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Sapundzhieva T, Sapundzhiev L, Batalov A. Practical Use of Ultrasound in Modern Rheumatology-From A to Z. Life (Basel) 2024; 14:1208. [PMID: 39337990 PMCID: PMC11433054 DOI: 10.3390/life14091208] [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: 08/19/2024] [Revised: 09/15/2024] [Accepted: 09/20/2024] [Indexed: 09/30/2024] Open
Abstract
During the past 20 years, the use of ultrasound (US) in rheumatology has increased tremendously, and has become a valuable tool in rheumatologists' hands, not only for assessment of musculoskeletal structures like joints and peri-articular tissues, but also for evaluation of nerves, vessels, lungs, and skin, as well as for increasing the accuracy in a number of US-guided aspirations and injections. The US is currently used as the imaging method of choice for establishing an early diagnosis, assessing disease activity, monitoring treatment efficacy, and assessing the remission state of inflammatory joint diseases. It is also used as a complementary tool for the assessment of patients with degenerative joint diseases like osteoarthritis, and in the detection of crystal deposits for establishing the diagnosis of metabolic arthropathies (gout, calcium pyrophosphate deposition disease). The US has an added value in the diagnostic process of polymyalgia rheumatica and giant-cell arteritis, and is currently included in the classification criteria. A novel use of US in the assessment of the skin and lung involvement in connective tissue diseases has the potential to replace more expensive and risky imaging modalities. This narrative review will take a close look at the most recent evidence-based data regarding the use of US in the big spectrum of rheumatic diseases.
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Affiliation(s)
- Tanya Sapundzhieva
- Department of Propedeutics of Internal Diseases, Faculty of Medicine, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria; (L.S.); (A.B.)
- Rheumatology Department, University Hospital ‘Pulmed’, 4002 Plovdiv, Bulgaria
| | - Lyubomir Sapundzhiev
- Department of Propedeutics of Internal Diseases, Faculty of Medicine, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria; (L.S.); (A.B.)
- Rheumatology Department, University Hospital ‘Pulmed’, 4002 Plovdiv, Bulgaria
| | - Anastas Batalov
- Department of Propedeutics of Internal Diseases, Faculty of Medicine, Medical University of Plovdiv, 4001 Plovdiv, Bulgaria; (L.S.); (A.B.)
- Rheumatology Clinic, University Hospital ‘Kaspela’, 4000 Plovdiv, Bulgaria
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Li Y, Zhang Z, Liu C, Kang Z, Li Z. Significance of High-Frequency Sonography for the Subclinical Progression of Rheumatoid Arthritis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024; 43:1509-1520. [PMID: 38720412 DOI: 10.1002/jum.16474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/19/2024] [Accepted: 04/21/2024] [Indexed: 07/14/2024]
Abstract
OBJECTIVES This study aims to investigate the use of high-frequency sonography as a tool for detecting inflammatory and destructive changes in the hand and foot joints of patients with early and long-term RA. METHODS This study employs a prospective cohort design involving 162 patients diagnosed with Rheumatoid arthritis (RA) who meet the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria. Patients were divided into two groups based on disease duration: Group 1 (n = 74) included patients with a disease duration of up to 2 years, or early РА (ERA;), Group 2 (n = 88) consisted of patients with a disease duration exceeding 2 years, or long-term persistent РА (LtRA). All patients underwent a clinical assessment of their joints, as well as radiography and arthrosonography, at the beginning of the study and again at 6 and 12 months later. RESULTS In the general group of patients, ultrasound examination revealed signs of synovitis in the joints of the hands more frequently (66%) compared with clinical examination (56% by a number of swollen joints [NSJ] and 55% by a number of painful joints [NPJ], P < .01). After 6 months of treatment, 12% of the patients achieved full US remission and 24% achieved partial US remission. CONCLUSIONS Within the scope of comprehensive RA diagnostics, arthrosonography of the joints of the hands and feet, utilizing a combination of greyscale and power Doppler, may surpass radiography in detecting early RA. This method allows for a more accurate assessment of disease activity and progression rates.
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Affiliation(s)
- Yudan Li
- Ultrasonography Division, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Ziteng Zhang
- Hepato-Biliary Surgery Division, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Cuicui Liu
- Department of Rehabilitation Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhilong Kang
- Hepato-Biliary Surgery Division, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
| | - Zhiyan Li
- Ultrasonography Division, Shenzhen Third People's Hospital, The Second Affiliated Hospital, Southern University of Science and Technology, Shenzhen, China
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Shirota S, Nishioka H. Lumbar facet arthritis after coronavirus disease 2019 vaccination-Utilization of ultrasound. Int J Rheum Dis 2024; 27:e15269. [PMID: 39022915 DOI: 10.1111/1756-185x.15269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/20/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Affiliation(s)
- Shogo Shirota
- Department of General Medicine, Osaka Medical and Pharmaceutical University Hospital, Takatsuki, Japan
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
| | - Hiroaki Nishioka
- Department of General Internal Medicine, Kobe City Medical Center General Hospital, Hyogo, Japan
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David P, Di Matteo A, Hen O, Dass S, Marzo-Ortega H, Wakefield RJ, Bissell LA, Nam J, Mankia K, Emery P, Saleem B, McGonagle D. Poly-Refractory Rheumatoid Arthritis: An Uncommon Subset of Difficult to Treat Disease With Distinct Inflammatory and Noninflammatory Phenotypes. Arthritis Rheumatol 2024; 76:510-521. [PMID: 38059326 DOI: 10.1002/art.42767] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/09/2023] [Accepted: 11/27/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE To investigate the prevalence of poly-refractory rheumatoid arthritis (RA) defined as failure of all biological (b)/targeted synthetic (ts)-disease-modifying drugs (DMARDs). To further investigate whether patients with persistent inflammatory refractory RA (PIRRA) and noninflammatory refractory RA (NIRRA), determined by objective ultrasound (US) synovitis, have distinct clinical phenotypes in both EULAR difficult-to-treat RA (D2T-RA) and poly-refractory RA groups. METHODS A cross-sectional study of 1,591 patients with RA on b/tsDMARDs that evaluated D2T-RA criteria and subclassified as poly-refractory if inefficacy/toxicity to at least one drug of all classes. PIRRA was defined if US synovitis in one or more swollen joint and NIRRA if absent. Univariate tests and multivariate logistic regression were conducted to investigate factors associated with poly-refractory, PIRRA, and NIRRA phenotypes. RESULTS 122 of 1,591 were excluded due to missing data. 247 of 1,469 (16.8%) had D2T-RA and only 40 of 1,469 (2.7%) poly-refractory RA. This latter group had higher disease activity score 28 C-reactive protein (CRP) (median 5.4 vs 5.02, P < 0.05), CRP levels (median 13 vs 5 mg/l, P < 0.01), and smoking (ever) rates (20% vs 4%, P < 0.01) compared with other D2T patients. Smoking was associated with poly-refractory RA (odds ratio 5.067, 95% CI 1.774-14.472, P = 0.002). Of 107 patients with D2T-RA with recent US, 61 (57%) were PIRRA and 46 (43%), NIRRA. Patients with NIRRA had elevated body mass index (median 30 vs 26, P < 0.001) and higher fibromyalgia prevalence (15% vs 3%, P < 0.05), lower swollen joint count (median: 2 vs 5, P < 0.001), and lower CRP levels (5 vs 10, P < 0.01). CONCLUSION Only 2.7% of D2T-RA failed all classes of b/tsDMARDs. Among D2T-RA, less than 60% had objective signs of inflammation, representing a target for innovative strategies.
