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Mantantzis K, Franks B, Kachroo P, Boncheva Bettex M. Topical Diclofenac Reduces Joint Synovitis in Hand Osteoarthritis: A Pilot Investigation Using Fluorescent Optical Imaging. J Pain Res 2024; 17:2279-2286. [PMID: 38947131 PMCID: PMC11214796 DOI: 10.2147/jpr.s463633] [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: 02/10/2024] [Accepted: 06/18/2024] [Indexed: 07/02/2024] Open
Abstract
Purpose Synovitis, the inflammation of joint synovia, is a prominent feature of osteoarthritis (OA) manifested by enhanced synovial vascularity, endothelial leakage, and perivascular oedema. In this pilot study, we assessed the effect of topical diclofenac in hand OA (HOA) using the established semi-quantitative methods Magnetic Resonance Imaging (MRI) and Ultrasonography (US), and compared them with Fluorescent Optical Imaging (FOI), an emerging imaging modality. Patients and Methods Ten patients with symptomatic and diagnosed HOA used topical diclofenac for 14 days, with FOI, MRI, US, and subjective pain assessed at Baseline and after 7 (Day 8), and 14 (Day 15) days of treatment. Changes in synovitis were assessed for all 10 joints of the hand (via sum scores), and separately for the two joints most affected by synovitis. A new, fully quantitative approach for objective synovitis assessment based on the FOI images was also developed and applied. Results The semi-quantitative analysis of the sum scores showed a small decrease in synovitis throughout the treatment duration across the different imaging modalities. The effect of the treatment was more prominent on the two most affected joints, with a synovitis reduction vs Baseline of 21.1% and 34.2% on Day 8 and Day 15, respectively, in the FOI. The quantitative FOI pixel analysis further strengthened the evidence for this effect, with observed reduction of 17.8% and 42.4% for Days 8 and 15, respectively. A similar trend was observed for subjective pain perception, with a reduction of 7.2 and 13.3 mm on Days 8 and 15. Conclusion This pilot study evidenced the effect of topical diclofenac on reducing synovitis in hand OA in semi- and fully quantitative analyses, with the effect being stronger in the most affected joints. Further, supporting studies are needed to probe the accuracy of the quantitative pixel analysis of FOI images.
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Affiliation(s)
| | - Billy Franks
- R&D, Haleon Netherlands B.V., Amersfoort, the Netherlands
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Oskroba A, Bartusik-Aebisher D, Myśliwiec A, Dynarowicz K, Cieślar G, Kawczyk-Krupka A, Aebisher D. Photodynamic Therapy and Cardiovascular Diseases. Int J Mol Sci 2024; 25:2974. [PMID: 38474220 DOI: 10.3390/ijms25052974] [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: 12/31/2023] [Revised: 02/24/2024] [Accepted: 03/01/2024] [Indexed: 03/14/2024] Open
Abstract
Cardiovascular diseases are the third most common cause of death in the world. The most common are heart attacks and stroke. Cardiovascular diseases are a global problem monitored by many centers, including the World Health Organization (WHO). Atherosclerosis is one aspect that significantly influences the development and management of cardiovascular diseases. Photodynamic therapy (PDT) is one of the therapeutic methods used for various types of inflammatory, cancerous and non-cancer diseases. Currently, it is not practiced very often in the field of cardiology. It is most often practiced and tested experimentally under in vitro experimental conditions. In clinical practice, the use of PDT is still rare. The aim of this review was to characterize the effectiveness of PDT in the treatment of cardiovascular diseases. Additionally, the most frequently used photosensitizers in cardiology are summarized.
