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Giraudo C, Sudol-Szopinska I, Fichera G, Evangelista L, Zanatta E, Del Grande F, Stramare R, Bazzocchi A, Guglielmi G, Rennie W. Update on Rheumatic Diseases in Clinical Practice: Recent Concepts and Developments. Radiol Clin North Am 2024; 62:725-738. [PMID: 39059968 DOI: 10.1016/j.rcl.2024.02.005] [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] [Indexed: 07/28/2024]
Abstract
Diagnostic imaging is essential in the diagnostic process of rheumatic diseases. Given the heterogeneity of this group of diseases and the tremendous impact of novel therapeutic options, guidelines and recommendations regarding the optimal choice of the most appropriate technique/s are continuously revised and radiologists should always be up-to-date. Last, because of the continuous technological innovations, we will assist to the progressive application of advanced techniques and tools in rheumatology.
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Affiliation(s)
- Chiara Giraudo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - DCTV, University of Padova, Via Giustiniani 2, Padova, 35122, Italy.
| | - Iwona Sudol-Szopinska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, 1- Spartanska Street, Warsaw, Poland
| | - Giulia Fichera
- Pediatric Radiology, Padova Hospital, Via Giustiniani 2, Padova, 35122, Italy
| | - Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Milan, 20072, Italy; IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, Milan, 20089, Italy
| | - Elisabetta Zanatta
- Department of Medicine -DIMED, Rheumatology Unit, University of Padova, Via Giustiniani 2, 35122, Padova, Italy
| | - Filippo Del Grande
- Istituto Di Imaging Della Svizzera Italiana (IIMSI), Clinica Di Radiologia Ente Ospedaliero Cantonale (EOC), Via Tesserete 46, Lugano 6900, Switzerland
| | - Roberto Stramare
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health - DCTV, University of Padova, Via Giustiniani 2, Padova, 35122, Italy
| | - Alberto Bazzocchi
- Department of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Via G. C. Pupilli 1, Bologna, 40136, Italy
| | - Giuseppe Guglielmi
- Department of Clinical and Experimental Medicine, Radiology Unit, Foggia University School of Medicine, Via Gramsci 89, 71122, Foggia, Italy; Department of Radiology, Scientific Institute "Casa Sollievo Della Sofferenza" Hospital, Viale Cappuccini, San Giovanni Rotondo, 71013, Italy
| | - Winston Rennie
- Department of Radiology, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, United Kingdom
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Salaffi F, Carotti M, Di Carlo M, Ceccarelli L, Farah S, Poliseno AC, Di Matteo A, Bandinelli F, Giovagnoni A. Magnetic Resonance Imaging (MRI)-Based Semi-Quantitative Methods for Rheumatoid Arthritis: From Scoring to Measurement. J Clin Med 2024; 13:4137. [PMID: 39064179 PMCID: PMC11277801 DOI: 10.3390/jcm13144137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/25/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease that primarily affects the small joints of the hands and feet, characterized by pain, inflammation, and joint damage. In this context, magnetic resonance imaging (MRI) is useful to identify and monitor joint/tendon inflammation and the evolution of joint damage, playing a key role in treatment response evaluation, in addition to clinical measurements. Various methods to quantify joint inflammation and damage with MRI in RA have been developed, such as RA-MRI Score (RAMRIS), Early RA-MRI Score (ERAMRS), and Simplified RA-MRI Score (SAMIS). RAMRIS, introduced in 2002, offers an objective means to assess inflammation and damage via MRI in RA trials, encompassing findings such as synovitis, bone erosion, and edema/osteitis. Recently, an updated RAMRIS version was developed, which also includes the evaluation of joint space narrowing and tenosynovitis. The RAMRIS-5, which is a condensed RAMSIS version focusing on five hand joints only, has been proven to be a valuable resource for the semi-quantitative evaluation of RA joint damage, both in early and established disease. This narrative literature review will provide an overview of the MRI scoring systems that have been developed for the assessment of joint inflammation and structural damage in RA patients.
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Affiliation(s)
- Fausto Salaffi
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Carlo Urbani Hospital, Jesi, 60035 Ancona, Italy; (F.S.); (S.F.)
| | - Marina Carotti
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (A.C.P.); (A.G.)
- Division of Radiology, Department of Radiological Sciences, University Hospital Azienda Ospedaliera Universitaria delle Marche, 60126 Ancona, Italy
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Carlo Urbani Hospital, Jesi, 60035 Ancona, Italy; (F.S.); (S.F.)
| | - Luca Ceccarelli
- Oncohematologic and Emergency Radiology Unit, Department of Pediatric and Adult Cardio-Thoracic and Vascular, IRCCS Policlinico di Sant’Orsola, 40138 Bologna, Italy;
| | - Sonia Farah
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Carlo Urbani Hospital, Jesi, 60035 Ancona, Italy; (F.S.); (S.F.)
| | - Anna Claudia Poliseno
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (A.C.P.); (A.G.)
- Division of Radiology, Department of Radiological Sciences, University Hospital Azienda Ospedaliera Universitaria delle Marche, 60126 Ancona, Italy
| | - Andrea Di Matteo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds LS2 9JT, UK;
- Leeds Biomedical Research Centre, National Institute for Health Research, Leeds Teaching Hospitals NHS Trust, Leeds LS9 7TF, UK
| | - Francesca Bandinelli
- Rheumatology Department, USL Tuscany Center, San Giovanni di Dio Hospital, 50143 Florence, Italy;
| | - Andrea Giovagnoni
- Department of Clinical, Special and Dental Sciences, Università Politecnica delle Marche, 60126 Ancona, Italy; (M.C.); (A.C.P.); (A.G.)
- Division of Radiology, Department of Radiological Sciences, University Hospital Azienda Ospedaliera Universitaria delle Marche, 60126 Ancona, Italy
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3
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Biddle G, Beck RT, Raslan O, Ebinu J, Jenner Z, Hamer J, Hacein-Bey L, Apperson M, Ivanovic V. Autoimmune diseases of the spine and spinal cord. Neuroradiol J 2024; 37:285-303. [PMID: 37394950 PMCID: PMC11138326 DOI: 10.1177/19714009231187340] [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] [Indexed: 07/04/2023] Open
Abstract
Magnetic resonance imaging (MRI) and clinicopathological tools have led to the identification of a wide spectrum of autoimmune entities that involve the spine. A clearer understanding of the unique imaging features of these disorders, along with their clinical presentations, will prove invaluable to clinicians and potentially limit the need for more invasive procedures such as tissue biopsies. Here, we review various autoimmune diseases affecting the spine and highlight salient imaging features that distinguish them radiologically from other disease entities.
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Affiliation(s)
- Garrick Biddle
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Ryan T Beck
- Neuroradiology, Radiology Department, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Osama Raslan
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Julius Ebinu
- Neurosurgery Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Zach Jenner
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - John Hamer
- Neuroradiology, Radiology Department, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Lotfi Hacein-Bey
- Radiology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Michelle Apperson
- Neurology Department, University of California Davis School of Medicine, Sacramento, CA, USA
| | - Vladimir Ivanovic
- Neuroradiology, Radiology Department, Medical College of Wisconsin, Milwaukee, WI, USA
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Mickley JP, Grove AF, Rouzrokh P, Yang L, Larson AN, Sanchez-Sotello J, Maradit Kremers H, Wyles CC. A Stepwise Approach to Analyzing Musculoskeletal Imaging Data With Artificial Intelligence. Arthritis Care Res (Hoboken) 2024; 76:590-599. [PMID: 37849415 DOI: 10.1002/acr.25260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/27/2023] [Accepted: 10/13/2023] [Indexed: 10/19/2023]
Abstract
The digitization of medical records and expanding electronic health records has created an era of "Big Data" with an abundance of available information ranging from clinical notes to imaging studies. In the field of rheumatology, medical imaging is used to guide both diagnosis and treatment of a wide variety of rheumatic conditions. Although there is an abundance of data to analyze, traditional methods of image analysis are human resource intensive. Fortunately, the growth of artificial intelligence (AI) may be a solution to handle large datasets. In particular, computer vision is a field within AI that analyzes images and extracts information. Computer vision has impressive capabilities and can be applied to rheumatologic conditions, necessitating a need to understand how computer vision works. In this article, we provide an overview of AI in rheumatology and conclude with a five step process to plan and conduct research in the field of computer vision. The five steps include (1) project definition, (2) data handling, (3) model development, (4) performance evaluation, and (5) deployment into clinical care.
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Mercer HL, Rodriguez D, Rivas R, Rivenbark E, Mikola E, Mercer D. Management of the Septic Wrist: A Systematic Review of Etiology and Therapeutic Strategies. Orthop Clin North Am 2024; 55:273-283. [PMID: 38403373 DOI: 10.1016/j.ocl.2023.11.002] [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] [Indexed: 02/27/2024]
Abstract
Septic arthritis of the wrist can have severe deleterious effects on cartilage and bone if not promptly addressed. Expedient diagnosis and early medical intervention are important. The most effective strategy involves immediate arthrocentesis of the infected joint, enabling precise antibiotic selection based on joint fluid analysis. Diagnostic imaging is important in excluding fractures and identifying abscesses. This review explores the etiologic factors underlying septic wrist joint, identifying risk factors, and delineating optimal diagnosis and treatment approaches. The overarching goal is to impart valuable insights and guidance in the management of septic wrist joint, ensuring the highest quality patient care and optimal clinical outcomes.
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Affiliation(s)
- Heather L Mercer
- Institute of Microbiology and Infection, School of Biosciences, Univeristy of Birmingham, Edgbaston, B15 2TT, England
| | - Diego Rodriguez
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Rhiana Rivas
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Elizabeth Rivenbark
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Elizabeth Mikola
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA
| | - Deana Mercer
- UNMHSC Department of Orthopedics and Rehabilitation, 1 University of New Mexico, MSC 10-5600, Albuquerque, NM 87131, USA.