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Affiliation(s)
- Paula David
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Sheba Medical Center- Tel Hashomer, Ramat Gan, Israel
| | - Andrea Di Matteo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Or Hen
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Sheba Medical Center- Tel Hashomer, Ramat Gan, Israel
| | - Shouvik Dass
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Helena Marzo-Ortega
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Jacqueline Nam
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Kulveer Mankia
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Benazir Saleem
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Dennis McGonagle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Ebadati S, Sahebari M, Ahmadzadeh AM, Emadzadeh M, Khoroushi F, Ragati Haghi H, Giti R, Aminzadeh B. Correlation of US-7 and US-9 Scores with Disease Activity Score using 28 Joint Counts (DAS28) in Patients with Rheumatoid Arthritis. IRANIAN JOURNAL OF MEDICAL SCIENCES 2024; 49:167-175. [PMID: 38584648 PMCID: PMC10997851 DOI: 10.30476/ijms.2023.97776.2996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/30/2023] [Accepted: 05/31/2023] [Indexed: 04/09/2024]
Abstract
Background The attentive management of rheumatoid arthritis (RA) has attracted particular attention. The German 7-joint Ultrasound (US-7) is the first scoring system that combines bone erosions and soft tissue lesions in a single composite scoring system. This study aimed to assess the correlation between US-7 and Disease Activity Score Using 28 Joint Counts (DAS28) in clinically active RA patients. The efficacy of a novel ultrasound score-based system, the US-9 score (joints assessed with US-7 plus knees), was also compared with the standard US-7 score. Methods All the RA patients referred to the outpatient rheumatology clinic of Ghaem Hospital, Mashhad, Iran, during 2019-2020 were included. 28 joints were clinically examined to calculate DAS28. Nine joints were assessed comprising the German US-7 plus knees using grayscale ultrasonography (GSUS) and power Doppler ultrasonography (PDUS). Retrieved data were analyzed by SPSS software, version 22. The Spearman Correlation test was used to find the correlation between DAS28 and ultrasonographic findings. The statistical significance level was set at P<0.05. Results This study was composed of thirty-five RA patients with a mean age of 49.1±12.0 years. US-7 synovitis scores in GSUS and PDUS were significantly correlated with DAS28 (P=0.02, r=0.38 and P=0.003, r=0.48, respectively). US-9 synovitis scores in GSUS and PDUS were also significantly correlated with DAS28 (P=0.003, r=0.49 and P=0.006, r=0.45, respectively). The synovitis score measured by GSUS was significantly correlated with the GSUS knee synovial score (P=0.01, r=0.42). Conclusion Ultrasound assessment of large joints such as knees can be an effective approach to determining RA severity. However, it can be proposed that adding more involved joints into the sonographic assessment does not necessarily provide a better clinical correlation.
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Affiliation(s)
- Sahar Ebadati
- Department of Radiology, Medical Imaging Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Sahebari
- Rheumatic Diseases Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Mahmoud Ahmadzadeh
- Transplant Research Center, Clinical Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maryam Emadzadeh
- Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzaneh Khoroushi
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Ragati Haghi
- Department of Radiology, Brigham and Women's Hospital, Boston, MA 02215, USA
| | - Ramesh Giti
- Department of Radiology, Medical Imaging Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Aminzadeh
- Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Anderson L, Ihaka B, Bowen C, Dando C, Stewart S. Do Dynamic Plantar Pressures Differ Based on Sonographic Evidence of Metatarsophalangeal Joint Synovitis in People With Rheumatoid Arthritis? ACR Open Rheumatol 2024; 6:113-122. [PMID: 38117793 PMCID: PMC10933642 DOI: 10.1002/acr2.11635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/22/2023] Open
Abstract
OBJECTIVE The metatarsophalangeal joints (MTPJs) are the most common location for synovitis in people with rheumatoid arthritis (RA), yet their association with plantar foot pressures has received very little attention. This study aimed to determine whether plantar pressures differed based on sonographic evidence of MTPJ synovitis in people with RA. METHOD Ultrasound was used to assess synovitis (grey scale synovial hypertrophy and power Doppler signal) in MTPJs 1 to 5 using the combined EULAR/Outcome Measures in Rheumatology scoring system. Peak pressure (PP) and pressure time integrals (PTIs) were assessed during barefoot walking for seven plantar foot regions (heel, midfoot, first metatarsal, second metatarsal, third to fifth metatarsals, hallux, lesser toes). Mixed-effects linear regression was used to determine the difference in PP and PTI between MTPJs with none/minimal synovitis and MTPJs with moderate/severe synovitis. RESULTS Thirty-five participants with RA were included. Mean age was 66.3 years and mean disease duration was 22.2 years. Participants with sonographic evidence of moderate/severe synovitis at the first MTPJ had reduced PTI at the hallux compared with those with none/minimal synovitis at this joint (P = 0.039). Participants with moderate/severe synovitis at the second MTPJ and fourth MTPJ had reduced PP and reduced PTI at lesser toes compared with those with none/minimal synovitis in these joints (all P ≤ 0.048). No significant differences were observed for synovitis in other joints. CONCLUSION These findings may be suggestive of an inverse relationship between plantar pressure and soft tissue pathology, which is consistent with an offloading strategy and reduced use of the toes during propulsion.
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Affiliation(s)
| | - Belinda Ihaka
- Active Living and Rehabilitation, Aotearoa, and Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of TechnologyAucklandNew Zealand
| | | | | | - Sarah Stewart
- Active Living and Rehabilitation, Aotearoa, and Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of TechnologyAucklandNew Zealand
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Seskute G, Jasionyte G, Rugiene R, Butrimiene I. The Use of Superb Microvascular Imaging in Evaluating Rheumatic Diseases: A Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1641. [PMID: 37763760 PMCID: PMC10537482 DOI: 10.3390/medicina59091641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/28/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Superb microvascular imaging is an advanced Doppler algorithm that seems to be useful in detecting low-velocity blood flow without using a contrast agent. Increasing evidence suggests that SMI is a more sensitive tool than conventional Doppler techniques for evaluating rheumatic diseases, especially inflammatory arthritis. We aimed to assess the use of SMI in evaluating joints and extraarticular structures. Materials and Methods: Two reviewers independently reviewed the literature to provide a global overview of the possibilities of SMI in rheumatology. Original English-language articles published between February 2014 and November 2022 were identified through database (PubMed, Medline, Ebsco, the Cochrane Library, and ScienceDirect) searching, and analysed to summarise existing evidence according to PRISMA methodology. Inclusion criteria covered original research articles reporting applications of SMI on rheumatic diseases and musculoskeletal disorders secondary to rheumatic conditions. Qualitative data synthesis was performed. Results: A total of 18 articles were included. No systematic reviews fulfilled our inclusion criteria. Most studies focused on characterising the synovial vascularity of rheumatoid arthritis. There have been several attempts to demonstrate SMI's value for evaluating extra-articular soft tissues (fat pads or salivary glands) and large-diameter vessels. The quantitative importance of SMI vascular indices could become a useful non-invasive diagnostic marker. Studies on therapeutic applications are still scarce, and the majority of studies have gaps in reporting the methodology (ultrasound performance technique and settings) of the research. Conclusions: SMI has proved to be useful in characterising low-flow vascularity, and growing evidence indicates that SMI is a non-invasive and lower-cost tool for prognostic assessment, especially in inflammatory arthritis. Preliminary findings also suggest potential interest in evaluating the effect of treatment.
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Affiliation(s)
- Goda Seskute
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
| | - Gabija Jasionyte
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
| | - Rita Rugiene
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
- Department of Experimental, Preventive and Clinical Medicine, State Research Institute Centre for Innovative Medicine, LT-08406 Vilnius, Lithuania
| | - Irena Butrimiene
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT-01513 Vilnius, Lithuania; (G.J.); (R.R.); (I.B.)
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Boldeanu MV, Boldeanu L, Cristea OM, Ciobanu DA, Poenariu SI, Dijmărescu AL, Bărbulescu AL, Pădureanu V, Sas TN, Dinescu ȘC, Vreju FA, Popoviciu HV, Ionescu RA. MMP-13, VEGF, and Disease Activity in a Cohort of Rheumatoid Arthritis Patients. Diagnostics (Basel) 2023; 13:diagnostics13091653. [PMID: 37175043 PMCID: PMC10184131 DOI: 10.3390/diagnostics13091653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/04/2023] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
Identifying certain serum biomarkers associated with the degree of rheumatoid arthritis (RA) activity can provide us with a more accurate view of the evolution, prognosis, and future quality of life for these patients. Our aim was to analyze the presence and clinical use of matrix metalloproteinase-13 (MMP-13), along with vascular endothelial growth factor (VEGF) and well-known cytokines such as tumor necrosis factor-alpha (TNF-α) and interleukin 6 (IL-6) for patients with RA. We also wanted to identify the possible correlations between MMP-13 and these serological markers, as well as their relationship with disease activity indices, quality of life, and ultrasonographic evaluation. For this purpose, we analyzed serum samples of 34 RA patients and 12 controls. In order to assess serum concentrations for MMP-13, VEGF, TNF-α, and IL-6, we used the enzyme-linked immunosorbent assay (ELISA) technique. Our results concluded that higher levels of MMP-13, VEGF, TNF-α, and IL-6 were present in the serum of RA patients compared to controls, with statistical significance. We furthermore identified moderately positive correlations between VEGF, MMP-13, and disease activity indices, as well as with the ultrasound findings. We also observed that VEGF had the best accuracy (97.80%), for differentiating patients with moderate disease activity. According to the data obtained in our study, that although MMP-13, TNF-α and C-reactive protein (CRP) have the same sensitivity (55.56%), MMP-13 has a better specificity (86.67%) in the diagnosis of patients with DAS28(4v) CRP values corresponding to moderate disease activity. Thus, MMP-13 can be used as a biomarker that can differentiate patients with moderate or low disease activity. VEGF and MMP-13 can be used as additional parameters, along with TNF-α and IL-6, that can provide the clinician a better picture of the inflammatory process, disease activity, and structural damage in patients with RA. Our data can certainly constitute a start point for future research and extended studies with multicenter involvement, to support the selection of individualized and accurate therapeutic management strategies for our patients.