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Affiliation(s)
- Aleksander Oskroba
- Science Club, Faculty of Medicine, Medical University of Lublin, 20-059 Lublin, Poland
| | - Dorota Bartusik-Aebisher
- Department of Biochemistry and General Chemistry, Medical College of The Rzeszów University, 35-959 Rzeszów, Poland
| | - Angelika Myśliwiec
- Center for Innovative Research in Medical and Natural Sciences, Medical College of the University of Rzeszów, 35-310 Rzeszów, Poland
| | - Klaudia Dynarowicz
- Center for Innovative Research in Medical and Natural Sciences, Medical College of the University of Rzeszów, 35-310 Rzeszów, Poland
| | - Grzegorz Cieślar
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Batorego 15 St., 41-902 Bytom, Poland
| | - Aleksandra Kawczyk-Krupka
- Department of Internal Medicine, Angiology and Physical Medicine, Center for Laser Diagnostics and Therapy, Medical University of Silesia in Katowice, Batorego 15 St., 41-902 Bytom, Poland
| | - David Aebisher
- Department of Photomedicine and Physical Chemistry, Medical College of The Rzeszów University, 35-959 Rzeszów, Poland
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Noversa de Sousa R, Tascilar K, Corte G, Atzinger A, Minopoulou I, Ohrndorf S, Waldner M, Schmidkonz C, Kuwert T, Knieling F, Kleyer A, Ramming A, Schett G, Simon D, Fagni F. Metabolic and molecular imaging in inflammatory arthritis. RMD Open 2024; 10:e003880. [PMID: 38341194 PMCID: PMC10862311 DOI: 10.1136/rmdopen-2023-003880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
It is known that metabolic shifts and tissue remodelling precede the development of visible inflammation and structural organ damage in inflammatory rheumatic diseases such as the inflammatory arthritides. As such, visualising and measuring metabolic tissue activity could be useful to identify biomarkers of disease activity already in a very early phase. Recent advances in imaging have led to the development of so-called 'metabolic imaging' tools that can detect these changes in metabolism in an increasingly accurate manner and non-invasively.Nuclear imaging techniques such as 18F-D-glucose and fibroblast activation protein inhibitor-labelled positron emission tomography are increasingly used and have yielded impressing results in the visualisation (including whole-body staging) of inflammatory changes in both early and established arthritis. Furthermore, optical imaging-based bedside techniques such as multispectral optoacoustic tomography and fluorescence optical imaging are advancing our understanding of arthritis by identifying intra-articular metabolic changes that correlate with the onset of inflammation with high precision and without the need of ionising radiation.Metabolic imaging holds great potential for improving the management of patients with inflammatory arthritis by contributing to early disease interception and improving diagnostic accuracy, thereby paving the way for a more personalised approach to therapy strategies including preventive strategies. In this narrative review, we discuss state-of-the-art metabolic imaging methods used in the assessment of arthritis and inflammation, and we advocate for more extensive research endeavours to elucidate their full field of application in rheumatology.
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Affiliation(s)
- Rita Noversa de Sousa
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Serviço de Medicina Interna, Hospital Pedro Hispano, Matosinhos, Portugal
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Koray Tascilar
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Giulia Corte
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Armin Atzinger
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ioanna Minopoulou
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Maximilian Waldner
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Institute for Medical Engineering, Ostbayerische Technische Hochschule Amberg-Weiden, Amberg, Germany
| | - Torsten Kuwert
- Department of Nuclear Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Ferdinand Knieling
- Department of Pediatrics and Adolescent Medicine, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Ramming
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
- Deutsches Zentrum fuer Immuntherapie (DZI), Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Sonin D, Papayan G, Istomina M, Anufriev I, Pochkaeva E, Minasian S, Zaytseva E, Mukhametdinova D, Mochalov D, Aleksandrov I, Petrishchev N, Galagudza M. Advanced technique of myocardial no-reflow quantification using indocyanine green. BIOMEDICAL OPTICS EXPRESS 2024; 15:818-833. [PMID: 38404317 PMCID: PMC10890880 DOI: 10.1364/boe.511912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 12/29/2023] [Indexed: 02/27/2024]
Abstract
The post-ischemic no-reflow phenomenon after primary percutaneous coronary intervention (PCI) is observed in more than half of subjects and is defined as the absence or marked slowing of distal coronary blood flow despite removal of the arterial occlusion. To visualize no-reflow in experimental studies, the fluorescent dye thioflavin S (ThS) is often used, which allows for the estimation of the size of microvascular obstruction by staining the endothelial lining of vessels. Based on the ability of indocyanine green (ICG) to be retained in tissues with increased vascular permeability, we proposed the possibility of using it to assess not only the severity of microvascular obstruction but also the degree of vascular permeability in the zone of myocardial infarction. The aim of our study was to investigate the possibility of using ICG to visualize no-reflow zones after ischemia-reperfusion injury of rat myocardium. Using dual ICG and ThS staining and the FLUM multispectral fluorescence organoscope, we recorded ICG and ThS fluorescence within the zone of myocardial necrosis, identifying ICG-negative zones whose size correlated with the size of the no-reflow zones detected by ThS. It is also shown that the contrast change between the no-reflow zone and nonischemic myocardium reflects the severity of blood stasis, indicating that ICG-negative zones are no-reflow zones. The described method can be an addition or alternative to the traditional method of measuring the size of no-reflow zones in the experiment.