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Bellia F, Lanza V, Naletova I, Tomasello B, Ciaffaglione V, Greco V, Sciuto S, Amico P, Inturri R, Vaccaro S, Campagna T, Attanasio F, Tabbì G, Rizzarelli E. Copper(II) Complexes with Carnosine Conjugates of Hyaluronic Acids at Different Dipeptide Loading Percentages Behave as Multiple SOD Mimics and Stimulate Nrf2 Translocation and Antioxidant Response in In Vitro Inflammatory Model. Antioxidants (Basel) 2023; 12:1632. [PMID: 37627627 PMCID: PMC10452038 DOI: 10.3390/antiox12081632] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/07/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
A series of copper(II) complexes with the formula [Cu2+Hy(x)Car%] varying the molecular weight (MW) of Hyaluronic acid (Hy, x = 200 or 700 kDa) conjugated with carnosine (Car) present at different loading were synthesized and characterized via different spectroscopic techniques. The metal complexes behaved as Cu, Zn-superoxide dismutase (SOD1) mimics and showed some of the most efficient reaction rate values produced using a synthetic and water-soluble copper(II)-based SOD mimic reported to date. The increase in the percentage of Car moieties parallels the enhancement of the I50 value determined via the indirect method of Fridovich. The presence of the non-functionalized Hy OH groups favors the scavenger activity of the copper(II) complexes with HyCar, recalling similar behavior previously found for the copper(II) complexes with Car conjugated using β-cyclodextrin or trehalose. In keeping with the new abilities of SOD1 to activate protective agents against oxidative stress in rheumatoid arthritis and osteoarthritis diseases, Cu2+ interaction with HyCar promotes the nuclear translocation of erythroid 2-related factor that regulates the expressions of target genes, including Heme-Oxigenase-1, thus stimulating an antioxidant response in osteoblasts subjected to an inflammatory/oxidative insult.
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Affiliation(s)
- Francesco Bellia
- Institute of Crystallography, National Council of Research (CNR), P. Gaifami 18, 95126 Catania, Italy; (F.B.); (V.L.); (I.N.); (V.C.); (T.C.); (F.A.); (E.R.)
| | - Valeria Lanza
- Institute of Crystallography, National Council of Research (CNR), P. Gaifami 18, 95126 Catania, Italy; (F.B.); (V.L.); (I.N.); (V.C.); (T.C.); (F.A.); (E.R.)
| | - Irina Naletova
- Institute of Crystallography, National Council of Research (CNR), P. Gaifami 18, 95126 Catania, Italy; (F.B.); (V.L.); (I.N.); (V.C.); (T.C.); (F.A.); (E.R.)
| | - Barbara Tomasello
- Department of Drug and Health Sciences, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy;
| | - Valeria Ciaffaglione
- Institute of Crystallography, National Council of Research (CNR), P. Gaifami 18, 95126 Catania, Italy; (F.B.); (V.L.); (I.N.); (V.C.); (T.C.); (F.A.); (E.R.)
| | - Valentina Greco
- Department of Chemical Sciences, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy; (V.G.); (S.S.)
| | - Sebastiano Sciuto
- Department of Chemical Sciences, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy; (V.G.); (S.S.)
| | - Pietro Amico
- Fidia Farmaceutici SpA, Contrada Pizzuta, 96017 Noto, Italy; (P.A.); (R.I.); (S.V.)
| | - Rosanna Inturri
- Fidia Farmaceutici SpA, Contrada Pizzuta, 96017 Noto, Italy; (P.A.); (R.I.); (S.V.)
| | - Susanna Vaccaro
- Fidia Farmaceutici SpA, Contrada Pizzuta, 96017 Noto, Italy; (P.A.); (R.I.); (S.V.)
| | - Tiziana Campagna
- Institute of Crystallography, National Council of Research (CNR), P. Gaifami 18, 95126 Catania, Italy; (F.B.); (V.L.); (I.N.); (V.C.); (T.C.); (F.A.); (E.R.)
| | - Francesco Attanasio
- Institute of Crystallography, National Council of Research (CNR), P. Gaifami 18, 95126 Catania, Italy; (F.B.); (V.L.); (I.N.); (V.C.); (T.C.); (F.A.); (E.R.)
| | - Giovanni Tabbì
- Institute of Crystallography, National Council of Research (CNR), P. Gaifami 18, 95126 Catania, Italy; (F.B.); (V.L.); (I.N.); (V.C.); (T.C.); (F.A.); (E.R.)
| | - Enrico Rizzarelli
- Institute of Crystallography, National Council of Research (CNR), P. Gaifami 18, 95126 Catania, Italy; (F.B.); (V.L.); (I.N.); (V.C.); (T.C.); (F.A.); (E.R.)
- Department of Chemical Sciences, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy; (V.G.); (S.S.)
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Damani A, Osmani H, Patel J, Robinson P, Dattani R, Ahmed N. Imaging for patients presenting with a painful shoulder. Br J Hosp Med (Lond) 2023; 84:1-10. [PMID: 37364877 DOI: 10.12968/hmed.2023.0058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023]
Abstract
Shoulder pain is a common cause of musculoskeletal presentation in primary care, where both traumatic and atraumatic pathologies can also lead to emergency department attendances. This article discusses common acute and chronic presentations of a painful shoulder, looking at the typical history of patients presenting with a painful shoulder, examination findings and the most appropriate imaging modalities to consider. Strengths and weaknesses of each imaging modality are discussed along with their role in aiding diagnosis, as well as management of the various pathologies encountered in primary and secondary care.
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Affiliation(s)
- Arees Damani
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Humza Osmani
- Department of Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Jugal Patel
- Department of Radiology, King's College Hospital NHS Foundation Trust, London, UK
| | - Philip Robinson
- Department of Radiology, Chapel Allerton Hospital, Leeds, UK
| | - Rupen Dattani
- Department of Orthopaedic Surgery, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - Naeem Ahmed
- Department of Radiology, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
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Drago S, Nazaroff H, Britton J, Veljkovic A. Assessment and Management of Atraumatic First Metatarsophalangeal Joint Pain. J Am Acad Orthop Surg 2023:00124635-990000000-00679. [PMID: 37126849 DOI: 10.5435/jaaos-d-22-00821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 03/11/2023] [Indexed: 05/03/2023] Open
Abstract
Nontraumatic pain in the first metatarsophalangeal joint is frequent and can be debilitating. The metatarsophalangeal joint complex comprises four articulating surfaces including the first metatarsal, the proximal phalanx, and tibial and fibular sesamoids, which are all contained within a synovial capsule. The most common causes of pain are hallux valgus and hallux rigidus. However, other diagnoses, such as functional hallux limitus, sesamoiditis, gout, and inflammatory autoimmune arthritis, need to be considered as well. A systematic approach is key to accurately diagnose the source of pain, which can sometimes be the result of more than one condition. The most important clinical information to obtain is a focused history, meticulous clinical examination based on understanding the precise anatomy and biomechanics of the first metatarsophalangeal joint, and analysis of the relevant imaging. Each pathology has a different treatment algorithm, as such, understanding the pathoanatomy and biomechanics is important in forming an effective treatment plan.
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Affiliation(s)
- Sebastián Drago
- From the Universidad de los Andes, facultad de medicina, Santiago, Chile (Drago), Department of Orthopedic Surgery, Hospital Félix Bulnes, Santiago, Chile (Drago), Faculty of Medicine, University of British Columbia, Kelowna, BC (Nazaroff, Britton, and Veljkovic), Footbridge clinic, Vancouver, BC (Veljkovic)
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Wen J, Li H, Dai H, Hua S, Long X, Li H, Ivanovski S, Xu C. Intra-articular nanoparticles based therapies for osteoarthritis and rheumatoid arthritis management. Mater Today Bio 2023; 19:100597. [PMID: 36910270 PMCID: PMC9999238 DOI: 10.1016/j.mtbio.2023.100597] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/19/2023] [Accepted: 02/24/2023] [Indexed: 02/27/2023] Open
Abstract
Osteoarthritis (OA) and rheumatoid arthritis (RA) are chronic and progressive inflammatory joint diseases that affect a large population worldwide. Intra-articular administration of various therapeutics is applied to alleviate pain, prevent further progression, and promote cartilage regeneration and bone remodeling in both OA and RA. However, the effectiveness of intra-articular injection with traditional drugs is uncertain and controversial due to issues such as rapid drug clearance and the barrier afforded by the dense structure of cartilage. Nanoparticles can improve the efficacy of intra-articular injection by facilitating controlled drug release, prolonged retention time, and enhanced penetration into joint tissue. This review systematically summarizes nanoparticle-based therapies for OA and RA management. Firstly, we explore the interaction between nanoparticles and joints, including articular fluids and cells. This is followed by a comprehensive analysis of current nanoparticles designed for OA/RA, divided into two categories based on therapeutic mechanisms: direct therapeutic nanoparticles and nanoparticles-based drug delivery systems. We highlight nanoparticle design for tissue/cell targeting and controlled drug release before discussing challenges of nanoparticle-based therapies for efficient OA and RA treatment and their future clinical translation. We anticipate that rationally designed local injection of nanoparticles will be more effective, convenient, and safer than the current therapeutic approach.
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Affiliation(s)
- Juan Wen
- School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia
- Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia
| | - Huimin Li
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
- Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Huan Dai
- School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia
- Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia
| | - Shu Hua
- School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia
- Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia
| | - Xing Long
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, 430079, China
| | - Huang Li
- Department of Orthodontics, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210009, China
| | - Sašo Ivanovski
- School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia
- Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia
- Corresponding author. School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia.
| | - Chun Xu
- School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia
- Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia
- Corresponding author. School of Dentistry, The University of Queensland, Brisbane, Queensland, 4006, Australia.
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Bruno MC, Cristiano MC, Celia C, d'Avanzo N, Mancuso A, Paolino D, Wolfram J, Fresta M. Injectable Drug Delivery Systems for Osteoarthritis and Rheumatoid Arthritis. ACS NANO 2022; 16:19665-19690. [PMID: 36512378 DOI: 10.1021/acsnano.2c06393] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Joint diseases are one of the most common causes of morbidity and disability worldwide. The main diseases that affect joint cartilage are osteoarthritis and rheumatoid arthritis, which require chronic treatment focused on symptomatic relief. Conventional drugs administered through systemic or intra-articular routes have low accumulation and/or retention in articular cartilage, causing dose-limiting toxicities and reduced efficacy. Therefore, there is an urgent need to develop improved strategies for drug delivery, in particular, the use of micro- and nanotechnology-based methods. Encapsulation of therapeutic agents in delivery systems reduces drug efflux from the joint and protects against rapid cellular and enzymatic clearance following intra-articular injection. Consequently, the use of drug delivery systems decreases side effects and increases therapeutic efficacy due to enhanced drug retention in the intra-articular space. Additionally, the frequency of intra-articular administration is reduced, as delivery systems enable sustained drug release. This review summarizes various advanced drug delivery systems, such as nano- and microcarriers, developed for articular cartilage diseases.