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Affiliation(s)
- Mihail Virgil Boldeanu
- Department of Immunology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Lidia Boldeanu
- Department of Microbiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Oana Mariana Cristea
- Department of Microbiology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dana Alexandra Ciobanu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Sabin Ioan Poenariu
- Doctoral School, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anda Lorena Dijmărescu
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Andreea Lili Bărbulescu
- Department of Pharmacology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Vlad Pădureanu
- Department of Internal Medicine, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Teodor Nicuşor Sas
- Department of Radiology and Imaging, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ștefan Cristian Dinescu
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Florentin Ananu Vreju
- Department of Rheumatology, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Horațiu Valeriu Popoviciu
- Department of Rheumatology, BFK and Medical Rehabilitation, University of Medicine, Pharmacy, Science and Technology of Targu Mures, 540139 Targu Mures, Romania
| | - Răzvan Adrian Ionescu
- Third Internal Medicine Department, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
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El Kosaier MA, Shaat RM, El.Arman MM, Afifi AEMA. Serum amyloid a level and musculoskeletal ultrasound in assessment of disease activity in rheumatoid arthritis patients. THE EGYPTIAN RHEUMATOLOGIST 2023. [DOI: 10.1016/j.ejr.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Ranganath VK, Ben-Artzi A, Brook J, Suliman Y, Floegel-Shetty A, Woodworth T, Taylor M, Ramrattan LA, Elashoff D, Kaeley GS. Optimizing Reliability of Real-Time Sonographic Examination and Scoring of Joint Synovitis in Rheumatoid Arthritis. Cureus 2022; 14:e31030. [DOI: 10.7759/cureus.31030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
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Seskute G, Montvydaite M, Butrimiene I. Power Doppler artifacts in evaluating inflammatory arthritis of small joints: comparison with a superb microvascular imaging technique. J Ultrasound 2022; 25:765-771. [PMID: 35029838 PMCID: PMC9402880 DOI: 10.1007/s40477-021-00643-2] [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: 08/24/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022] Open
Abstract
Conventional Doppler techniques provide clinical information about tissue vascularisation, but they have limitations in detecting low-velocity blood flow. The innovative Doppler technique called superb microvascular imaging provides visualization of microvascular flow never seen before with the ultrasound. The new tool suppresses the noise caused by motion artifacts with an innovative filter system without removing the weak signal arising from small vessel flow, hence it achieves a greater sensitivity than power Doppler. Explanation of motion artifact genesis reveals SMI imaging principles and helps to distinguish false-positive results. Due to the higher SMI sensitivity to flow, there are nuances in the interpretation of other artifacts as well as motion. The paper presents commonly encountered artifacts of power Doppler compared with a novel microvascular imaging technique focused on a small joints inflammation. The main attention is intent on the practical recommendations for ultrasound machine settings and evaluation of comparable images.
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Affiliation(s)
- Goda Seskute
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513, Vilnius, Lithuania.
| | - Marija Montvydaite
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513, Vilnius, Lithuania
| | - Irena Butrimiene
- Clinic of Rheumatology, Orthopaedics Traumatology, and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, 01513, Vilnius, Lithuania
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Hertrampf S, Klotsche J, Schefer Q, Glimm AM, Burmester GR, Hoff P, Schmittat G, Häupl T, Hermann S, Backhaus M, Ohrndorf S. Monitoring of patients with rheumatoid arthritis by indocyanine green (ICG)-enhanced fluorescence optical imaging treated with anti-TNFα therapy. Arthritis Res Ther 2022; 24:117. [PMID: 35596202 PMCID: PMC9123785 DOI: 10.1186/s13075-022-02795-w] [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: 02/17/2022] [Accepted: 04/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Fluorescence optical imaging (FOI) enables visualisation of inflammation in both hands in rheumatoid arthritis (RA). OBJECTIVE To investigate the usefulness of FOI in treatment monitoring under anti-TNFα therapy with certolizumab pegol (CZP) in patients with RA in comparison to clinical and laboratory outcome parameters. METHODS CZP-naïve patients with RA were eligible for this open-label study with an observational period of 52 weeks. Disease activity was monitored by the clinical score DAS28, tender/swollen joint count (TJC-28/SJC-28) and laboratory outcomes for systemic inflammation (CRP and ESR). FOI results were analysed in three different phases (P1-3) and PrimaVistaMode (PVM) by the FOI activity score (FOIAS). RESULTS Twenty-eight RA patients (median age 52.5 years, 26 females, thirteen with a history of other biologic therapy) were included. DAS28 (CRP) decreased from moderate disease activity at baseline (median 4.6, IQR 1.8) to low disease activity at week (w)52 (median 2.7, IQR 2.1; p < 0.001). Statistically significant decreases could also be demonstrated for SJC-28 and TJC-28. CRP/ESR were reduced numerically from baseline to w52. FOIAS in P1 (early phase) showed a continuous decrease of enhancement during the course of treatment period: from baseline (median 1.5, IQR 9.3) over w6 (median 1.0, IQR 3.0; p = 0.069), w12 (median 0.5, IQR 3.0; p = 0.171), w24 (n = 27, median 0.0, IQR 3.0; p = 0.004), until w52 (n = 18, median 0.0, IQR 2.8; p = 0.091), which could not be presented for FOIAS in P2, P3 and PVM. CONCLUSION FOI in P1 appears to be a valuable tool for fast and easy monitoring of treatment response to certolizumab in a clinical setting.
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Affiliation(s)
- S Hertrampf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - J Klotsche
- Deutsches Rheumaforschungszentrum (DRFZ) Berlin, Leibniz Research Network, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Q Schefer
- regenold GmbH, Zöllinplatz 4, Badenweiler, Germany
| | - A M Glimm
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - P Hoff
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany.,Endokrinologikum Berlin am Gendarmenmarkt, Berlin, Germany
| | - G Schmittat
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - T Häupl
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - S Hermann
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany
| | - M Backhaus
- Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, 10117, Berlin, Germany.
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13
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Shi Y, Fu K, Oo WM, Deveza LA, Wang X, Duong V, Robbins SR, Hunter DJ. Associations between radiographic features, clinical features and ultrasound of thumb-base osteoarthritis: A secondary analysis of the COMBO study. Int J Rheum Dis 2021; 25:38-46. [PMID: 34821056 PMCID: PMC9298930 DOI: 10.1111/1756-185x.14248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
Aim To investigate the associations of ultrasound and radiographic features of thumb‐base osteoarthritis (OA) with thumb‐base pain and hand function at baseline and 12 weeks. Method Data from a randomized controlled trial conducted in participants with symptomatic radiographic thumb‐base OA were analyzed. Participants who finished follow up were included in this secondary analysis. Pain and hand function were assessed using self‐reported measures. All participants underwent ultrasound examinations for synovitis, power Doppler signal (PDS), and osteophytes, and underwent radiography for osteophytes, joint space narrowing (JSN), and subchondral bone sclerosis at baseline. Hand pain and function were reassessed after the 12‐week follow up. The associations of ultrasound and radiographic findings with clinical features were further evaluated, using linear regression analyses, after adjustment for relevant confounding factors. Results A total of 166 participants (average age 66.2 years; 76.5% female) were included. At baseline, radiographic JSN and subchondral bone sclerosis were associated with hand function. There was a significant association between ultrasound‐detected PDS and patient's global assessment (PGA) at baseline. Baseline radiographic JSN was significantly associated with the changes in stiffness and PGA from baseline to 12 weeks. There was no association between ultrasound features and changes in the clinical outcomes over 12 weeks. Conclusion This study indicates that radiographic features significantly correlate with hand function, and ultrasound PDS is closely related to the PGA at baseline in thumb‐base OA. Radiographic JSN may be a predictor for stiffness and PGA in thumb‐base OA.