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Affiliation(s)
- Dmitry Sonin
- Institute of Experimental Medicine, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia
- Pavlov First Saint Petersburg State Medical University, 6–8 Lev Tolstoy Street, 197022 Saint Petersburg, Russia
| | - Garry Papayan
- Institute of Experimental Medicine, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia
- Pavlov First Saint Petersburg State Medical University, 6–8 Lev Tolstoy Street, 197022 Saint Petersburg, Russia
| | - Maria Istomina
- Institute of Experimental Medicine, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia
- Saint Petersburg Electrotechnical University “LETI”, 5 Professora Popova Street, 197376 Saint Petersburg, Russia
| | - Ilya Anufriev
- Institute of Experimental Medicine, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia
- Saint Petersburg Electrotechnical University “LETI”, 5 Professora Popova Street, 197376 Saint Petersburg, Russia
| | - Evgeniia Pochkaeva
- Peter the Great Saint Petersburg Polytechnic University, 29 Polytechnicheskaya str., 195251 Saint Petersburg, Russia
| | - Sarkis Minasian
- Institute of Experimental Medicine, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia
- Pavlov First Saint Petersburg State Medical University, 6–8 Lev Tolstoy Street, 197022 Saint Petersburg, Russia
| | - Ekaterina Zaytseva
- Institute of Experimental Medicine, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia
| | - Daria Mukhametdinova
- Institute of Experimental Medicine, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia
| | - Daniil Mochalov
- Institute of Experimental Medicine, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia
| | - Ilia Aleksandrov
- Institute of Experimental Medicine, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia
| | - Nickolay Petrishchev
- Pavlov First Saint Petersburg State Medical University, 6–8 Lev Tolstoy Street, 197022 Saint Petersburg, Russia
| | - Michael Galagudza
- Institute of Experimental Medicine, Almazov National Medical Research Centre, 2 Akkuratova Str., 197341 Saint Petersburg, Russia
- Pavlov First Saint Petersburg State Medical University, 6–8 Lev Tolstoy Street, 197022 Saint Petersburg, Russia
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5
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Werner SG, Backhaus M, Ohrndorf S. [Can rheuma be scanned? : Review of the current study situation on fluorescence optical imaging]. Z Rheumatol 2023; 82:627-637. [PMID: 37626223 DOI: 10.1007/s00393-023-01404-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The novel technique of indocyanine green (ICG)-based fluorescence optical imaging (FOI) using the Xiralite® system (Rheumascan) has been the subject of many different studies worldwide since approval for clinical use in the European Union (2009), USA (2014) and Asia. The FOI depicts the disturbed microcirculation in the joints of both hands caused by inflammation. OBJECTIVE The aim of this article is to provide an overview of the current state of studies on ICG-based FOI in different rheumatologic indications. METHODS A narrative literature review of publications on ICG-based FOI in the diagnosis of various inflammatory rheumatic joint diseases since 2010 is presented, its use in treatment monitoring is explained, and its value in systemic sclerosis is outlined. RESULTS In summary, studies have extensively demonstrated the accuracy of FOI in inflammation detection. Therefore, it can be concluded that FOI is a good supplement to existing imaging modalities. Due to characteristic patterns of both skin and nails, FOI is an indicated procedure especially in psoriatic arthritis and can be very helpful in the diagnostic process in early undifferentiated arthritis. The FOI has shown its usefulness in children (juvenile idiopathic arthritis), for monitoring the course of treatment, and for demonstrating disturbed microcirculation in patients with systemic sclerosis. CONCLUSION The presented data imply that FOI should be considered as a valuable complementary imaging tool in the diagnostic algorithm of daily rheumatologic practice, both for diagnosis and for follow-up monitoring. In particular, the automated analyses should be able in the future to objectify measurements of inflammatory activity as well as monitoring the response to treatment.
