints and the wrist of the clinically dominant hand). RESULTS FOI showed sensitivities and specificities, respectively, of 85% and of 94% for Phase-1 and 69% and 94% for Phase-2. Sensitivities and specificities were 100% and 35% for CE (tender or swollen), 92% and 41% for gray scale US, and 77% and 100% for color-Doppler US. CONCLUSIONS The performance characteristics of FOI in detection of synovitis in patients with active RA are comparable to those of US and more specific than CE. FOI has a potential as an assessment modality of RA.
Collapse
Affiliation(s)
- Fumio Hirano
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Waka Yokoyama-Kokuryo
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Hayato Yamazaki
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Michi Tsutsumino
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Ryoko Sakai
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Shiro Satoh
- c Department of Diagnostic Imaging , Ochanomizu Surugadai Clinic , Tokyo , Japan
| | - Tomo Kimura
- c Department of Diagnostic Imaging , Ochanomizu Surugadai Clinic , Tokyo , Japan
| | - Naoko Tojo
- d Department of Clinical Laboratory , Medical Hospital, Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Hitoshi Kohsaka
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Masayoshi Harigai
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| |
Collapse
|
15
|
Boeters DM, Nieuwenhuis WP, van Steenbergen HW, Reijnierse M, Landewé RBM, van der Helm-van Mil AHM. Are MRI-detected erosions specific for RA? A large explorative cross-sectional study. Ann Rheum Dis 2018; 77:861-868. [PMID: 29490980 DOI: 10.1136/annrheumdis-2017-212252] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 01/30/2018] [Accepted: 02/08/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVES MRI is recommended in the diagnostic process of rheumatoid arthritis (RA) to detect joint damage early. MRI-detected erosions are also present in symptom-free controls, especially at older age. It is unclear if RA-specific MRI-detected erosions can be distinguished from 'physiological' erosions in symptom-free individuals. This study compared MRI-detected erosions of patients with RA with healthy controls and with other arthritides. METHODS 589 newly presenting patients with early arthritis (238 RA, 351 other arthritides) and 193 symptom-free controls underwent contrast-enhanced 1.5T MRI of unilateral metacarpophalangeal and metatarsophalangeal (MTP) joints. Total erosion score (according to the Rheumatoid Arthritis MRI Scoring System), number, severity, location of erosions and simultaneous presence of MRI-detected inflammation (synovitis and/or bone marrow oedema) were compared; participants were categorised in three age groups (<40, 40-59, ≥60). RESULTS Patients with RA had statistically significant higher total erosion scores than controls but scores of individual persons largely overlapped. Grade ≥2 erosions and MTP5 erosions were specific for RA (specificity 98%-100% and 90%-98% for different age groups). MTP1 erosions were only specific if aged <40 (specificity 98%) and erosions with inflammation if aged <60 (specificity 91%-100%). ≥1 of the mentioned erosion characteristics were present in 29% of patients with RA. Comparing patients with RA with other arthritides revealed that grade ≥2 erosions and MTP5 erosions remained specific for RA (specificity ≥89%) as well as MTP1 erosions if aged <40 (specificity 93%), in contrast to erosions combined with inflammation (specificity 49%-85%). CONCLUSIONS Total erosion scores of individual persons were largely overlapping. Erosion characteristics specific for RA were identified, but were infrequently present. Caution is needed not to overestimate the value of MRI erosions in the diagnostic process.
Collapse
Affiliation(s)
- Debbie M Boeters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Wouter P Nieuwenhuis
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Robert B M Landewé
- Department of Clinical Rheumatology and Immunology, Amsterdam Medical Center Amsterdam and Atrium Medical Center Heerlen, Heerlen, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
16
|
Carotti M, Galeazzi V, Catucci F, Zappia M, Arrigoni F, Barile A, Giovagnoni A. Clinical utility of eco-color-power Doppler ultrasonography and contrast enhanced magnetic resonance imaging for interpretation and quantification of joint synovitis: a review. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:48-77. [PMID: 29350637 PMCID: PMC6179068 DOI: 10.23750/abm.v89i1-s.7010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/11/2022]
Abstract
With the introduction of new biologics such as anti-TNF-alpha antibodies and other therapies in the treatment of inflammatory arthritis, capable of halting joint destruction and functional disability, there are new pressures on diagnostic and prognostic imaging. Early demonstration of pre-erosive inflammatory features and monitoring of the long-term effects of treatment are becoming increasingly important. Early detection of synovitis offers advantages in terms of allowing early instigation of therapy and may allow the identification of those patients displaying more aggressive disease who might benefit from early intervention with expensive DMARD therapy. Advanced imaging techniques such as ultrasound (US) and magnetic resonance imaging (MRI) have focussed on the demonstration and quantification of synovitis and allow early diagnosis of inflammatory arthropathies such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Synovitis represents a potential surrogate measure of disease activity that can be monitored using either MRI or US; the techniques have, generally, focused on monitoring synovial volume or quality as assessed by its vascularity. However to achieve these goals, standardisation and validation of US and MRI are required to ensure accurate diagnosis, reproducibility and reliability. Each modality has different strengths and weaknesses and levels of validation. This article aims to increase the awareness of radiologists and rheumatologists about this field and to encourage them to participate and contribute to the ongoing development of these modalities. Without this collaboration, it is unlikely that these modalities will reach their full potential in the field of rheumatological imaging. This review is in two parts. The first part addresses the role of US and colour or power Doppler sonography (PDUS) in the detection and monitoring of synovitis in inflammatory arthropathies. The second part will look at advanced MR imaging and Dynamic contrast-enhanced MRI techniques and in particular how they are applied to the monitoring of the disease process.
Collapse
|
17
|
Xu H, Zhang Y, Zhang H, Wang C, Mao P. Comparison of the clinical effectiveness of US grading scoring system vs MRI in the diagnosis of early rheumatoid arthritis (RA). J Orthop Surg Res 2017; 12:152. [PMID: 29041980 PMCID: PMC5646118 DOI: 10.1186/s13018-017-0653-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Accepted: 10/02/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND As an irreversible disease, a treatment delay can negatively affect treatment response in rheumatoid arthritis (RA). Ultrasound and MRI have played an important role in assessing disease progression and response to treatment in RA for many years. The present study was designed to compare the diagnostic efficacy of ultrasound grading and MRI in early RA. METHODS In this retrospective study, 62 early RA patients within 12 months of symptom onset were included. DAS28, rheumatoid factor (RF), CRP, ESR, and anti-cyclic citrullinated peptide antibody (CCP) of the patients were measured. Bilateral hand joints and wrists were examined by ultrasonography (US) and MRI; diagnosis outcome was compared. Relationship between DAS28 scores, laboratory parameters, and ultrasound findings were analyzed. RESULTS Ultrasound and MRI had an equivalent diagnosis value in synovitis, joint effusion, and tenosynovitis. The detection rate of synovitis, arthroedema, and tenosynovitis on ultrasound and MRI was very close (P > 0.05). The detection rate of bone erosion was lower in ultrasonography than that in MRI (P < 0.05). There were significant differences between power Doppler ultrasonography (PDUS) and gray-scale ultrasonography (GSUS) in the diagnosis of synovitis (χ 2 = 3.92, P < 0.05); the sensitivity of GSUS was better than that of PDUS (P < 0.05). PDUS was positively correlated with DAS28, ESR, CRP, and CCP (P < 0.01), but not correlated with RF and disease duration (P > 0.05). GSUS was positively correlated with RF and CRP (P < 0.01), but not correlated with DAS28, CCP, ESR, and disease duration (P > 0.05). Bone erosion was positively correlated with disease duration, CCP, and RF (P < 0.01) and was not correlated with DAS28, ESR, and CRP (P > 0.05). CONCLUSION Ultrasonography has a high reliability in the diagnosis of early RA in synovitis, joint effusion, tenosynovitis, and bone erosion. Ultrasonography and clinical and laboratory parameters had a great correlativity. Both ultrasound and MRI are effective techniques. In view of the advantages of low cost and convenience, ultrasound may be a better choice during early RA diagnosis.