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Affiliation(s)
- Ying Shi
- Ultrasound Department, Shenzhen Longhua District Central Hospital, Shenzhen, China.,Ultrasound Department, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Kai Fu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Leticia A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Xia Wang
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah R Robbins
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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14
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Kim SK, Jung UH, Kim JW, Choe JY. The beneficial effect of baricitinib on ultrasound-detected synovial inflammation and bone damage in rheumatoid arthritis: Preliminarily data from single center-based observational study for 24 weeks. Medicine (Baltimore) 2021; 100:e26739. [PMID: 34397713 PMCID: PMC8322478 DOI: 10.1097/md.0000000000026739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 06/25/2021] [Indexed: 01/04/2023] Open
Abstract
Baricitinib is a Janus kinase (JAK) inhibitor that selectively blocks against JAK1 and JAK2 signaling. This study aimed to determine the effect of baricitinib on disease activity based on musculoskeletal ultrasound in patients with rheumatoid arthritis (RA).A total of 20 patients with RA receiving baricitinib for 24 weeks were assessed. Ultrasound scores of gray scale and power Doppler synovitis, joint effusion, and bone erosion in each patient were assessed between baseline and 24 weeks for 27 affected joints. Disease activity in RA was evaluated using the disease activity score for 28-joint count with erythrocyte sediment rate (DAS28-ESR), simplified disease activity index (SDAI), and clinical disease activity index (CDAI).Treatment with baricitinib for 12 weeks and 24 weeks significantly decreased disease activity composites such as DAS28-ESR, SDAI, and CDAI (P < .001 for all). Treatment with baricitinib for 24 weeks improved ultrasound-detected gray-scale and power Doppler synovitis and joint effusion compared to baseline (P = .002, P = .030, and P = .002, respectively). Bone erosion scores were not different between baseline and 24 weeks (P = .317). There were no differences in ultrasound abnormalities for improvement based on DAS28-ESR. Changes in power Doppler score were significantly associated with changes in DAS28-ESR (β = 0.590, P = .044), but not SDAI and CDAI.This study demonstrates that baricitinib treatment has a favorable effect on ultrasound-detected abnormalities including synovitis and bone erosion in patients with RA.
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15
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Bakeer N, Dover S, Babyn P, Feldman BM, von Drygalski A, Doria AS, Ignas DM, Abad A, Bailey C, Beggs I, Chang EY, Dunn A, Funk S, Gibikote S, Goddard N, Hilliard P, Keshava SN, Kruse-Jarres R, Li Y, Lobet S, Manco-Johnson M, Martinoli C, O'Donnell JS, Papakonstantinou O, Pergantou H, Poonnoose P, Querol F, Srivastava A, Steiner B, Strike K, Timmer M, Tyrrell PN, Vidarsson L, Blanchette VS. Musculoskeletal ultrasound in hemophilia: Results and recommendations from a global survey and consensus meeting. Res Pract Thromb Haemost 2021; 5:e12531. [PMID: 34268464 PMCID: PMC8271584 DOI: 10.1002/rth2.12531] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 03/18/2021] [Accepted: 04/24/2021] [Indexed: 01/19/2023] Open
Abstract
Introduction For persons with hemophilia, optimization of joint outcomes is an important unmet need. The aim of this initiative was to determine use of ultrasound in evaluating arthropathy in persons with hemophilia, and to move toward consensus among hemophilia care providers regarding the preferred ultrasound protocols for global adaptation. Methods A global survey of hemophilia treatment centers was conducted that focused on understanding how and why ultrasound was being used and endeavored to move toward consensus definitions of both point‐of‐care musculoskeletal ultrasound (POC‐MSKUS) and full diagnostic ultrasound, terminology to describe structures being assessed by ultrasound, and how these assessments should be interpreted. Next, an in‐person meeting of an international group of hemophilia health care professionals and patient representatives was held, with the objective of achieving consensus regarding the acquisition and interpretation of POC‐MSKUS and full diagnostic ultrasound for use in the assessment of musculoskeletal (MSK) pathologies in persons with hemophilia. Results The recommendations were that clear definitions of the types of ultrasound examinations should be adopted and that a standardized ultrasound scoring/measurement system should be developed, tested, and implemented. The scoring/measurement system should be tiered to allow for a range of complexity yet maintain the ability for comparison across levels. Conclusion Ultrasound is an evolving technology increasingly used for the assessment of MSK outcomes in persons with hemophilia. As adoption increases globally for clinical care and research, it will become increasingly important to establish clear guidelines for image acquisition, interpretation, and reporting to ensure accuracy, consistency, and comparability across groups.
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Affiliation(s)
- Nihal Bakeer
- Indiana Hemophilia & Thrombosis Center Indianapolis IN USA
| | - Saunya Dover
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Paul Babyn
- Department of Medical Imaging University of Saskatchewan and Saskatchewan Health Authority Saskatoon City Hospital SK Canada
| | - Brian M Feldman
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada.,Department of Pediatrics Faculty of Medicine University of Toronto Toronto ON Canada.,Institute of Health Policy, Management and Evaluation The Dalla Lana School of Public Health University of Toronto Toronto ON Canada.,Division of Rheumatology The Hospital for Sick Children Toronto ON Canada
| | | | - Andrea S Doria
- Department of Medical Imaging University of Toronto The Hospital for Sick Children Toronto ON Canada
| | - Danial M Ignas
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Audrey Abad
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | - Cindy Bailey
- Los Angeles Orthopaedic Treatment Centre Los Angeles CA USA
| | - Ian Beggs
- Department of Radiology Royal Infirmary of Edinburgh NHS Lothian Edinburgh UK
| | - Eric Y Chang
- University of California San Diego Medical Center San Diego CA USA
| | - Amy Dunn
- Division of Pediatric Hematology, Oncology & Marrow Transplant Department of Pediatrics Nationwide Children's Hospital The Ohio State University College of Medicine Columbus OH USA
| | - Sharon Funk
- Hemophilia and Thrombosis Center University of Colorado Anschutz Medical Campus Aurora CO USA
| | - Sridhar Gibikote
- Division of Clinical Radiology Christian Medical College Vellore India
| | - Nicholas Goddard
- Katherine Dormandy Haemophilia Centre Royal Free Hospital London UK
| | - Pamela Hilliard
- Child Health Evaluative Sciences, Research Institute The Hospital for Sick Children Toronto ON Canada
| | | | - Rebecca Kruse-Jarres
- University of Washington and Washington Center for Bleeding Disorders Seattle WA USA
| | - Yingjia Li
- Ultrasound Department Manfang Hospital Guangzhou China
| | - Sébastien Lobet
- Haemostasis and Thrombosis Unit Division of Haematology Cliniques Universitaires Saint-Luc Brussels Belgium
| | - Marilyn Manco-Johnson
- Hemophilia & Thrombosis Center Department of Pediatrics University of Colorado Anschutz Medical Center Aurora CO USA
| | - Carlo Martinoli
- Department of Health Sciences (DISSAL) Università di Genova IRCCS Ospedale Policlinico San Martino Genova Italy
| | - James S O'Donnell
- Irish Centre for Vascular Biology Royal College of Surgeons in Ireland Dublin Ireland
| | | | - Helen Pergantou
- Pediatric Hemophilia Centre/Haemostatis and Thrombosis Unit Aghia Sophia Children's Hospital Athens Greece
| | - Pradeep Poonnoose
- Department of Orthopedics Unit 2 Christian Medical College Vellore India
| | - Felipe Querol
- Haemostasis and Thrombosis Unit Hospital LA FE Universidad de Valencia Valencia Spain
| | - Alok Srivastava
- Department of Hematology Christian Medical College Vellore India
| | - Bruno Steiner
- Department of Rehabilitation Medicine Physical Therapy and MSKUS Program Washington Center for Bleeding Disorders University of Washington Seattle WA USA
| | - Karen Strike
- School of Rehabilitation Science Faculty of Health Science Hamilton Niagara Regional Hemophilia Program Hamilton Health Sciences McMaster University Hamilton ON Canada
| | - Merel Timmer
- van Creveldkliniek University Medical Center Utrecht Utrecht The Netherlands
| | - Pascal N Tyrrell