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Affiliation(s)
- Stephanie Gabriele Werner
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf und RHIO-Forschungsinstitut, Düsseldorf, Deutschland
| | - Marina Backhaus
- Abteilung für Rheumatologie und Klinische Immunologie, Parkklinik Weißensee, Berlin, Deutschland
| | - Sarah Ohrndorf
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
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Minopoulou I, Kleyer A, Yalcin-Mutlu M, Fagni F, Kemenes S, Schmidkonz C, Atzinger A, Pachowsky M, Engel K, Folle L, Roemer F, Waldner M, D'Agostino MA, Schett G, Simon D. Imaging in inflammatory arthritis: progress towards precision medicine. Nat Rev Rheumatol 2023; 19:650-665. [PMID: 37684361 DOI: 10.1038/s41584-023-01016-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/10/2023]
Abstract
Imaging techniques such as ultrasonography and MRI have gained ground in the diagnosis and management of inflammatory arthritis, as these imaging modalities allow a sensitive assessment of musculoskeletal inflammation and damage. However, these techniques cannot discriminate between disease subsets and are currently unable to deliver an accurate prediction of disease progression and therapeutic response in individual patients. This major shortcoming of today's technology hinders a targeted and personalized patient management approach. Technological advances in the areas of high-resolution imaging (for example, high-resolution peripheral quantitative computed tomography and ultra-high field MRI), functional and molecular-based imaging (such as chemical exchange saturation transfer MRI, positron emission tomography, fluorescence optical imaging, optoacoustic imaging and contrast-enhanced ultrasonography) and artificial intelligence-based data analysis could help to tackle these challenges. These new imaging approaches offer detailed anatomical delineation and an in vivo and non-invasive evaluation of the immunometabolic status of inflammatory reactions, thereby facilitating an in-depth characterization of inflammation. By means of these developments, the aim of earlier diagnosis, enhanced monitoring and, ultimately, a personalized treatment strategy looms closer.
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Affiliation(s)
- Ioanna Minopoulou
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Arnd Kleyer
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Melek Yalcin-Mutlu
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Filippo Fagni
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Stefan Kemenes
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christian Schmidkonz
- Department of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Institute for Medical Engineering, University of Applied Sciences Amberg-Weiden, Weiden, Germany
| | - Armin Atzinger
- Department of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Milena Pachowsky
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Lukas Folle
- Pattern Recognition Lab, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frank Roemer
- Institute of Radiology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Maximilian Waldner
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Department of Internal Medicine 1, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - Maria-Antonietta D'Agostino
- Division of Rheumatology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Université Paris-Saclay, UVSQ, Inserm U1173, Infection et Inflammation, Laboratory of Excellence Inflamex, Montigny-Le-Bretonneux, France
| | - Georg Schett
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany
| | - David Simon
- Department of Internal Medicine 3, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.
- Deutsches Zentrum Immuntherapie (DZI), Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Erlangen, Germany.