Collapse
Affiliation(s)
- Huajun Xu
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, San Xiang Road 1055, Suzhou, 215004 China
- Department of Ultrasound, Huzhou Central Hospital, Hong Qi Road 198, Huzhou, 313000 China
| | - Yingchun Zhang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, San Xiang Road 1055, Suzhou, 215004 China
| | - Huimei Zhang
- Department of Radiology, Huzhou Central Hospital, Hong Qi Road 198, Huzhou, 313000 China
| | - Caishan Wang
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, San Xiang Road 1055, Suzhou, 215004 China
| | - Pan Mao
- Department of Ultrasound, The Second Affiliated Hospital of Soochow University, San Xiang Road 1055, Suzhou, 215004 China
| |
Collapse
|
18
|
Mortada MA, Abdelwhab SM, Elgawish MH. Intra-articular methotrexate versus corticosteroid injections in medium-sized joints of rheumatoid arthritis patients—an intervention study. Clin Rheumatol 2017; 37:331-337. [DOI: 10.1007/s10067-017-3843-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 08/23/2017] [Accepted: 09/12/2017] [Indexed: 12/01/2022]
|
19
|
Alian A, Omar H, Chhabra A. Cross-Sectional Imaging for Inflammatory Arthropathy of the Pelvis. Semin Ultrasound CT MR 2017; 38:279-290. [PMID: 28705372 DOI: 10.1053/j.sult.2016.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Inflammatory arthropathy predominantly affecting the axial skeleton can cause pain, stiffness, disability, and ankylosis. This article discusses the use of cross-sectional imaging in the domain of inflammatory pelvic and axial arthropathy highlighting the key distinguishing features of common known diseases and their differential diagnoses.
Collapse
Affiliation(s)
- Ali Alian
- Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX; Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Hythem Omar
- Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX; Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Avneesh Chhabra
- Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, TX; Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, TX; Musculoskeletal Radiology, Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
20
|
Terslev L, Naredo E, Aegerter P, Wakefield RJ, Backhaus M, Balint P, Bruyn GAW, Iagnocco A, Jousse-Joulin S, Schmidt WA, Szkudlarek M, Conaghan PG, Filippucci E, D'Agostino MA. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 2: reliability and application to multiple joints of a standardised consensus-based scoring system. RMD Open 2017; 3:e000427. [PMID: 28948984 PMCID: PMC5597800 DOI: 10.1136/rmdopen-2016-000427] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Revised: 05/09/2017] [Accepted: 05/16/2017] [Indexed: 12/14/2022] Open
Abstract
Objectives To test the reliability of new ultrasound (US) definitions and quantification of synovial hypertrophy (SH) and power Doppler (PD) signal, separately and in combination, in a range of joints in patients with rheumatoid arthritis (RA) using the European League Against Rheumatisms–Outcomes Measures in Rheumatology (EULAR-OMERACT) combined score for PD and SH. Methods A stepwise approach was used: (1) scoring static images of metacarpophalangeal (MCP) joints in a web-based exercise and subsequently when scanning patients; (2) scoring static images of wrist, proximal interphalangeal joints, knee and metatarsophalangeal joints in a web-based exercise and subsequently when scanning patients using different acquisitions (standardised vs usual practice). For reliability, kappa coefficients (κ) were used. Results Scoring MCP joints in static images showed substantial intraobserver variability but good to excellent interobserver reliability. In patients, intraobserver reliability was the same for the two acquisition methods. Interobserver reliability for SH (κ=0.87) and PD (κ=0.79) and the EULAR-OMERACT combined score (κ=0.86) were better when using a ‘standardised’ scan. For the other joints, the intraobserver reliability was excellent in static images for all scores (κ=0.8–0.97) and the interobserver reliability marginally lower. When using standardised scanning in patients, the intraobserver was good (κ=0.64 for SH and the EULAR-OMERACT combined score, 0.66 for PD) and the interobserver reliability was also good especially for PD (κ range=0.41–0.92). Conclusion The EULAR-OMERACT score demonstrated moderate-good reliability in MCP joints using a standardised scan and is equally applicable in non-MCP joints. This scoring system should underpin improved reliability and consequently the responsiveness of US in RA clinical trials.
Collapse
Affiliation(s)
- Lene Terslev
- Rheumatology department, Centre for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Esperanza Naredo
- Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Philippe Aegerter
- Public Health Department, APHP, Hôpital Ambroise Paré, Boulogne-Billancourt; INSERM U1173, Versailles-Saint-Quentin University, Montigny le Bretonneaux, France
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Marina Backhaus
- Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Berlin, Germany
| | - Peter Balint
- National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George A W Bruyn
- Department of Rheumatology, MC Groep Hospitals, Lelystad, the Netherlands
| | | | | | - Wolfgang A Schmidt
- Medical Centre for Rheumatology, Immanuel Krankenhaus, Buch, Berlin, Germany
| | - Marcin Szkudlarek
- Department of Rheumatology, Zealand's University Hospital at Kàge, Copenaghen, Denmark
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Emilio Filippucci
- Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Maria Antonietta D'Agostino
- Rheumatology Department, APHP, Ambroise Paré Hospital, Boulogne-Billancourt, France.,INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Montigny le Bretonneaux, France
| |
Collapse
|
21
|
High-resolution ultrasound of the midfoot: sonography is more sensitive than conventional radiography in detection of osteophytes and erosions in inflammatory and non-inflammatory joint disease. Clin Rheumatol 2017; 36:2145-2149. [DOI: 10.1007/s10067-017-3658-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/18/2017] [Accepted: 04/21/2017] [Indexed: 01/04/2023]
|
22
|
Fluorescence optical imaging and 3T-MRI for detection of synovitis in patients with rheumatoid arthritis in comparison to a composite standard of reference. Eur J Radiol 2017; 90:6-13. [DOI: 10.1016/j.ejrad.2017.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/16/2017] [Accepted: 02/12/2017] [Indexed: 11/22/2022]
|
23
|
Möller I, Szkudlarek M. Imaging of regional pain syndromes; from syndromes to conditions using imaging? Best Pract Res Clin Rheumatol 2016; 30:707-719. [PMID: 27931963 DOI: 10.1016/j.berh.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Revised: 06/17/2016] [Accepted: 06/18/2016] [Indexed: 11/17/2022]
Abstract
Musculoskeletal regional pain syndromes often lead to patient referrals in general and rheumatological practice. Detailed history taking and clinical examination can in most cases reveal the cause for pain and direct the subsequent management of the conditions. Yet, when in doubt, imaging methods have to support the clinical assessment. This paper presents the underlying pathologies of the most frequently encountered regional pain syndromes and the role of musculoskeletal ultrasonography and magnetic resonance imaging in their visualization. It presents data, where available, on diagnostic accuracy and comparisons with gold standards. The article stresses the advantages and disadvantages of the analyzed imaging modalities and suggests the future research agenda.
Collapse
Affiliation(s)
- Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain; Department of Rheumatology, Zealand's University Hospital, Lykkebækvej 1, 4600, Køge, Denmark.
| | - Marcin Szkudlarek
- Department of Rheumatology, Zealand's University Hospital, Lykkebækvej 1, 4600, Køge, Denmark
| |
Collapse
|
24
|
Gutierrez M, Kaeley GS, Bertolazzi C, Pineda C. State of the art of ultrasound in the assessment of psoriasis and psoriatic arthritis. Expert Rev Clin Immunol 2016; 13:439-447. [DOI: 10.1080/1744666x.2017.1262765] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- Marwin Gutierrez
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, México City, Mexico
| | - Gurjit S Kaeley
- College of Medicine, University of Florida, Jacksonville, USA
| | - Chiara Bertolazzi
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, México City, Mexico
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitación, México City, Mexico
| |
Collapse
|
25
|
Schäfer VS, Schmidt WA, Backhaus M, Hartung W. Arthritis of the Knee Joint in Rheumatoid Arthritis - Evaluation of Treatment Response by Ultrasound in Daily Clinical Practice. Open Rheumatol J 2016; 10:81-87. [PMID: 27867432 PMCID: PMC5101627 DOI: 10.2174/1874312901610010081] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/22/2022] Open
Abstract
Background: Rheumatoid arthritis (RA) commonly involves the knee joint in up to 30% of patients. Musculoskeletal ultrasound enables the skilled clinician to easily assess disease activity. Objective: To evaluate the sensitivity to change of the sonography score of large joints in Rheumatology (SOLAR) for different treatments of knee arthritis in RA. Method: Joints were assessed by ultrasound at 4 visits. Laboratory, immunological and clinical parameters were recorded. Results: 225 RA patients were analyzed. The DAS 28 in the subgroup receiving systemic steroids was significantly higher (p < 0.001) than in patients treated with intraarticular glucocorticosteroids (GCs) at T0, comparing the values from T0 to T3 the same appeared (p=0.003). Concerning the acute GC treatment regimens, the gray scale ultrasound (GSUS) sum score was found to be significantly higher in patients receiving intraarticular GCs versus no GCs (p=0,035), as well as in patients receiving systemic versus intraarticular GCs (p=0.001). Regarding the differences from T0 and T3, similar to the baseline analysis, a high GSUS sum score was significantly associated with intraarticular GCs, a low to no GC administration (p=0.035), while a high GSUS sum score was significantly linked to intraarticular GCs, rather than systemic GCs (p=0.008). Conclusion: SOLAR score is sensitive to change in knee arthritis. Intraarticular GC administration is performed in patients with high GSUS scores. Systemic administration of GC is linked to high disease activity (DAS28) rather than GSUS or power Doppler ultrasound (PDUS) results.