- Department of Medical Imaging Institute of Medical Science Toronto ON Canada.,Department of Statistical Sciences University of Toronto Toronto ON Canada
| | - Logi Vidarsson
- Diagnostic Imaging The Hospital for Sick Children Toronto ON Canada
| | - Victor S Blanchette
- Department of Pediatrics Division of Hematology/Oncology University of Toronto The Hospital for Sick Children Toronto ON Canada
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16
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Abdelhafez YG, Godinez F, Sood K, Hagge RJ, Boutin RD, Raychaudhuri SP, Badawi RD, Chaudhari AJ. Feasibility of dual-phase 99mTc-MDP SPECT/CT imaging in rheumatoid arthritis evaluation. Quant Imaging Med Surg 2021; 11:2333-2343. [PMID: 34079705 DOI: 10.21037/qims-20-996] [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] [Indexed: 12/19/2022]
Abstract
Background To prospectively demonstrate the feasibility of performing dual-phase SPECT/CT for the assessment of the small joints of the hands of rheumatoid arthritis (RA) patients, and to evaluate the reliability of the quantitative and qualitative measures derived from the resulting images. Methods A SPECT/CT imaging protocol was developed in this pilot study to scan both hands simultaneously in participants with RA, in two phases of 99mTc-MDP radiotracer uptake, namely the soft-tissue blood pool phase (within 15 minutes after radiotracer injection) and osseous phase (after 3 hours). Joints were evaluated qualitatively (normal vs. abnormal uptake) and quantitatively [by measuring a newly developed metric, maximum corrected count ratio (MCCR)]. Qualitative and quantitative evaluations were repeated to assess reliability. Results Four participants completed seven studies (all four were imaged at baseline, and three of them at follow-up after 1-month of arthritis therapy). A total of 280 joints (20 per hand) were evaluated. The MCCR from soft-tissue phase scans was significantly higher for clinically abnormal joints compared to clinically normal ones; P<0.001, however the MCCR from the osseous phase scans were not different between the two joint groups. Intraclass Correlation Coefficient (ICC) for MCCR was excellent [0.9789, 95% confidence interval (CI): 0.9734-0.9833]. Intra-observer agreement for qualitative SPECT findings was substantial for both the soft-tissue phase (kappa =0.78, 95% CI: 0.72-0.83) and osseous-phase (kappa =0.70, 95% CI: 0.64-0.76) scans. Conclusions Extracting reliable quantitative and qualitative measures from dual-phase 99mTc-MDP SPECT/CT hand scans is feasible in RA patients. SPECT/CT may provide a unique means for assessing both synovitis and osseous involvement in RA joints using the same radiotracer injection.
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Affiliation(s)
- Yasser G Abdelhafez
- Department of Radiology, University of California Davis, Sacramento, CA, USA.,Nuclear Medicine Unit, South Egypt Cancer Institute, Assiut University, Assiut, Egypt
| | - Felipe Godinez
- Department of Radiology, University of California Davis, Sacramento, CA, USA.,School of Biomedical Engineering and Imaging Science, King's College, London, UK
| | - Kanika Sood
- Rheumatology Section, Sacramento Veterans Affairs Medical Center, Mather, CA, USA
| | - Rosalie J Hagge
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - Robert D Boutin
- Department of Radiology, University of California Davis, Sacramento, CA, USA.,Department of Radiology, Stanford University, Stanford, CA, USA
| | - Siba P Raychaudhuri
- Rheumatology Section, Sacramento Veterans Affairs Medical Center, Mather, CA, USA.,Department of Internal Medicine, University of California Davis, Sacramento, CA, USA
| | - Ramsey D Badawi
- Department of Radiology, University of California Davis, Sacramento, CA, USA
| | - Abhijit J Chaudhari
- Department of Radiology, University of California Davis, Sacramento, CA, USA
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17
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Fairchild R, Horomanski A, Sharpless L, Chung M, Li S, Hong J, Sheth K, Chung L. Ultrasound evaluation of the hands and wrists in patients with systemic sclerosis: Osteophytosis is a major contributor to tender joints. Semin Arthritis Rheum 2021; 51:735-740. [PMID: 34144383 DOI: 10.1016/j.semarthrit.2021.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/13/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate the prevalence and clinical associations of ultrasound (US) findings of inflammatory arthritis and joint and soft tissue pathology in patients with systemic sclerosis (SSc). METHODS The hands and wrists of 43 SSc patients and 35 age-balanced controls were evaluated by clinical exam and musculoskeletal US. Synovial and tenosynovial pathology were assessed using semi-quantitative Gray Scale (GS) and Power Doppler (PD) scoring. US evaluation for osteophytes, erosions, ulnar artery occlusion, and median nerve cross-sectional areas was performed. Tender joints (TJ), swollen joints (SJ), modified Rodnan skin score (mRSS), digital ulcers, contractures, and calcinosis were evaluated. Concordance between US and physical exam findings at each joint region were assessed, and associations between their severity were analyzed. RESULTS TJs and SJs were present in 44.2% and 62.8% of SSc patients, respectively. Inflammatory arthritis, defined as having both GS>0 and PD>0, was observed in 18.6% of SSc patients and no controls. There was a high concordance by joint region between GS synovial hypertrophy and osteophytes (κ=0.88) as well as TJs (κ=0.72). SSc patients had more osteophytes compared to controls (48.8% vs 22.9%, p = 0.018) as well as higher osteophyte severity (p = 0.033). CONCLUSIONS Despite a high percentage of tender and swollen joints, less than 20% of SSc patients met criteria for inflammatory arthritis on US. The high concordance of osteophytes with GS synovial hypertrophy and tender joints suggest that osteophytosis may be a significant contributor to joint pain in SSc patients.
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Affiliation(s)
- Robert Fairchild
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA.
| | - Audra Horomanski
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA
| | - Laurel Sharpless
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA
| | - Melody Chung
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA
| | - Shufeng Li
- Departments of Dermatology and Urology, Stanford University Medical Center, USA
| | - Jison Hong
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA
| | - Khushboo Sheth
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA; Division of Rheumatology, Palo Alto VA Healthcare System, USA
| | - Lorinda Chung
- Division of Immunology and Rheumatology, Stanford University Medical Center, USA; Division of Rheumatology, Palo Alto VA Healthcare System, USA
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18
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Jones MA, MacCuaig WM, Frickenstein AN, Camalan S, Gurcan MN, Holter-Chakrabarty J, Morris KT, McNally MW, Booth KK, Carter S, Grizzle WE, McNally LR. Molecular Imaging of Inflammatory Disease. Biomedicines 2021; 9:152. [PMID: 33557374 PMCID: PMC7914540 DOI: 10.3390/biomedicines9020152] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/25/2021] [Accepted: 01/31/2021] [Indexed: 02/06/2023] Open
Abstract
Inflammatory diseases include a wide variety of highly prevalent conditions with high mortality rates in severe cases ranging from cardiovascular disease, to rheumatoid arthritis, to chronic obstructive pulmonary disease, to graft vs. host disease, to a number of gastrointestinal disorders. Many diseases that are not considered inflammatory per se are associated with varying levels of inflammation. Imaging of the immune system and inflammatory response is of interest as it can give insight into disease progression and severity. Clinical imaging technologies such as computed tomography (CT) and magnetic resonance imaging (MRI) are traditionally limited to the visualization of anatomical information; then, the presence or absence of an inflammatory state must be inferred from the structural abnormalities. Improvement in available contrast agents has made it possible to obtain functional information as well as anatomical. In vivo imaging of inflammation ultimately facilitates an improved accuracy of diagnostics and monitoring of patients to allow for better patient care. Highly specific molecular imaging of inflammatory biomarkers allows for earlier diagnosis to prevent irreversible damage. Advancements in imaging instruments, targeted tracers, and contrast agents represent a rapidly growing area of preclinical research with the hopes of quick translation to the clinic.