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Kisten Y, Arnaud L, Levitsky A, Györi N, Larsson P, Hensvold A, Catrina A, af Klint E, Rezaei H. Distinct Fluorescence Optical Imaging Patient Clusters Emerge for Seropositive and Seronegative Rheumatoid Arthritis. ACR Open Rheumatol 2023; 5:474-480. [PMID: 37551033 PMCID: PMC10502810 DOI: 10.1002/acr2.11599] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 06/24/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023] Open
Abstract
OBJECTIVE To investigate whether digital activity fluorescence optical imaging (FOI) patterns of inflammation can identify distinct rheumatoid arthritis (RA) phenotypes. METHODS The hands of newly diagnosed patients with RA were evaluated by clinical examination, musculoskeletal ultrasound, and FOI. Inflammation on FOI was defined when capillary leakage and/or fluorophore perfusion was present. The FOI composite image was quantified into a digital disease activity (DACT) score, using novel computerized algorithms. Unsupervised clustering on FOI inflammatory patterns was used to identify subgroups of patients relative to anticyclic citrullinated peptides (ACPA) and/or rheumatoid factor (RF). RESULTS Of 1326 examined hand joints in 39 patients with RA (72% female; 56% ever-smokers; 54% RF positive and 69% ACPA positive), 400 (30%) showed inflammation by FOI, and 95% (37 of 39) of patients had DACT-FOI scores greater than 1. Unsupervised analysis on FOI patterns revealed two patient clusters, cluster 1 (n = 29) and cluster 2 (n = 10). The proportion of seropositive patients was significantly higher in cluster 1 versus cluster 2 (90%, 26 of 29 vs. 30%, 3 of 10; P < 0.01), whereas C-reactive-protein levels (minimum-maximum) were significantly higher in cluster 2 (20 mg/l [1-102]) versus cluster 1 (2 mg/l [0-119]; P = 0.01). A wider variety and proportion of inflamed joints emerged for patients with RA in cluster 2 versus cluster 1, in which inflammation was more concentrated around the wrists and the right metacarpophalangeal 2 (MCP2), bilateral MCP3, and, to a lesser degree, left MCP2 and proximal interphalangeal joint and tendon regions. Cluster 1 displayed lower mean (±SD) DACT scores compared with cluster 2 (3.6 ± 2.1 vs. 5.4 ± 2.1; P = 0.03). CONCLUSION FOI-based digital quantification of hand joint inflammation revealed two distinct RA subpopulations with and without ACPA and RF related autoantibodies.
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Affiliation(s)
- Yogan Kisten
- Karolinska Institute and Karolinska University HospitalStockholmSweden
| | - Laurent Arnaud
- Hôpitaux Universitaires de Strasbourg Service de RhumatologieNational Reference Center for Rare Systemic Autoimmune DiseasesStrasbourgAlsace‐Champagne‐ArdenneFrance
| | - Adrian Levitsky
- Karolinska Institute and Karolinska University HospitalStockholmSweden
| | - Noémi Györi
- Karolinska Institute and Karolinska University HospitalStockholmSweden
| | | | - Aase Hensvold
- Karolinska Institute and Karolinska University Hospital and Academic Specialist CenterStockholmSweden
| | - Anca Catrina
- Karolinska Institute and Karolinska University Hospital and Academic Specialist CenterStockholmSweden
| | - Erik af Klint
- Karolinska Institute and Karolinska University HospitalStockholmSweden
| | - Hamed Rezaei
- Karolinska Institute and Karolinska University HospitalStockholmSweden
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8
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Koehm M, Ohrndorf S, Foldenauer AC, Rossmanith T, Backhaus M, Werner SG, Burmester GR, Wassenberg S, Koehler B, Burkhardt H, Behrens F. Fluorescence-optical imaging as a promising easy-to-use imaging biomarker to increase early psoriatic arthritis detection in patients with psoriasis: a cross-sectional cohort study with follow-up. RMD Open 2022; 8:rmdopen-2022-002682. [PMID: 36597973 PMCID: PMC9730423 DOI: 10.1136/rmdopen-2022-002682] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/30/2022] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To evaluate the ability of fluorescence-optical imaging (FOI) to detect preclinical musculoskeletal inflammatory signs in patients with skin psoriasis at risk of developing psoriatic arthritis (PsA). METHODS This investigator-initiated prospective exploratory study evaluated adult patients with psoriasis with musculoskeletal complaints and/or nail psoriasis within the last 6 months. Patients underwent a comprehensive rheumatological clinical examination (CE) along with musculoskeletal ultrasound (MSUS) and FOI of both hands at a single visit. Patients with CE-/MSUS-/FOI+ findings had MRI performed on the symptomatic or dominant hand within 7 days. If MRI was negative, the patients were followed over 2 years for the onset of clinically manifest PsA. RESULTS A total of 389 patients were referred from dermatology centres and evaluated at 14 rheumatology sites in Germany. Seventy-seven (20%) patients with CE-/US-/FOI- were considered to have psoriasis only. PsA was diagnosed in 140/389 patients (36%) based on CE alone and in another 55 patients (14%) by additional MSUS; overall, 50% of the patient cohort was diagnosed with PsA. One hundred sixteen patients (30%) were FOI+ (CE-) of which 40 (37%) were FOI+/MRI+. In the 2-year follow-up of the FOI+/CE- patients, clinical PsA was confirmed in another 12%. CONCLUSION FOI is a promising method for the detection of signs of musculoskeletal inflammation in hands that may serve as an early imaging biomarker for transitions from psoriasis to PsA. This imaging technique has the potential to detect PsA in at-risk patients with psoriasis, reduce time to PsA diagnosis and improve patient outcomes.