Collapse
Affiliation(s)
- V S Schäfer
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology and Clinical Immunology Berlin-Buch, Lindenberger Weg 19, 13125 Berlin, Germany
| | - W A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology and Clinical Immunology Berlin-Buch, Lindenberger Weg 19, 13125 Berlin, Germany
| | - M Backhaus
- Department of Internal Medicine, Park-Klinik Weißensee, Rheumatology and Clinical Immunology, Schönstraße 80, 13086 Berlin, Germany
| | - W Hartung
- Department of Rheumatology and Clinical Immunology, Asklepios Clinic, Kaiser- Karl-V.-Allee 3, Bad Abbach, Germany
| |
Collapse
|
26
|
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.
Collapse
|
27
|
Wang MY, Wang XB, Sun XH, Liu FL, Huang SC. Diagnostic value of high-frequency ultrasound and magnetic resonance imaging in early rheumatoid arthritis. Exp Ther Med 2016; 12:3035-3040. [PMID: 27882112 DOI: 10.3892/etm.2016.3695] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 05/19/2016] [Indexed: 12/24/2022] Open
Abstract
Early diagnosis and management improve the outcome of patients with rheumatoid arthritis (RA). The present study explored the application of high-frequency ultrasound (US) and magnetic resonance imaging (MRI) in the detection of early RA. Thirty-nine patients (20 males and 19 females) diagnosed with early RA were enrolled in the study. A total of 1,248 positions, including 858 hand joints and 390 tendons, were examined by high-frequency US and MRI to evaluate the presence of bone erosion, bone marrow edema (BME), synovial proliferation, joint effusion, tendinitis and tendon sheath edema. The imaging results of the above abnormalities, detected by US, were compared with those identified using MRI. No statistically significant overall changes were observed between high-frequency US and MRI in detecting bone erosion [44 (5.1%) vs. 35 (4.1%), respectively; P>0.05], tendinitis [18 (4.6%) vs. 14 (1.5%), respectively; P>0.05] and tendon sheath edema [37 (9.5%) vs. 30 (7.7%), respectively; P>0.05]. Significant differences were observed between high-frequency US and MRI with regards to the detection of synovial proliferation [132 (15.4%) vs. 66 (7.7%), respectively; P<0.05] and joint effusion [89 (10.4%) vs. 52 (6.1%), respectively; P<0.05]. In addition, significant differences were identified between the detection of BME using MRI compared with high-frequency US (5.5 vs. 0%, respectively; P<0.05). MRI and high-frequency US of the dominant hand and wrist joints were comparably sensitive to bone erosion, tendinitis and tendon sheath edema. However, MRI was more sensitive in detecting bone marrow edema in early RA, while US was more sensitive in the evaluation of joint effusion and synovial proliferation. In conclusion, US and MRI are promising for the detection and diagnosis of inflammatory activity in patients with RA.
Collapse
Affiliation(s)
- Ming-Yu Wang
- Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Xian-Bin Wang
- Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Xue-Hui Sun
- Department of Rheumatology and Immunology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Feng-Li Liu
- Department of Rheumatology and Radiology, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| | - Sheng-Chuan Huang
- Department of Rheumatology and Ultrasonography, Yantai Yuhuangding Hospital, Yantai, Shandong 264000, P.R. China
| |
Collapse
|
28
|
Soldatos T, Pezeshk P, Ezzati F, Karp DR, Taurog JD, Chhabra A. Cross-sectional imaging of adult crystal and inflammatory arthropathies. Skeletal Radiol 2016; 45:1173-91. [PMID: 27209200 DOI: 10.1007/s00256-016-2402-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 02/02/2023]
Abstract
This article highlights the key aspects and current perspectives of the role of cross-sectional imaging in adult crystal and inflammatory arthropathies in adults, briefly discussing CT, and particularly focusing on MRI and US imaging as it supplements the conventional radiography. The role of conventional and advanced MR imaging techniques and imaging findings in this domain is discussed and illustrated with case examples. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article contains images and data, which were collected from patients as a part of a retrospective IRB from the institutional teaching files and informed consent was waived.
Collapse
Affiliation(s)
| | - Parham Pezeshk
- Musculoskeletal Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA
| | - Fatemeh Ezzati
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - David R Karp
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Joel D Taurog
- Division of Rheumatic Diseases, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Avneesh Chhabra
- Musculoskeletal Radiology and Orthopaedic Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9178, USA. .,Musculoskeletal Radiology, Russell H. Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| |
Collapse
|
29
|
Kaeley GS, Evangelisto AM, Nishio MJ, Goss SL, Liu S, Kalabic J, Kupper H. Methotrexate Dosage Reduction Upon Adalimumab Initiation: Clinical and Ultrasonographic Outcomes from the Randomized Noninferiority MUSICA Trial. J Rheumatol 2016; 43:1480-9. [PMID: 27307526 DOI: 10.3899/jrheum.151009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To examine the clinical and ultrasonographic (US) outcomes of reducing methotrexate (MTX) dosage upon initiating adalimumab (ADA) in MTX-inadequate responders with moderately to severely active rheumatoid arthritis (RA). METHODS MUSICA (NCT01185288) was a double-blind, randomized, parallel-arm study of 309 patients with RA receiving MTX ≥ 15 mg/week for ≥ 12 weeks before screening. Patients were randomized to high dosage (20 mg/week) or low dosage (7.5 mg/week) MTX; all patients received 40 mg open-label ADA every other week for 24 weeks. The primary endpoint was Week 24 mean 28-joint Disease Activity Score based on C-reactive protein (DAS28-CRP) to test for noninferiority of low-dosage MTX using a 15% margin. US images were scored using a 10-joint semiquantitative system incorporating OMERACT definitions for pathology, assessing synovial hypertrophy, vascularity, and bony erosions. RESULTS Rapid improvement in clinical indices was observed in both groups after addition of ADA. The difference in mean DAS28-CRP (0.37, 95% CI 0.07-0.66) comparing low-dosage (4.12, 95% CI 3.88-4.34) versus high-dosage MTX (3.75, 95% CI 3.52-3.97) was statistically significant and non-inferiority was not met. Statistically significant differences were not detected for most clinical, functional, and US outcomes. Pharmacokinetic and safety profiles were similar. CONCLUSION In MUSICA, Week 24 mean DAS28-CRP, the primary endpoint, did not meet non-inferiority for the low-dosage MTX group. Although the differences between the 2 MTX dosage groups were small, our study findings did not support routine MTX reduction in MTX inadequate responders initiating ADA.