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Affiliation(s)
- Meredith A. Jones
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA; (M.A.J.); (W.M.M.); (A.N.F.)
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
| | - William M. MacCuaig
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA; (M.A.J.); (W.M.M.); (A.N.F.)
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
| | - Alex N. Frickenstein
- Stephenson School of Biomedical Engineering, University of Oklahoma, Norman, OK 73019, USA; (M.A.J.); (W.M.M.); (A.N.F.)
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
| | - Seda Camalan
- Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA; (S.C.); (M.N.G.)
| | - Metin N. Gurcan
- Department of Internal Medicine, Wake Forest Baptist Health, Winston-Salem, NC 27157, USA; (S.C.); (M.N.G.)
| | - Jennifer Holter-Chakrabarty
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
- Department of Medicine, University of Oklahoma, Oklahoma City, OK 73104, USA
| | - Katherine T. Morris
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
- Department of Surgery, University of Oklahoma, Oklahoma City, OK 73104, USA
| | - Molly W. McNally
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
| | - Kristina K. Booth
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
- Department of Surgery, University of Oklahoma, Oklahoma City, OK 73104, USA
| | - Steven Carter
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
- Department of Surgery, University of Oklahoma, Oklahoma City, OK 73104, USA
| | - William E. Grizzle
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL 35294, USA;
| | - Lacey R. McNally
- Stephenson Cancer Center, University of Oklahoma, Oklahoma City, OK 73104, USA; (J.H.-C.); (K.T.M.); (M.W.M.); (K.K.B.); (S.C.)
- Department of Surgery, University of Oklahoma, Oklahoma City, OK 73104, USA
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19
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Manual Therapy (Postisometric Relaxation and Joint Mobilization) in Knee Pain and Function Experienced by Patients with Rheumatoid Arthritis: A Randomized Clinical Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2020; 2020:1452579. [PMID: 32922504 PMCID: PMC7453239 DOI: 10.1155/2020/1452579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 06/29/2020] [Accepted: 07/15/2020] [Indexed: 11/17/2022]
Abstract
Objectives The purpose of this study was to evaluate the impact of manual therapy on the management of rheumatoid arthritis (RA) patients with knee pain. Materials and Methods This was a small, randomized clinical pilot study. Subjects were 46 patients with diagnosed RA, randomly assigned to the manual therapy group (postisometric relaxation and joint mobilization) or control group (standard exercise). Subjects in each group had 10 sessions of interventions, once a day with one day break after the sixth day. Outcomes included the pain intensity of knee, Knee Society Score, Oxford Knee Score, and Health Assessment Questionnaire. Results There were no statistically significant differences between groups, except for the pain intensity of the knee. Conclusions This study suggests that manual therapy (postisometric relaxation and joint mobilization) may have clinical benefits for treating knee pain and function in rheumatoid patients. Further extended studies are expected to determine the effectiveness of manual therapy in RA patients with knee pain.
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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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Ultrasonographic Changes of Major Salivary Glands in Primary Sjögren's Syndrome. J Clin Med 2020; 9:jcm9030803. [PMID: 32188034 PMCID: PMC7141294 DOI: 10.3390/jcm9030803] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/13/2020] [Accepted: 03/13/2020] [Indexed: 12/11/2022] Open
Abstract
We aimed to evaluate the changes over time in salivary gland (SG) abnormalities by ultrasound (US) in patients with primary Sjögren’s syndrome (pSS). Patients with pSS (n = 70) and idiopathic sicca syndrome (n = 18) underwent baseline salivary gland ultrasound (SGUS) scans, and follow-up scans two years later. The semi-quantitative SGUS score (0–48) and intraglandular power Doppler signal (PDS) were assessed. We found that in the pSS group, the SGUS scores for total SGs and bilateral parotid glands significantly increased after the median 23.4-months follow-up. SGUS scores either worsened, improved, or were stable in 18.6%, 2.9%, and 78.6% of patients with pSS, respectively. The median changes from baseline in SGUS scores for total and parotid glands were +1.0 and +0.5, respectively. None of the SGUS scores changed significantly in the controls. The variables of homogeneity and hypoechoic showed a statistically significant progression of SGUS scores. In pSS patients, the baseline and follow-up PDS scores were significantly higher in the “worsening” group than in the “no change/improvement” group. Overall, the structural abnormalities in major SGs assessed using SGUS remained stable in patients with pSS. At the 2-year follow-up, SGUS scores worsened in 18.6% of patients with pSS. Intra-glandular hypervascularity was associated with the worsening of SG abnormalities.
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Validity of 7-Joint Versus Simplified 12-Joint Ultrasonography Scoring Systems in Assessment of Rheumatoid Arthritis Activity. J Clin Rheumatol 2020; 25:264-271. [PMID: 29965853 DOI: 10.1097/rhu.0000000000000847] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Musculoskeletal ultrasonography (US) is an objective tool for the evaluation of disease activity in rheumatoid arthritis (RA) patients. There is no consensus on the exact number of joints that should be examined. Examination of reduced joint count is more practical than the comprehensive one. OBJECTIVES This is a cross-sectional study investigated the validity of a 7-joint US score (US7) in assessment of joint inflammation in RA patients compared with a simplified 12-joint US score (US12) and correlated both to composite disease activity indices. METHODS The activity status of 50 RA patients was assessed clinically and ultrasonographically. The disease activity was calculated using 3 composite indices. Ultrasonography was performed by 1 blinded rheumatologist, using power Doppler (PD) and gray-scale (GS) US examination. The US7 and simplified US12 were performed as originally described. However, the GS synovitis and PD synovitis of US12 were computed in 2 separate scores instead of 1. Two sum US7 scores were added, sum (GS) US7 and sum (PD) US7 after summating synovitis and tenosynovitis scores. Ultrasonography interobserver/intraobserver reliability was evaluated on 40 stored images. RESULTS Correlation coefficient between the different ultrasonographic scores showed no difference. The GS scores showed no correlation with disease activity parameters; however, the PD scores did. The sum (PD) US7 was the only score that showed significant correlation with the 3 different composite disease indices. CONCLUSIONS All studied US scores proved valid in assessment of disease activity status in RA. This is in favor of using the less-time-consuming US7 scores. The strongest correlation found with sum (PD) US7 confirmed the importance of incorporating the tendon in the disease activity assessment.
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Gitto S, Messina C, Chianca V, Tuscano B, Lazzara A, Corazza A, Pedone L, Albano D, Sconfienza LM. Superb microvascular imaging (SMI) in the evaluation of musculoskeletal disorders: a systematic review. Radiol Med 2020; 125:481-490. [DOI: 10.1007/s11547-020-01141-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 01/16/2020] [Indexed: 12/12/2022]
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Bradford CM, McDonnell T, Raj D, Robinson GA, Cole A, Ramakrishnan S, González-Serrano R, Mak J, Eskiocak YC, Isenberg DA, Ciurtin C, Jury EC, Manson JJ. Characterization of a Subset of Patients With Rheumatoid Arthritis for Whom Current Management Strategies are Inadequate. ACR Open Rheumatol 2019; 1:145-155. [PMID: 31777790 PMCID: PMC6857995 DOI: 10.1002/acr2.1021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective A subset of patients with seropositive rheumatoid arthritis (RA) do not mount a C‐reactive protein (CRP) response during flares. We hypothesize that these patients are more likely to experience poor clinical care and less likely to respond to traditional therapy. This study questioned whether this presentation was associated with worse disease outcome and distinct immunological features. Methods Using Power Doppler ultrasound, 48 RA patients with active synovitis were recruited; 30 had normal (n)CRP (5 mg/L or less) and 18 had high (h)CRP (more than 5 mg/L) levels. All had equivalent disease burden assessed by other clinical and laboratory parameters. Results Time to diagnosis and time to first disease‐modifying antirheumatic drug were significantly longer in nCRP compared with hCRP patients (P < 0.05). Significantly more nCRP patients needed escalation to biologics after 2‐year follow‐up (P = 0.01). The inflammatory milieu was also different between the two subgroups. Synergy between inflammatory cytokines observed in hCRP patients was lost in nCRP patients, and nCRP patients had significantly increased regulatory T‐cell (Treg) frequencies that correlated positively with predictors of poor disease outcome. Conversely, hCRP but not nCRP patients demonstrated a significant upregulation of alternative complement pathway factors that correlated negatively with Treg frequency. Conclusion Patients with nCRP during flares of RA had an altered immunological profile compared with hCRP patients and experienced diagnostic delays and responded less favorably to conventional treatment.