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Affiliation(s)
- Maria Chiara Bruno
- Department of Health Sciences, School of Pharmacy and Nutraceuticals, University "Magna Græcia" of Catanzaro, Campus Universitario "S. Venuta", Building of BioSciences, Viale S. Venuta, Germaneto-Catanzaro, I-88100, Italy
| | - Maria Chiara Cristiano
- Department of Experimental and Clinical Medicine, School of Pharmacy and Nutraceuticals, University "Magna Græcia" of Catanzaro, Campus Universitario "S. Venuta", Building of BioSciences, Viale S. Venuta, Germaneto-Catanzaro, I-88100, Italy
| | - Christian Celia
- Department of Pharmacy, University of Chieti - Pescara "G. d'Annunzio", Via dei Vestini 31, Chieti, I-66100, Italy
- Laboratory of Drug Targets Histopathology, Institute of Cardiology, Lithuanian University of Health Sciences, A. Mickeviciaus g. 9, LT-44307, Kaunas, Lithuania
| | - Nicola d'Avanzo
- Department of Health Sciences, School of Pharmacy and Nutraceuticals, University "Magna Græcia" of Catanzaro, Campus Universitario "S. Venuta", Building of BioSciences, Viale S. Venuta, Germaneto-Catanzaro, I-88100, Italy
- Department of Pharmacy, University of Chieti - Pescara "G. d'Annunzio", Via dei Vestini 31, Chieti, I-66100, Italy
| | - Antonia Mancuso
- Department of Experimental and Clinical Medicine, School of Pharmacy and Nutraceuticals, University "Magna Græcia" of Catanzaro, Campus Universitario "S. Venuta", Building of BioSciences, Viale S. Venuta, Germaneto-Catanzaro, I-88100, Italy
| | - Donatella Paolino
- Department of Experimental and Clinical Medicine, School of Pharmacy and Nutraceuticals, University "Magna Græcia" of Catanzaro, Campus Universitario "S. Venuta", Building of BioSciences, Viale S. Venuta, Germaneto-Catanzaro, I-88100, Italy
| | - Joy Wolfram
- Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, Brisbane, QLD 4072, Australia
- School of Chemical Engineering, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Massimo Fresta
- Department of Health Sciences, School of Pharmacy and Nutraceuticals, University "Magna Græcia" of Catanzaro, Campus Universitario "S. Venuta", Building of BioSciences, Viale S. Venuta, Germaneto-Catanzaro, I-88100, Italy
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Miyama K, Bise R, Ikemura S, Kai K, Kanahori M, Arisumi S, Uchida T, Nakashima Y, Uchida S. Deep learning-based automatic-bone-destruction-evaluation system using contextual information from other joints. Arthritis Res Ther 2022; 24:227. [PMID: 36192761 PMCID: PMC9528108 DOI: 10.1186/s13075-022-02914-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND X-ray images are commonly used to assess the bone destruction of rheumatoid arthritis. The purpose of this study is to propose an automatic-bone-destruction-evaluation system fully utilizing deep neural networks (DNN). This system detects all target joints of the modified Sharp/van der Heijde score (SHS) from a hand X-ray image. It then classifies every target joint as intact (SHS = 0) or non-intact (SHS ≥ 1). METHODS We used 226 hand X-ray images of 40 rheumatoid arthritis patients. As for detection, we used a DNN model called DeepLabCut. As for classification, we built four classification models that classify the detected joint as intact or non-intact. The first model classifies each joint independently, whereas the second model does it while comparing the same contralateral joint. The third model compares the same joint group (e.g., the proximal interphalangeal joints) of one hand and the fourth model compares the same joint group of both hands. We evaluated DeepLabCut's detection performance and classification models' performances. The classification models' performances were compared to three orthopedic surgeons. RESULTS Detection rates for all the target joints were 98.0% and 97.3% for erosion and joint space narrowing (JSN). Among the four classification models, the model that compares the same contralateral joint showed the best F-measure (0.70, 0.81) and area under the curve of the precision-recall curve (PR-AUC) (0.73, 0.85) regarding erosion and JSN. As for erosion, the F-measure and PR-AUC of this model were better than the best of the orthopedic surgeons. CONCLUSIONS The proposed system was useful. All the target joints were detected with high accuracy. The classification model that compared the same contralateral joint showed better performance than the orthopedic surgeons regarding erosion.
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Affiliation(s)
- Kazuki Miyama
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan. .,Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka, 819-0395, Japan.
| | - Ryoma Bise
- Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka, 819-0395, Japan
| | - Satoshi Ikemura
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Kazuhiro Kai
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Masaya Kanahori
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Shinkichi Arisumi
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Taisuke Uchida
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Yasuharu Nakashima
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan
| | - Seiichi Uchida
- Department of Advanced Information Technology, Kyushu University, 744 Motooka, Nishi-Ku, Fukuoka, 819-0395, Japan
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12
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Jain A, Malhotra A, Chandak S, Jain A, Yogender Y, Deriya A, Sharma M. Comparison of High-Resolution Ultrasonography With Magnetic Resonance Imaging in Rheumatoid Arthritis. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221123071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: The aim of this study was to examine whether high-resolution ultrasonography (HRUS) can provide information, on signs of inflammation and destruction, due to rheumatoid arthritis (RA). The focus was on the wrist joint, during early and late disease and compared the findings to those with magnetic resonance imaging (MRI). Materials and Methods: The study was based on 31 RA patients, with joint involvements, who were selected from those attending the outpatient rheumatology clinic. The patients completed both HRUS and MRI examinations, and their results were compared. Results: The HRUS and MRI images had near-perfect agreement, for detecting joint anomalies, in those RA patients. While comparing the overall performance of the HRUS and MRI studies, it was observed that HRUS was equal or nearly equal, demonstrating 90.83%, 100.0% and 94.93%, diagnostic sensitivity, specificity, and accuracy, respectively, for diagnosing RA pathologies. Conclusion: The early diagnosis of RA with HRUS and MRI examinations is very important, in the early treatment of RA. The HRUS examinations demonstrated a sensitive and reliable diagnostic method for assessing inflammatory activity and destructive changes in the joints of these RA patients, with HRUS findings comparable to those of MRI.
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Affiliation(s)
- Anshul Jain
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College and Research Center, Moradabad, UP, India
| | - Ankur Malhotra
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College and Research Center, Moradabad, UP, India
| | - Shruti Chandak
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College and Research Center, Moradabad, UP, India
| | - Aswani Jain
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College and Research Center, Moradabad, UP, India
| | - Yogender Yogender
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College and Research Center, Moradabad, UP, India
| | - Arpit Deriya
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College and Research Center, Moradabad, UP, India
| | - Madhu Sharma
- Department of Radiodiagnosis, Teerthanker Mahaveer Medical College and Research Center, Moradabad, UP, India
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Ellatif M, Sharif B, Baxter D, Saifuddin A. Update on imaging of the cervical spine in rheumatoid arthritis. Skeletal Radiol 2022; 51:1535-1551. [PMID: 35146552 DOI: 10.1007/s00256-022-04012-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/04/2022] [Accepted: 02/06/2022] [Indexed: 02/02/2023]
Abstract
Rheumatoid arthritis is a multisystem, autoimmune, inflammatory disorder with numerous musculoskeletal manifestations. Involvement of the cervical spine is common and may result in severe complications due to synovitis, erosions, pannus formation, spinal instability and ankylosis. The purpose of this article is to review the current role of imaging in the rheumatoid spine, with emphasis on radiographs and MRI.
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Affiliation(s)
- Mostafa Ellatif
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK.
| | - Ban Sharif
- Department of Radiology, London North West University Healthcare NHS Trust, Harrow, UK
| | - David Baxter
- Department of Spinal Surgery, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Stanmore, UK
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14
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Momtazmanesh S, Nowroozi A, Rezaei N. Artificial Intelligence in Rheumatoid Arthritis: Current Status and Future Perspectives: A State-of-the-Art Review. Rheumatol Ther 2022; 9:1249-1304. [PMID: 35849321 PMCID: PMC9510088 DOI: 10.1007/s40744-022-00475-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/24/2022] [Indexed: 11/23/2022] Open
Abstract
Investigation of the potential applications of artificial intelligence (AI), including machine learning (ML) and deep learning (DL) techniques, is an exponentially growing field in medicine and healthcare. These methods can be critical in providing high-quality care to patients with chronic rheumatological diseases lacking an optimal treatment, like rheumatoid arthritis (RA), which is the second most prevalent autoimmune disease. Herein, following reviewing the basic concepts of AI, we summarize the advances in its applications in RA clinical practice and research. We provide directions for future investigations in this field after reviewing the current knowledge gaps and technical and ethical challenges in applying AI. Automated models have been largely used to improve RA diagnosis since the early 2000s, and they have used a wide variety of techniques, e.g., support vector machine, random forest, and artificial neural networks. AI algorithms can facilitate screening and identification of susceptible groups, diagnosis using omics, imaging, clinical, and sensor data, patient detection within electronic health record (EHR), i.e., phenotyping, treatment response assessment, monitoring disease course, determining prognosis, novel drug discovery, and enhancing basic science research. They can also aid in risk assessment for incidence of comorbidities, e.g., cardiovascular diseases, in patients with RA. However, the proposed models may vary significantly in their performance and reliability. Despite the promising results achieved by AI models in enhancing early diagnosis and management of patients with RA, they are not fully ready to be incorporated into clinical practice. Future investigations are required to ensure development of reliable and generalizable algorithms while they carefully look for any potential source of bias or misconduct. We showed that a growing body of evidence supports the potential role of AI in revolutionizing screening, diagnosis, and management of patients with RA. However, multiple obstacles hinder clinical applications of AI models. Incorporating the machine and/or deep learning algorithms into real-world settings would be a key step in the progress of AI in medicine.
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Affiliation(s)
- Sara Momtazmanesh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran, Iran
| | - Ali Nowroozi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Nima Rezaei
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran. .,Research Center for Immunodeficiencies, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Dr. Gharib St, Keshavarz Blvd, Tehran, Iran. .,Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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15
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Lee KC, Ahn KS, Kang CH, Hong SJ, Kim BH, Shim E. A Systematic Approach to Diagnosing Arthritis Based on Radiological Imaging. Curr Med Imaging 2022; 18:1160-1179. [DOI: 10.2174/1573405618666220428100951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 11/22/2022]
Abstract
:
Radiology plays key roles in diagnosis of arthritis. We herein suggest an algorithmic approach to diagnosing arthritis. First, the number of joint involvements is reviewed. Monoarticular arthritis includes septic arthritis, pigmented villonodular synovitis, and synovial chondromatosis. Second, polyarticular arthritis can be categorized by its characteristics: erosive, productive and mixed. Erosive disease includes rheumatoid arthritis, hemophilia, and amyloidosis while productive disease includes osteoarthritis, and hemochromatosis. Third, mixed diseases are subcategorized by symmetricity. Ankylosing spondylitis and inflammatory bowel disease related arthritis affect joints symmetrically while psoriatic arthritis, reactive arthritis, and crystalline arthropathy are asymmetric. Adjacent soft tissue density, periostitis, and bone density are ancillary findings that can be used as additional differential diagnostic clues. The final step in identifying the type of arthritis is to check whether the location is a site frequently affected by one particular disease over another. This systematic approach would be helpful for radiologist to diagnose arthritis.