Collapse
Affiliation(s)
- Gurjit S Kaeley
- From the University of Florida College of Medicine, Jacksonville, Florida; Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey; Diablo Clinical Research, Walnut Creek, California; AbbVie Inc., North Chicago, Illinois, USA; AbbVie Deutschland GmbH and Co. KG., Ludwigshafen, Germany.G.S. Kaeley, MBBS, MRCP, University of Florida College of Medicine; A.M. Evangelisto, MD, Arthritis, Rheumatic and Back Disease Associates; M.J. Nishio, MD, Diablo Clinical Research; S.L. Goss, PhD, AbbVie Inc.; S. Liu, PhD, AbbVie Inc.; J. Kalabic, MD, AbbVie Inc.; H. Kupper, MD, AbbVie Deutschland GmbH and Co. KG.
| | - Amy M Evangelisto
- From the University of Florida College of Medicine, Jacksonville, Florida; Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey; Diablo Clinical Research, Walnut Creek, California; AbbVie Inc., North Chicago, Illinois, USA; AbbVie Deutschland GmbH and Co. KG., Ludwigshafen, Germany.G.S. Kaeley, MBBS, MRCP, University of Florida College of Medicine; A.M. Evangelisto, MD, Arthritis, Rheumatic and Back Disease Associates; M.J. Nishio, MD, Diablo Clinical Research; S.L. Goss, PhD, AbbVie Inc.; S. Liu, PhD, AbbVie Inc.; J. Kalabic, MD, AbbVie Inc.; H. Kupper, MD, AbbVie Deutschland GmbH and Co. KG
| | - Midori J Nishio
- From the University of Florida College of Medicine, Jacksonville, Florida; Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey; Diablo Clinical Research, Walnut Creek, California; AbbVie Inc., North Chicago, Illinois, USA; AbbVie Deutschland GmbH and Co. KG., Ludwigshafen, Germany.G.S. Kaeley, MBBS, MRCP, University of Florida College of Medicine; A.M. Evangelisto, MD, Arthritis, Rheumatic and Back Disease Associates; M.J. Nishio, MD, Diablo Clinical Research; S.L. Goss, PhD, AbbVie Inc.; S. Liu, PhD, AbbVie Inc.; J. Kalabic, MD, AbbVie Inc.; H. Kupper, MD, AbbVie Deutschland GmbH and Co. KG
| | - Sandra L Goss
- From the University of Florida College of Medicine, Jacksonville, Florida; Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey; Diablo Clinical Research, Walnut Creek, California; AbbVie Inc., North Chicago, Illinois, USA; AbbVie Deutschland GmbH and Co. KG., Ludwigshafen, Germany.G.S. Kaeley, MBBS, MRCP, University of Florida College of Medicine; A.M. Evangelisto, MD, Arthritis, Rheumatic and Back Disease Associates; M.J. Nishio, MD, Diablo Clinical Research; S.L. Goss, PhD, AbbVie Inc.; S. Liu, PhD, AbbVie Inc.; J. Kalabic, MD, AbbVie Inc.; H. Kupper, MD, AbbVie Deutschland GmbH and Co. KG
| | - Shufang Liu
- From the University of Florida College of Medicine, Jacksonville, Florida; Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey; Diablo Clinical Research, Walnut Creek, California; AbbVie Inc., North Chicago, Illinois, USA; AbbVie Deutschland GmbH and Co. KG., Ludwigshafen, Germany.G.S. Kaeley, MBBS, MRCP, University of Florida College of Medicine; A.M. Evangelisto, MD, Arthritis, Rheumatic and Back Disease Associates; M.J. Nishio, MD, Diablo Clinical Research; S.L. Goss, PhD, AbbVie Inc.; S. Liu, PhD, AbbVie Inc.; J. Kalabic, MD, AbbVie Inc.; H. Kupper, MD, AbbVie Deutschland GmbH and Co. KG
| | - Jasmina Kalabic
- From the University of Florida College of Medicine, Jacksonville, Florida; Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey; Diablo Clinical Research, Walnut Creek, California; AbbVie Inc., North Chicago, Illinois, USA; AbbVie Deutschland GmbH and Co. KG., Ludwigshafen, Germany.G.S. Kaeley, MBBS, MRCP, University of Florida College of Medicine; A.M. Evangelisto, MD, Arthritis, Rheumatic and Back Disease Associates; M.J. Nishio, MD, Diablo Clinical Research; S.L. Goss, PhD, AbbVie Inc.; S. Liu, PhD, AbbVie Inc.; J. Kalabic, MD, AbbVie Inc.; H. Kupper, MD, AbbVie Deutschland GmbH and Co. KG
| | - Hartmut Kupper
- From the University of Florida College of Medicine, Jacksonville, Florida; Arthritis, Rheumatic and Back Disease Associates, Voorhees, New Jersey; Diablo Clinical Research, Walnut Creek, California; AbbVie Inc., North Chicago, Illinois, USA; AbbVie Deutschland GmbH and Co. KG., Ludwigshafen, Germany.G.S. Kaeley, MBBS, MRCP, University of Florida College of Medicine; A.M. Evangelisto, MD, Arthritis, Rheumatic and Back Disease Associates; M.J. Nishio, MD, Diablo Clinical Research; S.L. Goss, PhD, AbbVie Inc.; S. Liu, PhD, AbbVie Inc.; J. Kalabic, MD, AbbVie Inc.; H. Kupper, MD, AbbVie Deutschland GmbH and Co. KG
| |
Collapse
|
30
|
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]
|
31
|
General applications of ultrasound in rheumatology: why we need it in our daily practice. J Clin Rheumatol 2015; 21:133-43. [PMID: 25807093 DOI: 10.1097/rhu.0000000000000230] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Ultrasound (US) is a noninvasive imaging technique that continues to gain interest among rheumatologists because of its undoubted utility for the assessment of a wide range of abnormalities in rheumatic diseases. It also has a great potential to be used at the time of consultation as an extension of the clinical examination.Current data demonstrate that the standard clinical approach could result in an insensitive assessment of some the different aspects of the various rheumatic diseases for which US has become a feasible and effective imaging modality that allows early detection of anatomical changes, careful guidance for the aspiration and/or local treatment, and short- and long-term therapy monitoring at the joint, tendon, enthesis, nail, and skin levels. The spectrum of pathological conditions for which US plays a crucial role continues to increase over time and includes rheumatoid arthritis, spondyloarthropathies, osteoarthritis, crystal-related arthropathies, connective tissue disorders, and vasculitis.It is expected that the inclusion of more longitudinal studies with a larger number of patients and more rigorous methodological approach will undoubtedly provide a better understanding of the significance of the abnormal US findings detected in order to provide the proper diagnostic and/or therapeutic approaches. In this article, we analyze the current potential applications of US in rheumatology and discuss the evidence supporting its use in the daily rheumatologic practice.
Collapse
|
32
|
Szkudlarek M, Terslev L, Wakefield RJ, Backhaus M, Balint PV, Bruyn GAW, Filippucci E, Gandjbakhch F, Iagnocco A, Mandl P, Möller I, Naredo E, Schmidt WA, d'Agostino MA. Summary Findings of a Systematic Literature Review of the Ultrasound Assessment of Bone Erosions in Rheumatoid Arthritis. J Rheumatol 2015; 43:12-21. [PMID: 26628596 DOI: 10.3899/jrheum.141416] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Bone erosions in rheumatoid arthritis (RA) have been studied in an increasing amount of research. Both earlier and present classification criteria of RA contain erosions as a significant classification component. Ultrasound (US) can detect bone changes in accessible surfaces. Therefore, the study group performed a systematic literature review of assessment of RA bone erosions with US. METHODS A systematic search of PubMed and Embase was performed. Data on the definitions of RA bone erosions, their size, scoring, relation to synovitis, comparators, and elements of the OMERACT (Outcome Measures in Rheumatology Clinical Trials) filter were collected and analyzed. RESULTS The selection process identified 58 original research papers. The assessed joints were most frequently metacarpophalangeal (MCP; 41 papers), proximal interphalangeal (19 papers), and metatarsophalangeal joints (MTP; 18 papers). The OMERACT definition of RA bone erosion on US was used most often (17 papers). Second and fifth MCP and fifth MTP were recommended as target joints. Conventional radiography was the most frequently used comparator (27 papers), then magnetic resonance imaging (17 papers) and computed tomography (5 papers). Reliability of assessment was presented in 20 papers and sensitivity to change in 11 papers. CONCLUSION This paper presents results of a systematic literature review of bone erosion assessment in RA with US. The survey suggests that US can be a helpful adjunct to the existing methods of imaging bone erosions in RA. It analyzes definitions, scoring systems, used comparators, and elements of the OMERACT filter. It also presents recommendations for a future research agenda based on the results of the review.