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Affiliation(s)
| | | | | | | | - Andrew Cole
- University College London Hospital London UK
| | | | | | | | | | - David A Isenberg
- University College London and University College London Hospital London UK
| | - Coziana Ciurtin
- University College London and University College London Hospital London UK
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Liu H, Huang C, Chen S, Zheng Q, Ye Y, Ye Z, Lv G. Value of contrast-enhanced ultrasound for detection of synovial vascularity in experimental rheumatoid arthritis: an exploratory study. J Int Med Res 2019; 47:5740-5751. [PMID: 31547746 PMCID: PMC6862898 DOI: 10.1177/0300060519874159] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 08/15/2019] [Indexed: 12/27/2022] Open
Abstract
Objective This study aimed to examine the associations between contrast-enhanced ultrasound (CEUS) imaging and synovial hypervascularity and synovitis score in a rabbit model of antigen-induced arthritis (AIA), compared with power Doppler ultrasound (PDUS). Methods We investigated 50 knee joints in 25 AIA rabbits (AIA group), and 10 knee joints in five sham-injected rabbits (control group). PDUS and CEUS images were evaluated at the 8th week. Ultrasound-guided synovial biopsies were targeted in the area with hypervascularity, and synovial microvessel density (MVD) was evaluated by immunohistochemical staining of CD31. Results The PDUS score was significantly higher in the AIA group (2.61 ± 0.78) compared with the control group (0.50 ± 0.53). CEUS in the AIA group revealed a fast-in/slow-out pattern of contrast enhancement. MVD revealed by CD31+ vessel count and the synovitis score were significantly higher in the AIA group compared with the control group. In the AIA group, CEUS findings showed a better correlation with MVD revealed by CD31+ and synovitis score than PDUS findings. Conclusion CEUS is superior to PDUS for estimating synovial hypervascularity and hyperplasia in experimental rheumatoid arthritis.
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Affiliation(s)
- Hui Liu
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chao Huang
- Department of Nuclear Medicine, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Shuqiang Chen
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Qing Zheng
- Department of Hematology and Rheumatology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yuhong Ye
- Department of Pathology, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Zhen Ye
- Department of Ultrasound, the First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guorong Lv
- Department of Ultrasound, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
- Department of Clinical Medicine, Quanzhou Medical College, Quanzhou, China
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Association of Angiogenic and Inflammatory Markers with Power Doppler Ultrasound Vascularity Grade and DAS28-CRP in Early Rheumatoid Arthritis: A Comparative Analysis. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6906374. [PMID: 30596097 PMCID: PMC6286781 DOI: 10.1155/2018/6906374] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 09/26/2018] [Accepted: 10/30/2018] [Indexed: 01/09/2023]
Abstract
Objective Upregulation of various proinflammatory and angiogenic mediators orchestrates the typical pathological synovial alterations in rheumatoid arthritis (RA). DAS28-CRP is commonly used for assessment of RA disease activity and power Doppler ultrasonography (PDUS) is an important modality for assessing synovial vascularity. This study was intended to look for the association of various inflammatory and angiogenic mediators, with respect to different PDUS vascularity grades and disease activity status, in early RA patients. Methods 50 early RA patients (<6 months disease duration) with either moderate or high disease activity and 30 healthy controls were included in this study. RA patients were subcategorized based on PDUS vascularity grading of wrist joints. Serum levels of proinflammatory cytokines [tumor necrosis factor-α (TNF- α); interleukin-6(IL-6)] and angiogenic markers [angiopoietin-1 and 2 (Ang-1 and Ang-2); vascular endothelial growth factor (VEGF) ] were measured and compared among different patient subgroups. Results Among 50 patients, 22 and 28 patients had moderate and high DAS28-CRP score, respectively. Patients with grade 3 PDUS score, even with moderate DAS value, showed a significant rise in Ang-1 (p<0.02), VEGF (p<0.008), Ang-2 (p <0.001), and TNF-α (p<0.005) level compared to grade 2 PDUS patients with high DAS values. Conclusion Higher serum level of angiogenic and inflammatory markers was noted among patients with moderate disease activity but with advanced PDUS vascularity (grade 3) in comparison to high disease activity group with less severe PDUS vascularity (grade 2). PDUS vascularity grading better reflects some markers of angiogenesis and inflammation, than composite disease activity index.
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Leblond A, Pezet S, Trouvin AP, Elhai M, Gonzalez V, Allanore Y, Avouac J. Linking systemic angiogenic markers to synovial vascularization in rheumatoid arthritis. PLoS One 2018; 13:e0203607. [PMID: 30188942 PMCID: PMC6126858 DOI: 10.1371/journal.pone.0203607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 08/03/2018] [Indexed: 12/20/2022] Open
Abstract
Background Neoangiogenesis is a crucial event to promote the development of the hyperplasic proliferative pathologic synovium in Rheumatoid arthritis (RA). Ultrasound (US) is sensitive for detection of power Doppler (PD) vascularization. Objective To explore the associations between a set of complementary circulating angiogenic markers and a comprehensive US assessment in patients with RA. Patients and methods Serum levels of eight angiogenic markers were measured by quantitative ELISAs in a total of 125 patients with RA, who were all systematically assessed in parallel by PDUS, performed on 32 joints. Results Serum levels of soluble Vascular Cell Adhesion Molecule-1 (sVCAM-1) and Tie-2 were more likely to be increased in patients with synovial hyperemia detected on at least one joint (Power Doppler grade ≥1). sVCAM-1, Tie-2 and Angiostatin concentrations gradually increased together with the grade of the semiquantitative PDUS scale and concentrations of these three markers were markedly increased in patients with moderate to marked hyperemia (Power Doppler grade 2 and 3). Levels of sVCAM-1, Tie-2, and Angiostatin correlated with a global arthritis sum score, defined by the sum of the semiquantitative PDUS scores for all joints examined. Levels of Tie-2 and Placenta Growth Factor (PlGF) were associated with PDUS features indicating residual disease activity. Conclusion Our results support the relevance of measuring serum levels of vascular markers to evaluate the intensity and extent of synovial vascularization. Angiogenic markers, and particularly Tie-2, could be a valuable surrogate of active synovitis and their place in relation to PDUS in clinical practice deserve further investigation.
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Affiliation(s)
- Agathe Leblond
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Sonia Pezet
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Anne Priscille Trouvin
- Université Paris Descartes, Sorbonne Paris Cité, Service de Rhumatologie A, Hôpital Cochin, Paris, France
| | - Muriel Elhai
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Service de Rhumatologie A, Hôpital Cochin, Paris, France
| | - Virginie Gonzalez
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
| | - Yannick Allanore
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Service de Rhumatologie A, Hôpital Cochin, Paris, France
| | - Jérôme Avouac
- Université Paris Descartes, Sorbonne Paris Cité, INSERM U1016 and CNRS UMR8104, Institut Cochin, Paris, France
- Université Paris Descartes, Sorbonne Paris Cité, Service de Rhumatologie A, Hôpital Cochin, Paris, France
- * E-mail:
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Sarzi-Puttini P, Filippucci E, Adami S, Meroni PL, Batticciotto A, Idolazzi L, De Lucia O, Talavera P, Kumke T, Grassi W. Clinical, Ultrasound, and Predictability Outcomes Following Certolizumab Pegol Treatment (with Methotrexate) in Patients with Moderate-to-Severe Rheumatoid Arthritis: 52-Week Results from the CZP-SPEED Study. Adv Ther 2018; 35:1153-1168. [PMID: 30043210 PMCID: PMC6096970 DOI: 10.1007/s12325-018-0751-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To assess the impact of certolizumab pegol (CZP) treatment on clinical, patient-reported, and musculoskeletal ultrasound outcomes and to determine the treatment response time point most predictive of long-term outcomes in Italian patients with rheumatoid arthritis (RA). METHODS CZP-SPEED (NCT01443364) was a 52-week, open-label, prospective, interventional, multicenter study. Biologic-naïve patients with moderate-to-severe active RA, who had failed at least one DMARD treatment, received CZP (400 mg at weeks 0, 2, and 4, then 200 mg every 2 weeks) concomitantly with methotrexate. The primary objective was to identify the time point of clinical response {decrease in 28-joint Disease Activity Score [DAS28(ESR)] ≥ 1.2} most predictive of a clinical response at week 52. Additional clinical and patient-reported outcomes were measured. Power Doppler (PD) ultrasound was used to assess synovial effusion, synovial proliferation, PD signal, cartilage damage, and bone erosion according to international guidelines. RESULTS A total of 132 patients were enrolled and received CZP; 91/132 (69%) completed to week 52. Predicted 52-week responses for early responders (week 2 onwards) were between 65% and 70%. Rapid improvements in joint cavity widening and PD signal were observed to week 8 and maintained to week 52. Cartilage damage and bone erosion were stable over 52 weeks. No new safety signals were identified. CONCLUSION In Italian CZP-treated patients with moderate-to-severe RA, week 12 clinical responses may be predictive of long-term response at week 52. Rapid improvements in clinical, patient-reported, and musculoskeletal ultrasound outcomes were maintained to week 52. These data may aid rheumatologists to make earlier treatment decisions. TRIAL REGISTRATION ClinicalTrials.gov identifier, NCT01443364. FUNDING UCB Pharma.