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Affiliation(s)
- Kyu-Chong Lee
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kyung-Sik Ahn
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Chang Ho Kang
- Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Suk Joo Hong
- Department of Radiology, Korea University Guro Hospital, Seoul, Republic of Korea
| | - Baek Hyun Kim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Euddeum Shim
- Department of Radiology, Korea University Ansan Hospital, Ansan, Republic of Korea
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16
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Prakash M, Chandel K, Sinha A, Sharma A, Chouhan D, Sandhu M. Role of shear wave elastography of synovium to differentiate rheumatoid and tubercular arthritis. J Med Ultrasound 2022; 30:30-35. [PMID: 35465588 PMCID: PMC9030352 DOI: 10.4103/jmu.jmu_80_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 05/16/2021] [Accepted: 05/24/2021] [Indexed: 11/22/2022] Open
Abstract
Background: Synovitis is the underlying pathology in various arthritis, and sometimes, it is difficult to differentiate various arthritis clinically or even by imaging. The purpose of our study was to use shear wave elastography (SWE) to evaluate rheumatoid arthritis (RA) and tubercular (TB) arthritis and to differentiate them using synovial stiffness. Methods: The prospective study was performed on Supersonic Imagine Aixplorer Ultrasound (USG) machine using a linear array probe SL10-2 (2–10 MHz). A total of 29 participants, 15 of RA (ACR/EULAR criteria) and 14 of proven TB arthritis were included. Region of interest of 1 mm was applied on the hypertrophied synovium and quantitative SWE data in form of elasticity (kPa) and velocity (m/s) were measured. Discrete categorical data were presented as n (%). Mean values were recorded along with standard deviation and the range of values. To find a maximal cutoff value of elasticity and velocity - receiver operating characteristic curve were plotted. Results: The mean elasticity and velocity values were 54.81 ± 10.6 kPa and 4.2 m/s ± 0.42 for RA and 37 ± 10 kPa and 3.4 ± 0.47 m/s for TB group. Significant difference (P < 0.001) was seen in elastic modulus values between rheumatoid and TB group with cutoff of 43.6 kPa to differentiate the two groups (sensitivity – 86.7% and specificity – 80%). Similar significant (P < 0.001) results were seen with velocity values, with cutoff of 3.76 m/s (sensitivity – 86.7% and specificity – 80%). Conclusion: SWE shows the potential to be a useful adjunct to gray scale and color Doppler USG in differentiating various arthritis on the basis of elastic properties of the synovium. Elastic modulus and velocity are useful SWE quantitative parameters for synovial evaluation and can differentiate RA and TB arthritis.
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17
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Fang TJ, Lin CH, Lin YZ, Chiu MHS, Li RN, Chan HC, Yeh YT, Yen JH. Lower HDAC6 mRNA expression and promoter hypomethylation are associated with RA susceptibility. J Formos Med Assoc 2021; 121:1431-1441. [PMID: 34732304 DOI: 10.1016/j.jfma.2021.10.008] [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: 03/17/2021] [Revised: 09/25/2021] [Accepted: 10/12/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/PURPOSE Recent studies showed that Histone deacetylases 6 (HDAC6) inhibitors could improve arthritis in rheumatoid arthritis (RA) rodent models, whereas lower HDAC6 expression was observed in RA patients' synovial fibroblasts, raising the concerns to use HDAC6 inhibitors to treat RA patients. In the present study, we investigated the involvement of HDAC6 mRNA expression and promoter methylation in RA. METHODS The DNA and RNAs were extracted from the peripheral blood mononuclear cells (PBMCs) from 138 RA patients and 102 healthy controls. The pyrosequencing technique was used for promoter methylation analysis. The quantitative real-time polymerase chain reaction was used to determine the HDAC6 mRNA expression. The patients' clinical characteristics and disease biomarkers were recorded when blood sampling. RESULTS The HDAC6 mRNA expression was lower in the RA patients than controls (p = 0.001). The RA patients had significant hypomethylation of the HDAC6 promoter (p < 0.001). The HDAC6 promoter was hypo-methylated in the -229, -225, -144, and -142 CpG sites in RA patients (p < 0.05). Unexpectedly, promoter methylation and mRNA expression of the HDAC6 gene were positively associated (p < 0.001). The HDAC6 mRNA expression and promoter methylation status were associated with the risk of RA (p = 0.006 and 0.002, respectively). The inflammatory cytokines, TNF-α and IL-6, were significantly increased after HDAC6 knockdown in PMA-stimulated THP1 cells and SW982 cells (p < 0.05). CONCLUSION The HDAC6 mRNA expression and promoter methylation were lower in RA patients. Both HDAC6 mRNA expression level and promoter hypomethylation were associated the susceptibility of RA. HDAC6 inhibitors seem not proper for RA patients' treatment.
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Affiliation(s)
- Tzu-Jung Fang
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Division of Geriatrics and Gerontology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
| | - Chia-Hui Lin
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
| | - Yuan-Zhao Lin
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan
| | - Min-HSi Chiu
- Aging and Disease Prevention Research Center, Fooyin University, Taiwan; Biomedical Analysis Center, Fooyin University Hospital, Taiwan
| | - Ruei-Nian Li
- Department of Biomedical Science and Environmental Biology, College of Life Science, Kaohsiung Medical University, Taiwan
| | - Hua-Chen Chan
- Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medical Laboratory Science and Biotechnology, School of Medical and Health Sciences, Fooyin University, Kaohsiung, Taiwan
| | - Yao-Tsung Yeh
- Aging and Disease Prevention Research Center, Fooyin University, Taiwan; Biomedical Analysis Center, Fooyin University Hospital, Taiwan
| | - Jeng-Hsien Yen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Taiwan; Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Taiwan; College of Biological Science and Technology, National Yang Ming Chiao Tung University, Taiwan; Institute of Medical Science and Technology, National Sun Yat-sen University, Kaohsiung, Taiwan.
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18
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Xiao L, Huang Y, Zhan F. Knee alterations in rheumatoid arthritis: Comparison of US and MRI. Open Med (Wars) 2021; 16:913-918. [PMID: 34222666 PMCID: PMC8231465 DOI: 10.1515/med-2021-0310] [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: 09/25/2020] [Revised: 05/08/2021] [Accepted: 05/16/2021] [Indexed: 11/15/2022] Open
Abstract
Objective This study was designed to compare the diagnostic efficacy of ultrasonography (US) and magnetic resonance imaging (MRI) in detecting changes in the knee of patients with rheumatoid arthritis (RA) and discover the possible association between the serological index and bone erosion detected by US. Patients and methods In this retrospective study, the US images and MRI findings of the knee in patients with RA from December 2017 to January 2020 were evaluated. Diagnostic outcomes were compared. The rheumatoid factor, C-reactive protein, erythrocyte sedimentation rate, and anti-cyclic citrullinated peptide antibody (ACPA) levels of the patients were recorded. The relation between laboratory index and US findings was analyzed by multivariable logistic regression. Results US showed remarkable accuracy, sensitivity, and specificity in diagnosing synovitis, bone erosion, and soft tissue swelling. In terms of reliability, the agreement between US and MRI was moderate to almost perfect. Meanwhile, a positive association between ACPA level and bone erosion was observed in patients with RA. Conclusions US may have a role as the initial imaging modality in patients with RA. Patients with higher ACPA levels may need more active treatment because they are more likely to have bone erosion detected by US.
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Affiliation(s)
- Lu Xiao
- Department of Rheumatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Hainan 570311, China
| | - Yanyan Huang
- Department of Rheumatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Hainan 570311, China
| | - Feng Zhan
- Department of Rheumatology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Hainan 570311, China
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Abstract
STUDY DESIGN Narrative review. OBJECTIVE To provide an overview on the diagnosis and surgical management of rheumatoid involvement of the lumbar spine. Rheumatoid arthritis (RA) is a chronic inflammatory disease of synovial joints, most commonly appendicular followed by axial. Although cervical spine involvement of RA is well documented, data on lumbar spine involvement and surgical management remains limited. METHODS Using PubMed, studies published prior to November 2018 with the keywords "RA, etiology"; "RA, spine management"; "RA, surgical management"; "RA, treatment"; "RA, DMARDs"; "RA, lumbar spine"; "RA, spine surgical outcomes"; "RA, imaging" were evaluated. RESULTS The narrative review addresses the epidemiology, manifestations, imaging, surgical complications, and operative and nonoperative management of RA involvement of the lumbar spine. CONCLUSIONS Rheumatoid involvement of the lumbar spine can present with lower back pain, neurogenic claudication, radiculopathy, spinal deformity, and instability. Patients with RA have significantly higher rates of vertebral fractures and complications following surgical intervention. However, in the setting of instability and spinal deformity, thoughtful surgical planning in conjunction with optimal medical management is recommended.
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Affiliation(s)
- Peter Joo
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Laurence Ge
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Addisu Mesfin
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA,Addisu Mesfin, Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Box 665, Rochester, NY 14642, USA.
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20
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Shiraishi M, Fukuda T, Igarashi T, Tokashiki T, Kayama R, Ojiri H. Differentiating Rheumatoid and Psoriatic Arthritis of the Hand: Multimodality Imaging Characteristics. Radiographics 2020; 40:1339-1354. [PMID: 32735474 DOI: 10.1148/rg.2020200029] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Accurate diagnosis and therapeutic intervention at an early stage is paramount for the management of rheumatoid arthritis (RA) and psoriatic arthritis (PsA), which are the two major types of inflammatory arthritis that involve the hand joints. As more disease-specific medications are developed, medication selection according to the correct diagnosis becomes more important. A delay in diagnosis and inappropriate medication selection may result in poor functional prognosis. However, clinical differentiation between RA and PsA can be challenging and may become largely dependent on imaging interpretation results. Although there is substantial overlap in the imaging findings of RA and PsA, there are differences in the affected primary target sites, reflected by the various patterns of joint involvement, and different microanatomic localization of abnormalities within a single joint in each disease. Therefore, appropriate use of various imaging modalities and accurate image interpretation add significant value to the diagnosis and treatment process. The synovio-entheseal complex is an important concept for understanding the imaging features of PsA. The authors review the different features of RA and PsA of the hands seen with various imaging modalities, including radiography, US, MRI, and dual-energy CT, with updates on the contemporary role of imaging in diagnosis and treatment. The radiologist should have sufficient knowledge to interpret imaging findings and understand the strengths and weaknesses of each modality to recommend the appropriate imaging method and differentiate both diseases accurately. ©RSNA, 2020.