Collapse
Affiliation(s)
- Marcin Szkudlarek
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Lene Terslev
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Richard J Wakefield
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Marina Backhaus
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Peter V Balint
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - George A W Bruyn
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Emilio Filippucci
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Frederique Gandjbakhch
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Annamaria Iagnocco
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Peter Mandl
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Ingrid Möller
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Esperanza Naredo
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Wolfgang A Schmidt
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| | - Maria Antonietta d'Agostino
- From the Department of Rheumatology, Copenhagen University Hospital at Køge, Køge; Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM) Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin, Berlin; Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Germany; Third Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Department of Rheumatology, MC Groep, Lelystad, the Netherlands; Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona; Rheumatology Unit, Dipartmento Medicina Interna e Specialità Mediche, Sapienza Università di Roma, Rome, Italy; Rheumatology Department, Université Paris 6-Pierre et Marie Curie, Hôpital La Pitié Salpetrière, Assistance Publique - Hôpitaux de Paris (APHP), Paris; Rheumatology Department, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, Boulogne-Billancourt, France; Division of Rheumatology, University of Vienna, Vienna, Austria; Instituto Poal de Reumatologia-Hospital Platon, Barcelona; Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain.M. Szkudlarek, MD, PhD, Department of Rheumatology, Copenhagen University Hospital at Køge; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup; R.J. Wakefield, BM, FRCP, MD, Senior Lecturer and Honorary Consultant Rheumatologist, LIRMM Section of Musculoskeletal Disease, University of Leeds, Chapel Allerton Hospital; M. Backhaus, Professor, Dr. Med., Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin; P.V. Balint, MD, PhD, FRCP, Third Department of Rheumatology, Nationa
| |
Collapse
|
33
|
Padovano I, Costantino F, Breban M, D'Agostino MA. Prevalence of ultrasound synovial inflammatory findings in healthy subjects. Ann Rheum Dis 2015; 75:1819-23. [DOI: 10.1136/annrheumdis-2015-208103] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 11/06/2015] [Indexed: 01/18/2023]
|
34
|
Ling S, Liu Y, Fu J, Colletta A, Gilon C, Holoshitz J. Shared epitope-antagonistic ligands: a new therapeutic strategy in mice with erosive arthritis. Arthritis Rheumatol 2015; 67:2061-70. [PMID: 25892196 DOI: 10.1002/art.39158] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 04/09/2015] [Indexed: 01/16/2023]
Abstract
OBJECTIVE The mechanisms underlying bone damage in rheumatoid arthritis (RA) are incompletely understood. We recently identified the shared epitope (SE), an HLA-DRB1-coded 5-amino acid sequence motif carried by the majority of RA patients as a signal transduction ligand that interacts with cell surface calreticulin and accelerates osteoclast (OC)-mediated bone damage in collagen-induced arthritis (CIA). Given the role of the SE/calreticulin pathway in arthritis-associated bone damage, we sought to determine the therapeutic targetability of calreticulin. METHODS A library of backbone-cyclized peptidomimetic compounds, all carrying an identical core DKCLA sequence, was synthesized. The ability of these compounds to inhibit SE-activated signaling and OC differentiation was tested in vitro. The effect on disease severity and OC-mediated bone damage was studied by weekly intraperitoneal administration of the compounds to DBA/1 mice with CIA. RESULTS Two members of the peptidomimetics library were found to have SE-antagonistic effects and antiosteoclast differentiation effects at picomolar concentrations in vitro. The lead mimetic compound, designated HS(4-4)c Trp, potently ameliorated arthritis and bone damage in vivo when administered in picogram doses to mice with CIA. Another mimetic analog, designated HS(3-4)c Trp, was found to lack activity, both in vitro and in vivo. The differential activity of the 2 analogs depended on minor differences in their respective ring sizes and correlated with distinctive geometry when computationally docked to the SE binding site on calreticulin. CONCLUSION These findings identify calreticulin as a novel therapeutic target in erosive arthritis and provide sound rationale and early structure/activity relationships for future drug design.
Collapse
Affiliation(s)
- Song Ling
- University of Michigan School of Medicine, Ann Arbor
| | - Ying Liu
- University of Michigan School of Medicine, Ann Arbor
| | - Jiaqi Fu
- University of Michigan School of Medicine, Ann Arbor
| | | | - Chaim Gilon
- The Hebrew University of Jerusalem, Jerusalem, Israel
| | | |
Collapse
|
35
|
Ultrasound in psoriatic arthritis. Can it facilitate a best routine practice in the diagnosis and management of psoriatic arthritis? Clin Rheumatol 2015; 34:1847-55. [DOI: 10.1007/s10067-015-3053-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/11/2015] [Indexed: 01/08/2023]
|
36
|
Amitai I, Werner S, Schicke B, Burmester GR, Minet O, Zabaryło U, Backhaus M, Ohrndorf S. Comparison of Photo Optical Imaging with Musculoskeletal Ultrasound and Clinical Examination in the Assessment of Inflammatory Activity in Proximal Interphalangeal Joints in Rheumatoid Arthritis and Osteoarthritis. J Rheumatol 2015; 42:1595-602. [DOI: 10.3899/jrheum.150098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/29/2015] [Indexed: 11/22/2022]
Abstract
Objective.Lightscan is a novel, rapid, low-cost, easily operated and noninvasive imaging technology used to assess inflammatory activity in proximal interphalangeal (PIP) joints. The results are calculated automatically. To our knowledge, this is the first comparative study of photo optical imaging (POI), with clinical examination (CE), disease activity score at 28 joints (DAS28)-erythrocyte sedimentation rate (ESR), and musculoskeletal ultrasonography (US) in healthy subjects and patients with rheumatoid arthritis (RA) or osteoarthritis (OA).Methods.There were 688 PIP joints of both hands examined in 87 subjects (38 RA, 21 OA, 28 healthy) by Lightscan and compared with CE for clinically swollen and tender joints, DAS28-ESR (only RA), and US.Results.With US as reference, POI had a sensitivity of 74% and a specificity of 93%. In the receiver-operating curve (ROC) analysis, the Lightscan showed a higher sensitivity and specificity [area under the curve (AUC) 0.879] for the distinction of healthy subjects versus patients (OA, RA) than US in greyscale (GSUS; AUC 0.797) and power Doppler (PDUS; AUC 0.67). POI correlated significantly with GSUS (r 0.473, p < 0.01) and PDUS (r 0.486, p < 0.01). The agreement rates between POI and GSUS were up to 79%, between POI and PDUS up to 92%, and between POI and CE up to 66%. POI did not correlate with DAS28-ESR.Conclusion.The Lightscan is a new technology offering sensitive imaging detection of inflammatory changes in subjects with RA and OA with PIP arthritis. POI was more sensitive than CE and correlated significantly to GSUS and PDUS, while presenting a higher sensitivity and specificity for the detection of healthy subjects versus patients (RA, OA) based on the ROC analysis.
Collapse
|
37
|
Kisten Y, Györi N, Af Klint E, Rezaei H, Levitsky A, Karlsson A, van Vollenhoven R. Detection of clinically manifest and silent synovitis in the hands and wrists by fluorescence optical imaging. RMD Open 2015; 1:e000106. [PMID: 26535142 PMCID: PMC4612680 DOI: 10.1136/rmdopen-2015-000106] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 01/11/2023] Open
Abstract
Objectives The correct identification of synovitis is critical for achieving optimal therapy results. Fluorescence optical imaging (FOI) is a novel modality based on the use of an intravenous fluorophore, which enables fluorescent imaging of the hands and wrists with increased focal optical signal intensities in areas of high perfusion and/or capillary leakage. The study objective was to determine the diagnostic utility of FOI in detecting apparent and clinically non-apparent active synovitis. Methods Bilateral hand and wrist joints (n=872) of 26 patients with inflammatory arthritis assessed by standard clinical examination, musculoskeletal ultrasound (MSUS) and FOI were studied. Synovitis was defined as tender and swollen joints on clinical examination, presence of synovial thickening and intra-articular Doppler signals on MSUS, and abnormal focal optical signal intensities on FOI, respectively. Subclinical synovitis was defined as being clinically non-apparent, but positively inflamed on MSUS. Results Depending on the standard used to define inflammation, FOI ranged from 73–83% sensitive and 83–95% specific for detecting manifest synovitis. For detecting clinically silent synovitis, the sensitivity, specificity and positive and negative predictive values of FOI were 80%, 96%, 77% and 97%, respectively. Conclusions The high degree of agreement between MSUS and FOI suggest its use in clinical practice, especially when MSUS is not available, in order to identify synovitis earlier and with greater confidence. FOI may be particularly useful in identifying patients with clinically non-apparent joint inflammation of the hands and/or wrists.