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Affiliation(s)
| | | | - Silvano Adami
- Università degli Studi di Verona, Azienda Ospedaliera di Verona, Verona, Italy
| | - Pier Luigi Meroni
- ASST Centro Ortopedico Traumatologico Gaetano Pini-CTO-Università degli Studi di Milano, Milan, Italy
| | | | - Luca Idolazzi
- Università degli Studi di Verona, Azienda Ospedaliera di Verona, Verona, Italy
| | - Orazio De Lucia
- ASST Centro Ortopedico Traumatologico Gaetano Pini-CTO-Università degli Studi di Milano, Milan, Italy
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Ozer PK, Sahin O, Ozer Z, Cengiz AK, Durmaz Y, Kaptanoglu E. Ultrasound-defined remission for good functional status in rheumatoid arthritis. Indian J Med Res 2018; 146:230-236. [PMID: 29265024 PMCID: PMC5761033 DOI: 10.4103/ijmr.ijmr_548_15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background & objectives: It has been shown that joint damage due to subclinical synovitis progresses despite apparent clinical remission in rheumatoid arthritis (RA). Hence, finding more objective methods to investigate subclinical synovitis has become a current issue. Ultrasonography (US) has been among the most investigated methods. This study was conducted to detect whether there was subclinical inflammation in RA patients in clinical remission by power Doppler ultrasonography (PDUS) and to evaluate the effects of this inflammation on upper extremity function. Methods: Forty five RA patients fulfilled the remission criteria of disease activity score 28 using erythrocyte sedimentation rate (DAS28-ESR), were enrolled in the study. Bilateral wrist, 2nd and 3th metacarpophalangeal and proximal interphalangeal joints and 2nd and 5th metatarsophalangeal joints were examined by PDUS. Upper extremity function was assessed with Michigan Hand Outcomes Questionnaire (MHQ) and handgrip strength. The pain was evaluated by visual analogue scale (VAS). Results: In 29 of 45 RA patients in clinical remission, synovitis was detected by PDUS at least in one joint. VAS and DAS28-ESR scores were significantly lower and total MHQ, some subgroup scores of MHQ (overall hand function, activity of daily living and work performance) and grip strength of the dominant hand were higher in patients with PD signal negativity. Interpretation & conclusions: PDUS showed a crucial role in determining the subclinical synovitis. Subclinical synovitis negatively affects the upper extremity function. Ultrasound-defined remission may be considered for good functional status and real remission in patients with RA.
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Affiliation(s)
- Pinar Kaplan Ozer
- Department of Physical Medicine & Rehabilitation, Sivas State Hospital, Sivas, Turkey
| | - Ozlem Sahin
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
| | - Zafer Ozer
- Department of Physical Medicine & Rehabilitation, Sivas Numune Hospital, Sivas, Turkey
| | - Ahmet Kivanc Cengiz
- Department of Physical Medicine & Rehabilitation, Division of Rheumatology, Sivas Numune Hospital, Sivas, Turkey
| | - Yunus Durmaz
- Department of Physical Medicine & Rehabilitation, Division of Rheumatology, Mehmet Akif Inan Education & Research Hospital, Sanliurfa, Turkey
| | - Ece Kaptanoglu
- Department of Physical Medicine & Rehabilitation, Faculty of Medicine, Cumhuriyet University, Sivas, Turkey
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Karimzadeh H, Karami M, Bazgir N, Karimifar M, Yadegarfar G, Mohammadzadeh Z. Ultrasonographic findings of rheumatoid arthritis patients who are in clinical remission. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2018; 23:38. [PMID: 29887906 PMCID: PMC5961277 DOI: 10.4103/jrms.jrms_308_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Revised: 07/05/2017] [Accepted: 01/17/2018] [Indexed: 12/03/2022]
Abstract
BACKGROUND The aim of this study was to recognize the findings of ultrasonography (US) in remitted rheumatic arthritis (RA) patients for detection subclinical arthritis. MATERIALS AND METHODS This descriptive study was conducted during 2016 in a rheumatology center. A total of 70 patients with remitted RA were included in the study. Sonography was performed on all 70 patients who did not show any clinical arthritis in clinical examination to find synovitis and effusion were evaluated with gray scale and hyperemia with power Doppler US. RESULTS Nearly 44.3% (n = 31) of our patients had positive sonography results including 20% synovitis, 21.4% hyperemia, and 18.6% (n = 13) effusion. A total of 1960 joints of 70 patients were evaluated, in which 3.2% (n = 63) of joints had positive sonography findings including 1.2% synovitis, 1.5% hyperemia, and 1.1 with effusion. CONCLUSION US can diagnosis subclinical arthritis in patients with remitted RA who does not show any joint involvement in clinical examination.
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Affiliation(s)
- Hadi Karimzadeh
- Department of Internal Medicine, Isfahan Bone Metabolic Disorders Research Center, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Mehdi Karami
- Department of Radiology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nasrin Bazgir
- Department of Internal Medicine, Isfahan Bone Metabolic Disorders Research Center, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
- Department of Internal Medicine, Mostafa Khomyni Hospital, Ilam University of Medical Sciences, Ilam, Iran
| | - Mansour Karimifar
- Department of Rheumatology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ghasem Yadegarfar
- Department of Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zohrea Mohammadzadeh
- Department of Radiology, Medical School, Isfahan University of Medical Sciences, Isfahan, Iran
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Orlandi D, Gitto S, Perugin Bernardi S, Corazza A, De Flaviis L, Silvestri E, Cimmino MA, Sconfienza LM. Advanced Power Doppler Technique Increases Synovial Vascularity Detection in Patients with Rheumatoid Arthritis. ULTRASOUND IN MEDICINE & BIOLOGY 2017; 43:1880-1887. [DOI: 10.1016/j.ultrasmedbio.2017.05.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Forien M, Ottaviani S. Ultrasound and follow-up of rheumatoid arthritis. Joint Bone Spine 2016; 84:531-536. [PMID: 27777169 DOI: 10.1016/j.jbspin.2016.08.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/31/2016] [Indexed: 01/09/2023]
Abstract
Rheumatoid arthritis (RA) is chronic rheumatic disorder leading to joint inflammation and potential structural damages. This destruction occurs early in the disease outcome leading to the concept of window of opportunity. New diagnosis RA criteria have been proposed to allow an earlier diagnosis and subsequently a better management of the disease. Moreover, tight control of the disease was able to improve the prognosis of RA. For this, rheumatologists need routinely feasible tools and ultrasound (US) appears as the ideal imaging modality. US is superior to clinical exam for the detection of subclinical synovitis. US has a good correlation with clinical findings and markers of inflammation. US persistence of synovitis is associated with higher rate of relapse and more radiographic progression. However, standardization of scoring and settings procedures is necessary before being universally accepted as a marker of disease activity. Finally, US did not improve the tight control strategy and did not replace clinical exam for RA management.
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Affiliation(s)
- Marine Forien
- Service de Rhumatologie, Hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France
| | - Sébastien Ottaviani
- Service de Rhumatologie, Hôpital Bichat, AP-HP, 46, rue Henri-Huchard, 75018 Paris, France.
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