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Affiliation(s)
- Megumi Shiraishi
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takeshi Fukuda
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Takao Igarashi
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Tadashi Tokashiki
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Reina Kayama
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Hiroya Ojiri
- From the Department of Radiology, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo 105-8461, Japan
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21
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Gous E, Ally MMTM, Meyer PWA, Suleman FE. Simple Erosion Narrowing Score of the hands as a predictor of cervical spine subluxation in rheumatoid arthritis. SA J Radiol 2020; 24:1876. [PMID: 32832120 PMCID: PMC7433238 DOI: 10.4102/sajr.v24i1.1876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/13/2020] [Indexed: 11/17/2022] Open
Abstract
Background Involvement of the cervical spine is common in patients with rheumatoid arthritis and can lead to devastating or even fatal consequences. Currently no guidelines exist as to whether radiographs of the cervical spine should be included in follow-up visits. Objectives To determine whether the Simple Erosion Narrowing Score (SENS) of the hands correlate with the presence of cervical spine subluxation in patients with rheumatoid arthritis. Method This was a retrospective, observational, cross-sectional study. A total of 56 rheumatoid arthritis patients with hand radiographs and lateral radiographs of the cervical spine were evaluated. The SENS of the hands and the presence of cervical spine subluxation were compared. The SENS of the hands was correlated with the prevalence of cervical spine subluxation, as was the erosion and joint space narrowing scores of the hands. Results A correlation between the SENS of the hands and the prevalence of cervical spine subluxation was confirmed. A higher prevalence of cervical spine subluxation correlated with an increase in the SENS of the hands (p = 0.0002). The erosion and joint space narrowing scores of the hands also correlated with the prevalence of cervical spine subluxation (p = 0.0001). Conclusion This study confirmed that a correlation exists between cervical spine subluxation, peripheral joint space erosions and joint space narrowing in patients with rheumatoid arthritis and SENS may therefore be used as a predictor of cervical spine disease.
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Affiliation(s)
- Eric Gous
- Department of Radiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Mahmood M T M Ally
- Department of Rheumatology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Pieter W A Meyer
- Department of Medical Immunology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Farhana E Suleman
- Department of Radiology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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22
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Korvatko Y, Bogar WC. Radiographically Occult Manifestation of Rheumatoid Arthritis in a Patient With Prolonged Clinical and Laboratory Evidence of Rampant Disease: A Case Report. J Chiropr Med 2020; 19:128-135. [PMID: 33318731 PMCID: PMC7729203 DOI: 10.1016/j.jcm.2019.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 11/27/2019] [Accepted: 12/03/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to present a case of rampant rheumatoid synovitis and arthritis of a patient with a long duration of symptoms and no radiographic abnormalities of rheumatoid arthritis at the initial diagnosis. CLINICAL FEATURES A 49-year-old Hispanic woman presented to a chiropractic teaching clinic with an 8-month history of bilateral, symmetrical hand pain and stiffness noted specifically in her second and third metacarpophalangeal joints. The patient has reported no other health changes and no history of rheumatoid arthritis in the family. INTERVENTION AND OUTCOME Based on this patient's complaint, initial bilateral 3-view radiographic examination of the hands using computed radiography was performed. Despite prolonged history of inflammatory joint pain and rheumatoid arthritis confirmed by abnormally high levels of rheumatoid factor, C-reactive protein, and anti-cyclic citrulline peptide antibodies, the patient had no radiographic evidence of rheumatoid arthritis during the initial and repeat radiographic studies. CONCLUSION Some patients with rheumatoid arthritis may present with rampant clinical and laboratory abnormalities despite an apparent lack of radiographically detectable rheumatoid arthritis. This case demonstrates that astute clinicians should primarily rely on the results of clinical and laboratory abnormalities of rheumatoid arthritis and not be deterred or mislead by an apparent lack of radiographic changes at diagnosis. If the diagnosis of rheumatoid arthritis requires diagnostic imaging confirmation, then magnetic resonance imaging or diagnostic ultrasound of the hands should be used, especially if the initial radiographic assessment remains unrewarding.
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Affiliation(s)
- Yuri Korvatko
- Diagnostic Imaging Department, Clinical Sciences Department, National University of Health Sciences, Lombard, Illinois
| | - William C. Bogar
- Diagnostic Imaging Department, Clinical Sciences Department, National University of Health Sciences, Lombard, Illinois
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Abrar DB, Schleich C, Nebelung S, Frenken M, Radke KL, Vordenbäumen S, Brinks R, Schneider M, Ostendorf B, McGonagle D, Sewerin P. High-resolution MRI of flexor tendon pulleys using a 16-channel hand coil: disease detection and differentiation of psoriatic and rheumatoid arthritis. Arthritis Res Ther 2020; 22:40. [PMID: 32122392 PMCID: PMC7052970 DOI: 10.1186/s13075-020-2135-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/20/2020] [Indexed: 02/08/2023] Open
Abstract
Background To evaluate the value of 3 Tesla (T) magnetic resonance imaging (MRI) changes of flexor tendon pulleys for the differentiation of psoriatic (PsA) and rheumatoid arthritis (RA), using a novel 16-channel high-resolution hand coil. Methods Seventeen patients with active PsA, 20 patients with active RA, and 16 healthy controls (HC) underwent high-resolution 3 T MRI using the dedicated 16-channel hand coil. Images were analyzed by three independent readers for the degree of inflammatory changes, thickness of flexor tendon pulleys, and comparison to the outcome measures for RA clinical trials (OMERACT) PsA MRI score (PsAMRIS) and to its sub-scores. For correlation analyses, Spearman rho correlation was calculated. Results Flexor tendon pulleys were thicker in PsA than in RA patients (mean difference 0.16 mm, p < 0.001) and HC (mean difference 0.2 mm, p < 0.001) and showed a higher degree of associated inflammatory changes (mean difference from RA 4.7, p = 0.048; mean difference from HC 14.65, p < 0.001). Additionally, there was a strong correlation of accessory pulley inflammation and PsAMRIS and its acute-inflammatory sub-scores, flexor tenosynovitis, synovitis, and periarticular inflammation (for the second digit synovitis ρ = 0.72, flexor tenosynovitis ρ = 0.7, overall PsAMRIS ρ = 0.72, p < 0.01). Similar robust correlations were evident in digits 3–5. Weaker correlations were evident in RA (synovitis ρ = 0.49, flexor tenosynovitis ρ = 0.49, periarticular inflammation ρ = 0.4). Conclusion The assessment of MRI changes of flexor tendon pulleys is potentially beneficial for disease detection in PsA, as well as for its distinction from RA and HC. Trial registration 2014123117, December 2014.
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Affiliation(s)
- Daniel B Abrar
- Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Christoph Schleich
- Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Sven Nebelung
- Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Miriam Frenken
- Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Karl Ludger Radke
- Institute for Diagnostic and Interventional Radiology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Stefan Vordenbäumen
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Ralph Brinks
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Matthias Schneider
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Benedikt Ostendorf
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Dennis McGonagle
- NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals Trust and The University of Leeds, Leeds, UK
| | - Philipp Sewerin
- Policlinic and Hiller Research Unit for Rheumatology, UKD, Heinrich Heine University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
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Abstract
The purpose of this article is to describe the imaging appearance, etiology, clinical features, and treatment of rare presentations of common bone and joint diseases known to mimic Hill-Sachs lesions. Knowledge of uncommonly encountered manifestations of ankylosing spondylitis, rheumatoid arthritis, septic joint, hyperparathyroidism, hydroxyapatite deposition disease, malignant bone tumors, and benign bone cysts which mimic traumatic Hill-Sachs lesions is important for radiologists to guide the clinical care of patients who present with shoulder symptoms.
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Affiliation(s)
- Allison Herring
- Department of Diagnostic Radiology and Nuclear Medicine, 21668University of Maryland Medical Center, Baltimore, MD, USA
| | - Derik L Davis
- Department of Diagnostic Radiology and Nuclear Medicine, 21668University of Maryland School of Medicine, Baltimore, MD, USA
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Tokdemir S, Toprak H, Alkan A. Unusual Cerebral Involvement of Rheumatoid Arthritis Mimicking a Tumor. Curr Med Imaging 2020; 16:145-148. [PMID: 32003314 DOI: 10.2174/1573405614666180911121222] [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: 01/10/2018] [Revised: 08/09/2018] [Accepted: 08/19/2018] [Indexed: 11/22/2022]
Abstract
BACKGROUND The central nervous system's involvement in Rheumatoid Arthritis (RA) is infrequent and can be life-threatening. Mass-like CNS involvement is an unusual presentation. A 45 year old man had suffered seropositive rheumatoid arthritis for five years referred to our hospital with one-week history of right-sided facial paralysis, left hemiparesis and headache. DISCUSSION MRI demonstrated hyperintense mass-like lesion extended from mesencephalon to right hippocampus and basal ganglia on T2 and FLAIR images. On DWI, restricted diffusion was not present. After contrast administration, minimal contrast enhancement was noted. After methotrexate and steroid treatment, the size had been markedly shrunken on the follow-up images. The clinical symptoms were also improved. CONCLUSION To our knowledge, the mass-like presentation was not reported in the literature. We report an unusual case of brain involvement of rheumatoid arthritis mimicked tumor.