Collapse
Affiliation(s)
- Yogan Kisten
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Noémi Györi
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Erik Af Klint
- The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Hamed Rezaei
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden ; The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Adrian Levitsky
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Anna Karlsson
- The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Ronald van Vollenhoven
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden ; The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| |
Collapse
|
38
|
Toprak H, Kılıç E, Serter A, Kocakoç E, Özgöçmen S. Doppler US in rheumatic diseases with special emphasis on rheumatoid arthritis and spondyloarthritis. Diagn Interv Radiol 2015; 20:72-7. [PMID: 23996840 DOI: 10.5152/dir.2013.13127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Developments in digital ultrasonography (US) technology and the use of high-frequency broadband transducers have increased the quality of US imaging, particularly of superficial tissues. Thus, US, particularly color US or power Doppler US, in which high-resolution transducers are used, has become an important imaging modality in the assessment of rheumatic diseases. Furthermore, therapeutic interventions and biopsies can be performed under US guidance during the assessment of lesions. In this era of effective treatments, such as biologics, improvements in synovial inflammation in rheumatoid arthritis as well as changes in enthesitis in spondyloarthropathies, including ankylosing spondylitis and psoriatic arthritis, can be monitored effectively using gray-scale and/or power Doppler US. US is also a good imaging modality for crystal arthropathies, including gout and pseudogout, in which synovitis, erosions, tophi, and crystal deposition within or around the joint can be visualized readily. Vascular and tenosynovial structures, as well as the salivary glands, can be assessed with US in vasculitis and connective tissue disorders, including systemic lupus erythematosus and Sjögren's syndrome. Current research is focused on improving the sensitivity, specificity, validity, and reproducibility of US findings. In this review, we summarized the role of US, particularly power Doppler US, in rheumatic diseases and inflammation in superficial tissues.
Collapse
Affiliation(s)
- Hüseyin Toprak
- From the Department of Radiology (H.T., A.S., E. Kocakoç e-mail: ), Bezmialem Vakıf University School of Medicine, İstanbul, Turkey; the Division of Rheumatology (E.Kılıç, S.Ö.), Department of Physical Medicine and Rehabilitation, Erciyes University School of Medicine, Kayseri, Turkey
| | | | | | | | | |
Collapse
|
39
|
Comparison of prevalence of synovitis by ultrasound assessment in subjects exposed or not to self-reported physical overexertion: the Monday's synovitis. ScientificWorldJournal 2014; 2014:563981. [PMID: 25431790 PMCID: PMC4241274 DOI: 10.1155/2014/563981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 09/20/2014] [Accepted: 09/22/2014] [Indexed: 11/30/2022] Open
Abstract
Objective. To compare the proportion of synovitis detected by ultrasonographic study (USS) of the hands, in subjects with no rheumatologic known disease according to self-reported level of overexertion performed the day before. Methods. 407 consecutive volunteers were enrolled in a twelve-month period and underwent an ultrasound assessment of the hand. All studies were performed on Monday or Friday. Subjects were grouped according to their self-reported overexertion carried out the day before. Presence or absence of ultrasonographic findings compatible with synovitis was compared between groups. Results. 95.8% of those tested on Friday had made no overexertion the day before the study, while 30.2% of those assessed on Monday declared to have carried out an overexertion. Presence of carpal synovial hypertrophy, synovial fluid/effusion, and power-Doppler signal was statistically higher in subjects who carried out an overexertion the day before the study than the rest of subjects when the dominant hand was assessed. Globally, presence of any synovitis ultrasonographic finding was statistically higher in subjects who were studied on Monday than Friday (34.9% versus 12.1%) and in subjects who self-reported an overexertion the day before compared to the rest of subjects (47.7 versus 11.5%). Conclusions. In general, we recommend performing the USS as many days as possible after the most recent overexertion.
Collapse
|
40
|
Gent YY, Ahmadi N, Voskuyl AE, Hoetjes N, van Kuijk C, Britsemmer K, Turkstra F, Boers M, Hoekstra OS, van der Laken CJ. Detection of Subclinical Synovitis with Macrophage Targeting and Positron Emission Tomography in Patients with Rheumatoid Arthritis without Clinical Arthritis. J Rheumatol 2014; 41:2145-52. [DOI: 10.3899/jrheum.140059] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To determine whether macrophage targeting by (R)-11C-PK11195 positron emission tomography (PET) can visualize subclinical joint inflammation in patients with rheumatoid arthritis (RA) without clinical arthritis during or after treatment, with flare as clinical outcome measure.Methods.(R)-11C-PK11195 PET and contrast-enhanced magnetic resonance imaging (MRI) of hands/wrists were performed in 29 patients with RA without clinical arthritis. (R)-11C-PK11195 PET uptake (semiquantitative score 0–3) in metacarpophalangeal, proximal interphalangeal, and wrist joints (i.e., 22 joints per patient) was scored and summed to obtain a cumulative PET score (range 0–66). Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) was performed on similar joints. Synovitis and bone marrow edema scores (> 1) were summed to obtain a cumulative MRI score (range 0–288). Occurrence of flare was determined during 3-year followup.Results.Flare was observed in 17/29 patients (59%). (R)-11C-PK11195 PET showed enhanced tracer uptake in 16/29 patients (55%), of which 11 (69%) developed a flare. Highest cumulative PET scores (> 6, n = 3) corresponded with highest cumulative MRI scores (> 39) and were related to development of flare in hands/wrists within 6 months. Cumulative PET scores of patients developing a flare were higher than those of patients without a flare [median (interquartile range) 2 (0–4.5) vs 0 (0–1), p < 0.05]. In contrast, no significant differences were found between cumulative MRI scores of patients with and without a flare.Conclusion.(R)-11C-PK11195 PET showed enhanced uptake, pointing to presence of subclinical synovitis in over half of patients without clinical arthritis. (R)-11C-PK11195 PET may be of value for prediction of exacerbation of RA, since cumulative PET scores > 1 were associated with development of flare within 3 years.
Collapse
|
41
|
Rezaei H, Torp-Pedersen S, af Klint E, Backheden M, Kisten Y, Györi N, van Vollenhoven RF. Diagnostic utility of musculoskeletal ultrasound in patients with suspected arthritis--a probabilistic approach. Arthritis Res Ther 2014; 16:448. [PMID: 25270355 PMCID: PMC4209056 DOI: 10.1186/s13075-014-0448-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2014] [Accepted: 09/01/2014] [Indexed: 01/19/2023] Open
Abstract
Introduction This study aimed to assess the utility of musculoskeletal ultrasound (MSUS) in patients with joint symptoms using a probabilistic approach. Methods One hundred and three patients without prior rheumatologic diagnosis and referred to our clinic for evaluation of inflammatory arthritis were included. Patients were assessed clinically including joint examination, laboratory testing including acute-phase reactants, rheumatoid factor (RF) and anti citrulinated protein antibody (ACPA), and radiographs of hands and feet if clinically indicated. A diagnostic assessment was then performed by the responsible rheumatologist where the probability of a) any inflammatory arthritis and b) rheumatoid arthritis was given on a 5-point scale ranging from 0 to 20% up to 80 to 100% probability. Subsequently, an ultrasound examination of the wrist, metacarpophalangeal (MCP), proximal interphalangeal (PIP) joints 2 to 5 in both hands, metatarsophalangeal (MTP) joints 2 to 5 in both feet and any symptomatic joints was performed and the results presented to the same rheumatologist. The latter then assessed the diagnostic probabilities again, using the same scale. Results The rheumatologists’ certainty for presence/absence of inflammatory arthritis and rheumatoid arthritis was increased significantly following ultrasound performance. The proportion of patient for whom diagnostic certainty for inflammatory arthritis was maximal was 33.0% before and 71.8% after musculoskeletal ultrasound (P <0.001). With regard to a diagnosis of RA, the proportions were 31.1% pre-test and 61.2% post-test (P <0.001). MSUS findings agreed with the final diagnosis in 95% of patients. Conclusion Musculoskeletal ultrasound, when added to routine rheumatologic investigation, greatly increases the diagnostic certainty in patients referred for the evaluation of inflammatory arthritis. The changes from pre-test to post-test probability quantify the diagnostic utility of musculoskeletal ultrasound in probabilistic terms.
Collapse
|
42
|
Schäfer VS, Hartung W, Hoffstetter P, Berger J, Stroszczynski C, Müller M, Fleck M, Ehrenstein B. Quantitative assessment of synovitis in patients with rheumatoid arthritis using fluorescence optical imaging. Arthritis Res Ther 2014; 15:R124. [PMID: 24432363 PMCID: PMC3978726 DOI: 10.1186/ar4304] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Introduction To prospectively evaluate quantitative assessment of fluorescence optical imaging (FOI) for differentiation of synovitic from non-synovitic joints in patients suffering from rheumatoid arthritis (RA). Methods FOI of the hands was performed in patients with active RA, and a stratified quantitative fluorescence readout (FLRO) of 3 phases (1-120 s; 121-240 s; 241-360 s) was generated for 5 individual joints of the clinical predominant hand (carpal joint, metacarpophalangeal and proximal interphalangeal joints of digits II & III). To dissect the effect of the overall perfusion of the hand from the perfusion due to synovitis, a fluorescence ratio (FLRA) was additionally calculated, dividing each FLRO by the readout of the eponychium of digit II. The mean FLRO and FLRA were compared between joints with absent vs. present synovitis determined by clinical examination, grayscale, color Doppler ultrasonography, or magnetic resonance imaging (MRI). Results The analysis for 90 individual joints from 18 patients yielded FLRO ranging from 4.4 to 49.0 × 103, and FLRAs ranging from 0.37 to 2.27. Overall, the analyses based on the FLRA revealed a higher discrimination than the analyses related to the FLRO, demonstrating most significant differences in phases 2 and 3. A sensitivity of 26/39 (67%) and a specificity of 31/40 (77%) were calculated for FLRA of phase 3 using a cut-off value of more than 1.2 to detect MRI-confirmed synovitis with FOI. Conclusions FOI has a potential for visualizing synovitis in subjects with RA. For adequate FOI interpretation, quantitative analysis should be based on the novel FLRA calculated for phases 2 and 3.
Collapse
|
43
|
Tavares R, Beattie KA, Bensen WG, Bobba RS, Cividino AA, Finlay K, Goeree R, Hart LE, Jurriaans E, Larche MJ, Parasu N, Tarride JE, Webber CE, Adachi JD. A double-blind, randomized controlled trial to compare the effect of biannual peripheral magnetic resonance imaging, radiography and standard of care disease progression monitoring on pharmacotherapeutic escalation in rheumatoid and undifferentiated inflammatory arthritis: study protocol for a randomized controlled trial. Trials 2014; 15:268. [PMID: 24997587 PMCID: PMC4227117 DOI: 10.1186/1745-6215-15-268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Accepted: 06/05/2014] [Indexed: 11/28/2022] Open
Abstract
Background Permanent joint damage is a major consequence of rheumatoid arthritis (RA), the most common and destructive form of inflammatory arthritis. In aggressive disease, joint damage can occur within 6 months from symptom onset. Early, intensive treatment with conventional and biologic disease-modifying anti-rheumatic drugs (DMARDs) can delay the onset and progression of joint damage. The primary objective of the study is to investigate the value of magnetic resonance imaging (MRI) or radiography (X-ray) over standard of care as tools to guide DMARD treatment decision-making by rheumatologists for the care of RA. Methods A double-blind, randomized controlled trial has been designed. Rheumatoid and undifferentiated inflammatory arthritis patients will undergo an MRI and X-ray assessment every 6 months. Baseline adaptive randomization will be used to allocate participants to MRI, X-ray, or sham-intervention groups on a background of standard of care. Prognostic markers, treating physician, and baseline DMARD therapy will be used as intervention allocation parameters. The outcome measures in rheumatology RA MRI score and the van der Heijde-modified Sharp score will be used to evaluate the MRI and X-ray images, respectively. Radiologists will score anonymized images for all patients regardless of intervention allocation. Disease progression will be determined based on the study-specific, inter-rater smallest detectable difference. Allocation-dependent, intervention-concealed reports of positive or negative disease progression will be reported to the treating rheumatologist. Negative reports will be delivered for the sham-intervention group. Study-based radiology clinical reports will be provided to the treating rheumatologists for extra-study X-ray requisitions to limit patient radiation exposure as part of diagnostic imaging standard of care. DMARD treatment dose escalation and therapy changes will be measured to evaluate the primary objective. A sample size of 186 (62 per group) patients will be required to determine a 36% difference in pharmacological treatment escalation between the three groups with intermediate dispersion of data with 90% power at a 5% level of significance. Discussion This study will determine if monitoring RA and undifferentiated inflammatory arthritis patients using MRI and X-ray every 6 months over 2 years provides incremental evidence over standard of care to influence pharmacotherapeutic decision-making and ultimately hinder disease progression. Trial registration This trial has been registered at ClinicalTrials.gov: NCT00808496 (registered on 12 December 2008).
Collapse
Affiliation(s)
- Ruben Tavares
- UNCOVER Clinical Research Company, Milton, ON, Canada.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Evaluation of a new erosion score by musculoskeletal ultrasound in patients with rheumatoid arthritis. Clin Rheumatol 2014; 33:1255-62. [DOI: 10.1007/s10067-014-2646-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 02/24/2014] [Accepted: 04/20/2014] [Indexed: 10/25/2022]
|
45
|
Reiche BE, Ohrndorf S, Feist E, Messerschmidt J, Burmester GR, Backhaus M. Usefulness of power Doppler ultrasound for prediction of re-therapy with rituximab in rheumatoid arthritis: a prospective study of longstanding rheumatoid arthritis patients. Arthritis Care Res (Hoboken) 2014; 66:204-16. [PMID: 23925935 DOI: 10.1002/acr.22103] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 07/30/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To assess the value of gray-scale (GS) and power Doppler (PD) ultrasound (US) in detecting inflammatory/destructive changes and for prediction of necessity of re-therapy with rituximab (RTX) in patients with rheumatoid arthritis (RA) over 1 year of followup. METHODS GSUS and PDUS were performed to assess synovitis, tenosynovitis, and erosions on the clinically dominant hand and forefoot of 20 patients with RA before and after therapy with RTX. US parameters were compared with clinical (Disease Activity Score in 28 joints, tender/swollen joint counts, and patients' visual analog scale of disease activity) and laboratory parameters (C-reactive protein level and erythrocyte sedimentation rate). Results were compared for patients with and without re-therapy with RTX. RESULTS Significant decreases in clinical and laboratory parameters were observed after 6 and 12 months. US synovitis scores significantly decreased after 6 and 12 months (P < 0.05 for each). Regarding patients who received re-therapy between 6 and 9 months after the start of therapy (n = 9), a fair therapy response was still detectable before re-therapy. In these patients, PD-positive synovitis was the only parameter that increased up to the 6-month examination. All patients negative for rheumatoid factor and anti-cyclic citrullinated peptide (n = 4) were in the group of patients receiving a second course of treatment. Seropositive patients showed a better response to treatment with less need for re-therapy. CONCLUSION Response to therapy was measurable by clinical and laboratory parameters as well as by US. Since PDUS was able to detect the onset of disease activity before worsening of clinical symptoms occurred, PDUS is most helpful in evaluating disease activity and making earlier therapy decisions.