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Affiliation(s)
- Sevil Tokdemir
- Department of Radiology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Huseyin Toprak
- Department of Radiology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Alpay Alkan
- Department of Radiology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
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In vivo imaging of early stages of rheumatoid arthritis by α5β1-integrin-targeted positron emission tomography. EJNMMI Res 2019; 9:87. [PMID: 31501931 PMCID: PMC6733939 DOI: 10.1186/s13550-019-0541-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/18/2019] [Indexed: 01/25/2023] Open
Abstract
Background Rheumatoid arthritis (RA) is one of the most common rheumatic diseases. Joint inflammation and pathological growth of joint cartilage cause swollen and painful joints, which severely diminishes the patients’ life quality. There is no causal treatment. Symptomatic therapies should start as early as possible to take maximal effect. Hence, diagnostic procedures capable of detecting affected joints before the onset of clinical symptoms are highly desirable. We explored the value of PET imaging of integrin subtypes αvβ3 and α5β1 for early detection of RA foci in collagen-induced arthritis (CIA) mouse models. Results Development of RA in CIA mice was monitored by paw scoring, and αvβ3- and α5β1-integrin expression was quantified by μPET using 68Ga-Avebetrin and 68Ga-Aquibeprin. For consecutive sections of selected decalcified joints (knee, ankle), arthritic degeneration and integrin expression were assessed by MOVAT staining and β3/α5 immunohistochemistry (IHC), respectively. β3- and α5-IHC revealed elevated levels of both αvβ3- and α5β1-integrin in arthritic joints. Unlike αvβ3, α5β1 is strongly expressed in the proliferating synovial lining layer, which suggests that its presence is directly related to RA development. For mice with advanced RA (6 weeks after CIA), PET signals for α5β1-integrin were substantially stronger (> 300% of baseline) than that of αvβ3-integrin (< 200%). A longitudinal PET follow-up revealed that the manifestation of clinical symptoms of RA is preceded by upregulation of α5β1- but not of αvβ3-integrin. Conclusion α5β1-integrin PET could add a new functional imaging aspect to the portfolio of RA diagnostics because it appears to be a sensitive biomarker for early RA development. We suggest α5β1-integrin PET as a valuable tool to achieve a higher precision for early diagnosis of RA, including initial staging, monitoring of the disease course, and drug treatment, and for planning of radiosynoviorthesis (RSO).
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Biehler-Gomez L, Tritella S, Martino F, Campobasso CP, Franchi A, Spairani R, Sardanelli F, Cattaneo C. The synergy between radiographic and macroscopic observation of skeletal lesions on dry bone. Int J Legal Med 2019; 133:1611-1628. [PMID: 31300917 DOI: 10.1007/s00414-019-02122-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/04/2019] [Indexed: 02/06/2023]
Abstract
The diagnosis of bone lesions is a fundamental part of the study of skeletal remains, both in the archeological and forensic context. On the one side, the literature proved the relevance of radiography for the detection of bone lesions; on the other side, the careful macroscopic observation of the morphology of bone lesions is often underestimated. For this study, we examined and performed plain radiography on 14 skeletons of the CAL Milano Cemetery Skeletal Collection diagnosed with rheumatoid arthritis, diabetes, multiple myeloma, metastatic cancer, and osteomalacia to compare the macroscopic morphology and radiographic visualization of bone lesions. At least 200 osteolytic lesions and 65 areas of proliferative bone reaction (either spongiosclerotic or periosteal) were studied. We realized "comparative sets" of macroscopic pictures and radiographic imaging of the same skeletal elements to allow comparisons of detection and recognition of bone lesions. As a result, while trabecular lesions may be lost through naked eye observation, many lesions can also be unperceived on radiographs due to contrast, including periosteal reactions, osteolytic lesions, and spongiosclerosis. The aim of this research was to investigate the strengths and pitfalls of digital radiography and macroscopic analysis and to demonstrate the synergy of a complementary approach between the two methods for lesion analysis in dry bone.
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Affiliation(s)
- Lucie Biehler-Gomez
- Laboratorio Di Antropologia E Odontologia Forense (LABANOF), Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy.
| | - Stefania Tritella
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy
| | - Federica Martino
- Dipartimento di Medicina Sperimentale, Università degli Studi della Campania "Luigi Vanvitelli", via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Carlo Pietro Campobasso
- Dipartimento di Medicina Sperimentale, Università degli Studi della Campania "Luigi Vanvitelli", via Santa Maria di Costantinopoli 16, 80138, Naples, Italy
| | - Angélique Franchi
- Forensic Medicine Department, University Hospital of Lyon, Lyon, 69003, France
| | - Riccardo Spairani
- Post-Graduate School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesco Sardanelli
- Unit of Radiology, IRCCS Policlinico San Donato, Via Morandi 30, 20097, San Donato Milanese, Milan, Italy.,Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Cristina Cattaneo
- Laboratorio Di Antropologia E Odontologia Forense (LABANOF), Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, 20133, Milan, Italy
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Conventional radiography of the hands and wrists in rheumatoid arthritis. What a rheumatologist should know and how to interpret the radiological findings. Rheumatol Int 2019; 39:1331-1341. [DOI: 10.1007/s00296-019-04326-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 05/15/2019] [Indexed: 01/06/2023]
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Sheikh ASF, Wong E. Erosive rheumatoid arthritis in a young patient with mirror hand. BMJ Case Rep 2019; 12:12/2/bcr-2018-227739. [PMID: 30824464 DOI: 10.1136/bcr-2018-227739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Mirror hand is a congenital anomaly characterised by duplication of the ulnar ray, resulting in polydactyly and functional disability of the hand. It can cause arthralgias and weakness in intrinsic muscles of the hand. We present a young woman who had a surgically corrected mirror hand and subsequently developed aggressive rheumatoid arthritis, which increased her limitations to a significant degree. Early diagnosis and treatment in such cases is very important to prevent long-term disability.
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Affiliation(s)
| | - Ernest Wong
- Rheumatology, Queen Alexandra Hospital, Portsmouth, UK
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30
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Thoracic Diseases With Musculoskeletal Manifestations and Vice Versa: A Review. AJR Am J Roentgenol 2018; 211:1000-1009. [DOI: 10.2214/ajr.18.19803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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31
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Chetina EV, Markova GA. [Upcoming value of gene expression analysis in rheumatology]. BIOMEDIT︠S︡INSKAI︠A︡ KHIMII︠A︡ 2018; 64:221-232. [PMID: 29964257 DOI: 10.18097/pbmc20186403221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology, which involves disturbance in immune system signaling pathway functions, damage of other tissues, pain and joint destruction. Modern treatment attempts to improve pathophysiological and biochemical mechanisms damaged by the disease. However, due to the RA patient heterogeneity personalized approach to treatment is required; the choice of personalized treatment is complicated by the variability of patient's response to treatment. Gene expression analysis might serve a tool for the disease control and therapy personification for inhibition of inflammation and pain as well as for prevention of joint destruction.
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Affiliation(s)
- E V Chetina
- Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - G A Markova
- Nasonova Research Institute of Rheumatology, Moscow, Russia
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32
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Biehler-Gomez L, Cattaneo C. The Diagnostic Implications of Two Cases of Known Rheumatoid Arthritis from the CAL Milano Cemetery Skeletal Collection. J Forensic Sci 2018; 63:1880-1887. [PMID: 29684943 DOI: 10.1111/1556-4029.13799] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2018] [Revised: 03/23/2018] [Accepted: 03/23/2018] [Indexed: 12/16/2022]
Abstract
Rheumatoid arthritis (RA) is the most common erosive arthropathy and is of particular interest to forensic sciences. However, its diagnosis on bones remains challenging. We examined two skeletons from the CAL Milano Cemetery Skeletal Collection diagnosed with the pathology during life, to test the validity of the diagnostic criteria on bones. The first showed typical lesions of RA described in the literature. The second exhibited secondary osteoarthrosis, suggesting long-standing RA. A differential diagnosis including all four seronegative spondyloarthropathies, erosive osteoarthritis, gout and neuropathic arthropathy was also considered. Both shared common features consistent with the literature: symmetric erosions of bones in the hands, wrists and elbows, sparing of the distal interphalangeal joints, and the absence of sacroiliac and spinal fusion. Given the paucity of studies on known RA skeletons, these results strengthen the criteria for diagnosis. This research is, to our knowledge, the first study on identified and known individuals with RA.
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Affiliation(s)
- Lucie Biehler-Gomez
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, Milan, 20133, Italy
| | - Cristina Cattaneo
- LABANOF, Laboratorio Di Antropologia E Odontologia Forense, Sezione Di Medicina Legale, Dipartimento Di Scienze Biomediche per La Salute, Università Degli Studi Di Milano, Via Mangiagalli 37, Milan, 20133, Italy
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Mohan HK, Strobel K, van der Bruggen W, Gnanasegaran G, Kampen WU, Kuwert T, Van den Wyngaert T, Paycha F. The role of hybrid bone SPECT/CT imaging in the work-up of the limping patient: a symptom-based and joint-oriented review. Eur J Hybrid Imaging 2018; 2:8. [PMID: 29782592 PMCID: PMC5954706 DOI: 10.1186/s41824-018-0026-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/17/2018] [Indexed: 12/30/2022] Open
Abstract
A vast spectrum of lower limb bone and joint disorders (hip, knee, ankle, foot) present with a common clinical presentation: limping. Too often this symptom generates an inefficient cascade of imaging studies. This review attempts to optimise the diagnostic effectiveness of bone scintigraphy using the hybrid SPECT/CT technique in relation to the diagnostic clues provided by other imaging modalities, discusses the appropriate clinical indications, optimal scintigraphic procedures and illustrates updated image pattern-oriented reporting. Frequent lower limb bone and joint pathologies that can now be reliably diagnosed using hybrid bone SPECT/CT imaging will be reviewed. Bone SPECT/CT can be an effective problem-solving tool in patients with persistent limping when careful history taking, clinical examination, and first-line imaging modalities fail to identify the underlying cause.
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Affiliation(s)
- H K Mohan
- Department of Nuclear Medicine, Sri Shankara Cancer Hospital and Research Centre, Bengaluru, India
| | - K Strobel
- 2Department of Radiology and Nuclear Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - W van der Bruggen
- 3Department of Radiology and Nuclear Medicine, Slingeland Hospital, Doetinchem, The Netherlands
| | - G Gnanasegaran
- 4Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - W U Kampen
- Nuclear Medicine Spitalerhof, Hamburg, Germany
| | - T Kuwert
- 6Clinic of Nuclear Medicine, University Hospital Erlangen, Erlangen, Germany
| | - T Van den Wyngaert
- 7Department of Nuclear Medicine, Antwerp University Hospital, Wilrijkstraat 10, 2650 Edegem, Belgium.,8Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - F Paycha
- 9Department of Nuclear Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
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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.
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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.
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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
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Tchetina E, Markova G. The clinical utility of gene expression examination in rheumatology. Mediterr J Rheumatol 2017; 28:116-126. [PMID: 32185269 PMCID: PMC7046055 DOI: 10.31138/mjr.28.3.116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/24/2017] [Indexed: 01/09/2023] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease with unknown etiology that affects various pathways within the immune system, involves many other tissues and is associated with pain and joint destruction. Current treatments fail to address pathophysiological and biochemical mechanisms involved in joint degeneration and the induction of pain. Moreover, RA patients are extremely heterogeneous and require specific treatments, the choice of which is complicated by the fact that not all patients equally respond to therapy. Gene expression analysis offer tools for patient management and personalization of patient’s care to meet individual needs in controlling inflammation and pain and delaying joint destruction.
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Affiliation(s)
- Elena Tchetina
- Immunology and Molecular Biology Laboratory, Nasonova Research Institute of Rheumatology, Moscow, Russia
| | - Galina Markova
- Immunology and Molecular Biology Laboratory, Nasonova Research Institute of Rheumatology, Moscow, Russia
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Chang CY, Rosenthal DI, Mitchell DM, Handa A, Kattapuram SV, Huang AJ. Imaging Findings of Metabolic Bone Disease. Radiographics 2017; 36:1871-1887. [PMID: 27726750 DOI: 10.1148/rg.2016160004] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Metabolic bone diseases are a diverse group of diseases that result in abnormalities of (a) bone mass, (b) structure mineral homeostasis, (c) bone turnover, or (d) growth. Osteoporosis, the most common metabolic bone disease, results in generalized loss of bone mass and deterioration in the bone microarchitecture. Impaired chondrocyte development and failure to mineralize growth plate cartilage in rickets lead to widened growth plates and frayed metaphyses at sites of greatest growth. Osteomalacia is the result of impaired mineralization of newly formed osteoid, which leads to characteristic Looser zones. Hypophosphatasia is a congenital condition of impaired bone mineralization with wide phenotypic variability. Findings of hyperparathyroidism are the result of bone resorption, most often manifesting as subperiosteal resorption in the hand. Renal osteodystrophy is the collection of skeletal findings observed in patients with chronic renal failure and associated secondary hyperparathyroidism and can include osteopenia, osteosclerosis, and "rugger jersey spine." Hypoparathyroidism is most commonly due to iatrogenic injury, and radiographic findings of hypoparathyroidism reflect an overall increase in bone mass. Thyroid hormone regulates endochondral bone formation; and congenital hypothyroidism, when untreated, leads to delayed bone age and absent, irregular, or fragmented distal femoral and proximal tibial epiphyses. Soft-tissue proliferation of thyroid acropachy is most often observed in the hands and feet. The findings of acromegaly are due to excess growth hormone secretion and therefore proliferation of the bones and soft tissues. Vitamin C deficiency, or scurvy, impairs posttranslational collagen modification, leading to subperiosteal hemorrhage and fractures. ©RSNA, 2016.
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Affiliation(s)
- Connie Y Chang
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology (C.Y.C., D.I.R., S.V.K., A.J.H.), and the Pediatric Endocrine Division, Department of Pediatrics (D.M.M.), Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and the Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (A.H.)
| | - Daniel I Rosenthal
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology (C.Y.C., D.I.R., S.V.K., A.J.H.), and the Pediatric Endocrine Division, Department of Pediatrics (D.M.M.), Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and the Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (A.H.)
| | - Deborah M Mitchell
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology (C.Y.C., D.I.R., S.V.K., A.J.H.), and the Pediatric Endocrine Division, Department of Pediatrics (D.M.M.), Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and the Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (A.H.)
| | - Atsuhiko Handa
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology (C.Y.C., D.I.R., S.V.K., A.J.H.), and the Pediatric Endocrine Division, Department of Pediatrics (D.M.M.), Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and the Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (A.H.)
| | - Susan V Kattapuram
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology (C.Y.C., D.I.R., S.V.K., A.J.H.), and the Pediatric Endocrine Division, Department of Pediatrics (D.M.M.), Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and the Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (A.H.)
| | - Ambrose J Huang
- From the Division of Musculoskeletal Imaging and Intervention, Department of Radiology (C.Y.C., D.I.R., S.V.K., A.J.H.), and the Pediatric Endocrine Division, Department of Pediatrics (D.M.M.), Massachusetts General Hospital, 55 Fruit St, Yawkey 6E, Boston, MA 02114; and the Department of Radiology, St. Luke's International Hospital, Tokyo, Japan (A.H.)
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Cervical spine instability in the course of rheumatoid arthritis - imaging methods. Reumatologia 2017; 55:201-207. [PMID: 29056776 PMCID: PMC5647537 DOI: 10.5114/reum.2017.69782] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/16/2017] [Indexed: 11/17/2022] Open
Abstract
Cervical spine is affected in more than a half of patients with rheumatoid arthritis (RA). Depending on the degree of damage to the individual joints and ligaments RA-related cervical spine instability takes the form of atlanto-axial subluxation, subaxial subluxation or cranial settling. In the advanced cases spinal stenosis can occur as well as spinal cord injuries with typical neurological symptoms. The identification of patients with cervical spine instability before the occurrence of neurological complications still constitutes a diagnostic challenge. The article presents the methods of cervical spine imaging with the use of plain radiographs, magnetic resonance imaging (MRI) and computed tomography (CT). We discuss the advantages and disadvantages associated with each method and the possibility of its application in the diagnosis of cervical spine instability in RA. The knowledge of the above mentioned issues is indispensable to select an appropriate time for surgical intervention.
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Llopis E, Kroon HM, Acosta J, Bloem JL. Conventional Radiology in Rheumatoid Arthritis. Radiol Clin North Am 2017; 55:917-941. [PMID: 28774455 DOI: 10.1016/j.rcl.2017.04.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
In clinical practice, the conventional radiography is still the radiologic method for the diagnosis of rheumatoid arthritis (RA). Moreover, it provides a quick overview of the symptomatic joints to narrow the differential diagnosis and to evaluate progression. RA is a polyarticular disease with bilateral and symmetric involvement of the peripheral joints, especially small joints, and less frequently, the cervical spine. The radiologic features are soft tissue swelling, periarticular osteoporosis, erosions, loss of joint space, and in advanced disease, osteolysis and typical subluxations or deformities, such as ulnar deviation.
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Affiliation(s)
- Eva Llopis
- Department of Radiology, Hospital de la Ribera, Carretera Corbera km1, Alzira, Valencia 46600, Spain.
| | - Herman M Kroon
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden 233 ZA, The Netherlands
| | - Jose Acosta
- Department of Radiology, Hospital Universitario Ramon y Cajal, Carretera de Colmenar Viejo KM 9, 100, Madrid 28034, Spain
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, Leiden 233 ZA, The Netherlands
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Yoo HJ, Hong SH, Oh HY, Choi JY, Chae HD, Ahn JM, Kang HS. Diagnostic Accuracy of a Fluid-attenuated Inversion-Recovery Sequence with Fat Suppression for Assessment of Peripatellar Synovitis: Preliminary Results and Comparison with Contrast-enhanced MR Imaging. Radiology 2017; 283:769-778. [DOI: 10.1148/radiol.2016160155] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Adly AS, Adly AS, Adly MS, Serry ZMH. Laser acupuncture versus reflexology therapy in elderly with rheumatoid arthritis. Lasers Med Sci 2017; 32:1097-1103. [PMID: 28451815 DOI: 10.1007/s10103-017-2213-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 04/19/2017] [Indexed: 12/16/2022]
Abstract
The purposes of this study are to determine and compare efficacy of laser acupuncture versus reflexology in elderly with rheumatoid arthritis. Thirty elderly patients with rheumatoid arthritis aged between 60 and 70 years were classified into two groups, 15 patients each. Group A received laser acupuncture therapy (904 nm, beam area of 1cm2, power 100 mW, power density 100 mW/cm2, energy dosage 4 J, energy density 4 J/cm2, irradiation time 40 s, and frequency 100,000 Hz). The acupuncture points that were exposed to laser radiation are LR3, ST25, ST36, SI3, SI4, LI4, LI11, SP6, SP9, GB25, GB34, and HT7. While group B received reflexology therapy, both offered 12 sessions over 4 weeks. The changes in RAQoL, HAQ, IL-6, MDA, ATP, and ROM at wrist and ankle joints were measured at the beginning and end of treatment. There was significant decrease in RAQoL, HAQ, IL-6, and MDA pre/posttreatment for both groups (p < 0.05); significant increase in ATP pre/posttreatment for both groups (p < 0.05); significant increase in ankle dorsi-flexion, plantar-flexion, wrist flexion, extension, and ulnar deviation ROM pre/posttreatment in group A (p < 0.05); and significant increase in ankle dorsi-flexion and ankle plantar-flexion ROM pre/posttreatment in group B (p < 0.05). Comparison between both groups showed a statistical significant decrease in MDA and a statistical significant increase in ATP in group A than group B. Percent of changes in MDA was 41.82%↓ in group A versus 21.68%↓ in group B; changes in ATP was 226.97%↑ in group A versus 67.02%↑ in group B. Moreover, there was a statistical significant increase in ankle dorsi-flexion, ankle plantar-flexion, wrist flexion, wrist extension, and radial deviation in group A than group B. Laser therapy is associated with significant improvement in MDA and ATP greater than reflexology. In addition, it is associated with significant improvement in ankle dorsi-flexion, ankle plantar-flexion, wrist flexion, wrist extension, and radial deviation greater than reflexology in elderly patients with rheumatoid arthritis.