Collapse
Affiliation(s)
- B E Reiche
- Charite University Hospital, Berlin, Germany
| | | | | | | | | | | |
Collapse
|
46
|
Epis O, Paoletti F, d'Errico T, Favalli E, Garau P, Mancarella L, Pomponio G, Sandri G, Scioscia C, Selvi E, Tirri E. Ultrasonography in the diagnosis and management of patients with inflammatory arthritides. Eur J Intern Med 2014; 25:103-11. [PMID: 24041708 DOI: 10.1016/j.ejim.2013.08.700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/04/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
In primary care and internal medicine settings clinicians are often reluctant to take advantage of the resources that ultrasonography (US) offers as a diagnostic tool in the initial management of patients with inflammatory arthritis, despite the recognised importance of an accurate and timely diagnosis of rheumatoid arthritis (RA) and of early referral to ensure optimal patient management. Both grey-scale (GS) and power Doppler (PD) imaging have been extensively used in early detection of synovitis and bone erosions in patients with inflammatory arthritides. We reviewed the main data on the clinical use of US in the initial management of patients with inflammatory arthritis, focusing on RA diagnosis in patients with undifferentiated arthritis, prediction of disease severity, differential diagnoses and assessment of synovitis in children with juvenile idiopathic arthritis (JIA). The role of US in assessing treatment response and monitoring disease activity in clinical remission was also briefly evaluated. The reliability of US as a diagnostic tool in rheumatological diseases has greatly advanced in the last years and the use of this imaging technique, in association with conventional assessments such as physical examination and serological tests, should be considered more often also in primary care settings.
Collapse
Affiliation(s)
- Oscar Epis
- S.C. Reumatologia, A.O. Ospedale Niguarda Ca' Granda, Milano, Italy.
| | - Franco Paoletti
- U.O. Reumatologia, Ospedale 'S. Francesco Caracciolo', Agnone, Italy
| | - Tito d'Errico
- Ambulatiorio di Reumatologia, P.O. 'S.M.d.P degli Incurabili', Napoli, Italy
| | - Ennio Favalli
- Divisione di Reumatologia, Istituto Ortopedico G. Pini, Milano, Italy
| | - Pietro Garau
- Struttura Complessa di Reumatologia, A.O.U. Cagliari, Italy
| | | | | | - Gilda Sandri
- Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università degli Studi di Modena e Reggio Emilia, Italy
| | | | - Enrico Selvi
- Sezione di Reumatologia, A.O.U. Senese, Siena, Italy
| | - Enrico Tirri
- U.O. Reumatologia, Ospedale 'S. Giovanni Bosco', Napoli, Italy
| |
Collapse
|
47
|
Utility of the Ultrasound Examination of the Hand and Wrist Joints in the Management of Established Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2014; 66:236-44. [DOI: 10.1002/acr.22119] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/08/2013] [Indexed: 02/02/2023]
|
48
|
Mérot O, Le Goff B. [Ultrasonography in chronic inflammatory rheumatic and connective tissue disorders]. Rev Med Interne 2014; 35:531-9. [PMID: 24439720 DOI: 10.1016/j.revmed.2013.12.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/21/2013] [Indexed: 01/08/2023]
Abstract
Musculoskeletal ultrasonography is now widely used by almost all rheumatologists thanks to an improvement in the quality of ultrasound unit and probe and to the systematic teaching of this imaging technique to the rheumatology fellows. Applications have broadened from the study of degenerative and mechanical diseases to inflammatory rheumatic diseases. Ultrasound is more sensitive than clinical examination. Power Doppler allows the direct visualisation of inflammation within the tissues. Finally, it is a prognostic tool helping the physician in the management of the disease. This review will focus on the value and applications of ultrasonography in the 2 most frequent rheumatic diseases: rheumatoid arthritis and spondyloarthritis. We will also give some recent data on the usefulness of this imaging technique in the study of musculoskeletal manifestations associated with connective tissue disease.
Collapse
Affiliation(s)
- O Mérot
- Service de rhumatologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France
| | - B Le Goff
- Service de rhumatologie, CHU Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes cedex 1, France; Inserm, UMR957, physiopathologie de la résorption osseuse et thérapie des tumeurs osseuses primitives, 44035 Nantes, France.
| |
Collapse
|
49
|
Zayat AS, Ellegaard K, Conaghan PG, Terslev L, Hensor EMA, Freeston JE, Emery P, Wakefield RJ. The specificity of ultrasound-detected bone erosions for rheumatoid arthritis. Ann Rheum Dis 2014; 74:897-903. [PMID: 24445255 DOI: 10.1136/annrheumdis-2013-204864] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 12/27/2013] [Indexed: 02/02/2023]
Abstract
BACKGROUND Bone erosion is one of the hallmarks of rheumatoid arthritis (RA), but also seen in other rheumatic diseases. The objective of this study was to determine the specificity of ultrasound (US)-detected bone erosions (including their size) in the classical 'target' joints for RA. METHODS Patients fulfilling the diagnostic criteria for RA, psoriatic arthritis, osteoarthritis or gout in addition to healthy volunteers were included. The following areas were examined by US: distal radius and ulna, 2nd, 3rd and 5th metacarpophalangeal (MCP), 2nd and 3rd proximal interphalangeal (PIP) and 1st and 5th metatarsophalangeal (MTP) joints. All joints were scanned in four quadrants using both semiquantitative (0-3) and quantitative (erosion diameter) scoring systems. RESULTS 310 subjects were recruited. The inter-reader and intrareader agreements were good to excellent. US-detected bone erosions were more frequent but not specific for RA (specificity 32.9% and sensitivity 91.4%). The presence of erosions with semiquantitative score ≥2 in four target joints (2nd, 5rd MCP, 5th MTP joints and distal ulna) was highly specific for RA (specificity 97.9% and sensitivity 41.4%). Size of erosion was found to be associated with RA. Erosions of any size in the 5th MTP joint were both specific and sensitive for RA (specificity 85.4% and sensitivity 68.6%). CONCLUSIONS The presence of US-detected erosions is not specific for RA. However, larger erosions in selected joints, especially 2nd and 5rd MCP, 5th MTP joints and distal ulna, were highly specific for and predictive of RA.
Collapse
Affiliation(s)
- Ahmed S Zayat
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Karen Ellegaard
- Department of Rheumatology, Parker Institute, Frederiksberg Hospital, Copenhagen, Denmark
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Jane E Freeston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds & NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, UK
| |
Collapse
|
50
|
Gandjbakhch F, Haavardsholm EA, Conaghan PG, Ejbjerg B, Foltz V, Brown AK, Døhn UM, Lassere M, Freeston JE, Olsen IC, Bøyesen P, Bird P, Fautrel B, Hetland ML, Emery P, Bourgeois P, Hørslev-Petersen K, Kvien TK, McQueen FM, Østergaard M. Determining a Magnetic Resonance Imaging Inflammatory Activity Acceptable State Without Subsequent Radiographic Progression in Rheumatoid Arthritis: Results from a Followup MRI Study of 254 Patients in Clinical Remission or Low Disease Activity. J Rheumatol 2013; 41:398-406. [DOI: 10.3899/jrheum.131088] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Objective.To assess the predictive value of magnetic resonance imaging (MRI)-detected subclinical inflammation for subsequent radiographic progression in a longitudinal study of patients with rheumatoid arthritis (RA) in clinical remission or low disease activity (LDA), and to determine cutoffs for an MRI inflammatory activity acceptable state in RA in which radiographic progression rarely occurs.Methods.Patients with RA in clinical remission [28-joint Disease Activity Score-C-reactive protein (DAS28-CRP) < 2.6, n = 185] or LDA state (2.6 ≤ DAS28-CRP < 3.2, n = 69) with longitudinal MRI and radiographic data were included from 5 cohorts (4 international centers). MRI were assessed according to the Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system (RAMRIS). Statistical analyses included an underlying conditional logistic regression model stratified per cohort, with radiographic progression as dependent variable.Results.A total of 254 patients were included in the multivariate analyses. At baseline, synovitis was observed in 95% and osteitis in 49% of patients. Radiographic progression was observed in 60 patients (24%). RAMRIS synovitis was the only independent predictive factor in multivariate analysis. ROC analysis identified a cutoff value for baseline RAMRIS synovitis score of 5 (maximum possible score 21). Rheumatoid factor (RF) status yielded a significant interaction with synovitis (p value = 0.044). RF-positive patients with a RAMRIS synovitis score of > 5 vs ≤ 5, had an OR of 4.4 (95% CI 1.72–11.4) for radiographic progression.Conclusion.High MRI synovitis score predicts radiographic progression in patients in clinical remission/LDA. A cutoff point for determining an MRI inflammatory activity acceptable state based on the RAMRIS synovitis score was established. Incorporating MRI in future remission criteria should be considered.
Collapse
|