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Affiliation(s)
- Afnan Sedky Adly
- Medical Applications of Laser in Physical Medicine, Physical Therapy for Cardiovascular-Respiratory Disorders and Geriatrics, Cairo University Kasr El Aini Medical School, Cairo, Egypt
| | - Aya Sedky Adly
- Computer Science, Biomedical Informatics, Helwan University Faculty of Computers and Information, Cairo, Egypt.
| | - Mahmoud Sedky Adly
- Orthodontics and Dentofacial Orthopedics, Medical Applications of Laser, Cairo University Faculty of Oral and Dental Medicine, Cairo, Egypt
| | - Zahra M H Serry
- Physical Therapy for Cardiovascular-Respiratory Disorders and Geriatrics, Cairo University Faculty of Physical Therapy, Cairo, Egypt
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Porrino J, Carlson B, Kani KK, Mulcahy H, Wyatt A, Chew FS. Disappearing Acts: The Many Causes of Rapidly Destructive Arthritis. Curr Probl Diagn Radiol 2017; 46:63-73. [DOI: 10.1067/j.cpradiol.2016.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/24/2016] [Indexed: 01/12/2023]
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Burge AJ, Nwawka OK, Berkowitz JL, Potter HG. Imaging of Inflammatory Arthritis in Adults. Rheum Dis Clin North Am 2016; 42:561-585. [DOI: 10.1016/j.rdc.2016.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Scharmga A, Peters M, van Tubergen A, van den Bergh J, Barnabe C, Finzel S, van Rietbergen B, Geusens P. Heterogeneity of Cortical Breaks in Hand Joints of Patients with Rheumatoid Arthritis and Healthy Controls Imaged by High-resolution Peripheral Quantitative Computed Tomography. J Rheumatol 2016; 43:1914-1920. [DOI: 10.3899/jrheum.160646] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective.Conventional radiographs (CR) of the hands are the gold standard for imaging bone erosions. The presence of bone erosions, reflected by the presence of cortical breaks, is a poor prognostic factor in patients with rheumatoid arthritis (RA). The availability of high-resolution peripheral quantitative computed tomography (HR-pQCT) enables detailed investigation of cortical breaks in rheumatic diseases. The aim of this image review is to show HR-pQCT images of the spectrum of cortical breaks with and without underlying trabecular bone changes in metacarpophalangeal (MCP) joints of healthy controls (HC) and patients with RA, with corresponding images on CR and magnetic resonance imaging (MRI).Methods.Second and third MCP joints of 41 patients (of which 10 were early RA with ≤ 2 years and 24 longstanding RA with ≥ 10 years of disease duration) and 38 HC were imaged by CR, MRI, and HR-pQCT (XtremeCT1, Scanco Medical AG). Representative images of the spectrum of cortical breaks were selected.Results.Cortical breaks were found in early and longstanding RA, but also in HC. They were heterogeneous in size, location, and number per joint, with a variety of surrounding cortical and underlying trabecular bone characteristics.Conclusion.Using HR-pQCT images of MCP joints, heterogeneous cortical breaks with and without surrounding trabecular bone changes were found, not only in RA but also in HC. The underlying mechanisms and significance of this spectrum of cortical breaks as found with high 3-D resolution needs further investigation.
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Taljanovic MS, Melville DM, Gimber LH, Scalcione LR, Miller MD, Kwoh CK, Klauser AS. High-Resolution US of Rheumatologic Diseases. Radiographics 2016; 35:2026-48. [PMID: 26562235 DOI: 10.1148/rg.2015140250] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
For the past 15 years, high-resolution ultrasonography (US) is being routinely and increasingly used for initial evaluation and treatment follow-up of rheumatologic diseases. This imaging technique is performed by using high-frequency linear transducers and has proved to be a powerful diagnostic tool in evaluation of articular erosions, simple and complex joint and bursal effusions, tendon sheath effusions, and synovitis, with results comparable to those of magnetic resonance imaging, excluding detection of bone marrow edema. Crystal deposition diseases including gouty arthropathy and calcium pyrophosphate deposition disease (CPPD) have characteristic appearances at US, enabling differentiation between these two diseases and from inflammatory arthropathies. Enthesopathy, which frequently accompanies psoriatic and reactive arthritis, also has a characteristic appearance at high-resolution US, distinguishing these two entities from other inflammatory and metabolic arthropathies. The presence of Doppler signal in examined joints, bursae, and tendon sheaths indicates active synovitis. Microbubble echo contrast agents augment detection of tissue vascularity and may act in the future as a drug delivery vehicle. Frequently, joint, tendon sheath, and bursal fluid aspirations and therapeutic injections are performed under US guidance. The authors describe the high-resolution US technique including gray-scale, color or power Doppler, and contrast agent-enhanced US that is used in evaluation of rheumatologic diseases of the wrist and hand and the ankle and foot in their routine clinical practice. This article demonstrates imaging findings of normal joints, rheumatoid arthritis, gouty arthritis, CPPD, psoriatic and reactive arthritis, and osteoarthritis.
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Affiliation(s)
- Mihra S Taljanovic
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - David M Melville
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Lana H Gimber
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Luke R Scalcione
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Margaret D Miller
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - C Kent Kwoh
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
| | - Andrea S Klauser
- From the Department of Medical Imaging (M.S.T., D.M.M., L.H.G., L.R.S.), Department of Medicine (M.D.M.), and Division of Rheumatology (C.K.K.), University of Arizona, Banner-University Medical Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724; and Department of Radiology, Medical University Innsbruck, Innsbruck, Austria (A.S.K.)
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Ultrasound Techniques in Rheumatoid Arthritis. CURRENT RADIOLOGY REPORTS 2016. [DOI: 10.1007/s40134-016-0175-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Scharmga A, Peters M, van Tubergen A, van den Bergh J, de Jong J, Loeffen D, van Rietbergen B, Weijers R, Geusens P. Visual detection of cortical breaks in hand joints: reliability and validity of high-resolution peripheral quantitative CT compared to microCT. BMC Musculoskelet Disord 2016; 17:271. [PMID: 27401097 PMCID: PMC4940720 DOI: 10.1186/s12891-016-1148-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 06/29/2016] [Indexed: 01/20/2023] Open
Abstract
Background To study the reliability and validity of high-resolution peripheral quantitative CT (HR-pQCT) with microCT (μCT) as gold standard in the visual detection of cortical breaks in metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Methods Ten cadaveric fingers (10 MCP and 9 PIP joints) were imaged by HR-pQCT and μCT and visually analyzed by two independent readers. Intra- and interreader reliability were evaluated for the presence (yes/no, kappa statistics) and the total number (intraclass correlation coefficient, ICC) of cortical breaks. Sensitivity, specificity, positive and negative predictive value (PPV respectively NPV) of HR-pQCT in detecting cortical breaks were calculated. Results With HR-pQCT, mean 149 cortical breaks were identified and with μCT mean 129 (p < 0.05). Intrareader reliability for the presence of a cortical break per quadrant was 0.52 (95 % CI 0.48–0.56) and 0.71 (95 % CI 0.67–0.75) for HR-pQCT and μCT, respectively, and for the total number of cortical breaks 0.61 (95 % CI 0.49–0.70) and 0.75 (95 % CI 0.68–0.82). Interreader reliability for the presence of a cortical break per quadrant was 0.37 (95 % CI 0.33–0.41) and 0.45 (95 % CI 0.41–0.49) for HR-pQCT and μCT, respectively, and for the number of cortical breaks 0.55 (95 % CI 0.43–0.65) and 0.54 (95 % CI 0.35–0.67). Sensitivity, specificity, PPV and NPV of HR-pQCT were 81.6, 64.0, 81.6, and 64 % respectively. Conclusion Cortical breaks were commonly visualized in MCP and PIP joints with HR-pQCT and μCT. Reliability of both HR-pQCT and μCT was fair to moderate. HR-pQCT was highly sensitive to detect cortical breaks with μCT as gold standard. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1148-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A Scharmga
- Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands. .,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.
| | - M Peters
- Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - A van Tubergen
- Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
| | - J van den Bergh
- Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Viecuri Medical Center, Venlo, The Netherlands.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - J de Jong
- Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - D Loeffen
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - B van Rietbergen
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - R Weijers
- Department of Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - P Geusens
- Department of Medicine, division of Rheumatology, Maastricht University Medical Centre, P.O. Box 5800, NL-6202 AZ, Maastricht, The Netherlands.,CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
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Lee WJ, Kim JY, Wu TP, Park LS. The establishment of a porcine rheumatoid arthritis model: Collagen induced arthritis minipig model. J Pharmacol Sci 2016; 132:41-47. [PMID: 27156927 DOI: 10.1016/j.jphs.2016.04.012] [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: 01/02/2016] [Revised: 04/03/2016] [Accepted: 04/04/2016] [Indexed: 01/10/2023] Open
Abstract
Rheumatoid arthritis (RA) research has been largely dependent on collagen induced arthritis (CIA) rodent models, however, they may not translate well to humans due to innate differences in the size, physiology and lifespan. The present study aimed to establish a CIA porcine model with the physical, hematological, histopathological and etiological properties closer to their human equivalent in an attempt to better meet the needs of RA research. Three month old minipigs were administered of bovine type II collagen (CII) emulsified with complete Freund's adjuvants on Day 1 and incomplete Freund's adjuvants on Day 22, via an intradermal or intra-articular route. The clinical, radiological and hematological assessments of immunized animals were made periodically until Day 43, during which period the onset and progression of arthritis was recorded and characterized. In addition, the histopathological and micro-tomographic assessments of the cartilage degradation with regard to mononuclear cell infiltration, and joint deformity indicated a higher severity in the intradermal injection group over the intra-articular group. With confirmation of the susceptibility to heterogeneous CII for arthritis induction in minipig, the potential suitability of this test system as a large animal model for RA has been demonstrated.
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Affiliation(s)
- Won Jae Lee
- PWG Genetics Pte Ltd, 15 Tech Park Crescent, 638117 Singapore
| | - Ji Yeon Kim
- PWG Genetics Pte Ltd, 15 Tech Park Crescent, 638117 Singapore
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Narváez JA, Hernández-Gañán J, Isern J, Sánchez-Fernández JJ. Rheumatic diseases of the spine: imaging diagnosis. RADIOLOGIA 2016; 58 Suppl 1:35-49. [PMID: 26908249 DOI: 10.1016/j.rx.2016.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/15/2015] [Accepted: 01/05/2016] [Indexed: 11/28/2022]
Abstract
Spinal involvement is common both in the spondyloarthritides and in rheumatoid arthritis, in which the cervical segment is selectively affected. Rheumatoid involvement of the cervical spine has characteristic radiologic manifestations, fundamentally different patterns of atlantoaxial instability. Magnetic resonance imaging (MRI) is the technique of choice for evaluating the possible repercussions of atlantoaxial instability on the spinal cord and/or nerve roots in patients with rheumatoid arthritis as well as for evaluating parameters indicative of active inflammation, such as bone edema and synovitis. Axial involvement is characteristic in the spondyloarthritides and has distinctive manifestations on plain-film X-rays, which reflect destructive and reparative phenomena. The use of MRI has changed the conception of spondyloarthritis because it is able to directly detect the inflammatory changes that form part of the disease, making it possible to establish the diagnosis early in the disease process, when plain-film X-ray findings are normal (non-radiographic axial spondyloarthritis), to assess the prognosis of the disease, and to contribute to treatment planning.
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Affiliation(s)
- J A Narváez
- Sección de Radiología Músculo-Esquelética, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España.
| | - J Hernández-Gañán
- Sección de Radiología Músculo-Esquelética, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| | - J Isern
- Sección de Radiología Músculo-Esquelética, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
| | - J J Sánchez-Fernández
- Institut de Diagnòstic per la Imatge, Hospital Universitari de Bellvitge, ĹHospitalet de Llobregat, Barcelona, España
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Hasan NMA, Alam-Eldean MH, Mousa SS. Stiff elbow in adult: MR imaging findings. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2015. [DOI: 10.1016/j.ejrnm.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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