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Affiliation(s)
- Michaela Koehm
- Rheumatology, Goethe University, Frankfurt am Main, Germany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany,Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ann C Foldenauer
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany,Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
| | - Tanja Rossmanith
- Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany,Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
| | | | - Stephanie G Werner
- RHIO (Rheumatologie, Immunologie und Osteologie) Düsseldorf, Düsseldorf, Germany
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Harald Burkhardt
- Rheumatology, Goethe University, Frankfurt am Main, Germany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany,Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
| | - Frank Behrens
- Rheumatology, Goethe University, Frankfurt am Main, Germany,Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Frankfurt am Main, Germany,Fraunhofer Cluster of Excellence Immune-mediated Diseases CIMD, Frankfurt am Main, Germany
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9
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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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10
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He X, Chen H, Chang S, Zhu S. Multifunctional Nanoparticles Co-Loaded with Perfluoropropane, Indocyanine Green, and Methotrexate for Enhanced Multimodal Imaging of Collagen-Induced Arthritis. Mol Pharm 2022; 19:2418-2428. [PMID: 35484086 DOI: 10.1021/acs.molpharmaceut.2c00174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA), a common chronic inflammatory joint disease with features of synovitis and pannus formation, may lead to irreparable joint damage and disability. Methotrexate (MTX) is known as the cornerstone of therapy for RA. However, the therapeutic effects of MTX are unsatisfactory due to its low retention in the inflammatory joints as well as systemic toxic effects. Fortunately, the use of multifunctional nanoparticles for diagnostics and in treatment shows potential for application as a strategy for traceable and targeted RA therapy. This research aims to develop novel nanoparticles that carry with perfluoropropane (PFP), indocyanine green (ICG), and MTX and investigate the corresponding enhancement in multimodal imaging both in vitro and in vivo. A modified double emulsion method was applied for the construction of encapsulated PFP-O2, ICG, and MTX (OIM@NPs), and the essential properties of the developed NPs were determined. The fluorescence and ultrasonic and photoacoustic imaging characteristics were experimentally evaluated both in in vitro and in vivo models. The OIM@NPs are stable and efficient nanoagents. They enable more targeted distribution in the inflammatory joints in RA rats. Moreover, the NPs play an important role as contrast agents for prominent ultrasound and photoacoustic imaging after laser and low-intensity focused ultrasound excitation, providing precision guidance and monitoring for subsequent treatment. This research may provide a novel and efficient strategy to better enable monitoring in inflammatory joints of RA patients and the developed NPs may be a promising nanoplatform for integrating multimodal image monitoring.
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Affiliation(s)
- Xinyu He
- Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China.,Chongqing Key Laboratory of Ultrasound Molecular Imaging, Chongqing 400016, China.,State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing 400016, China
| | - Huanhuan Chen
- Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shufang Chang
- Department of Obstetrics and Gynecology, Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
| | - Shenyin Zhu
- Department of Pharmacy, First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, China
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11
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Detection of microvascular changes in systemic sclerosis and other rheumatic diseases. Nat Rev Rheumatol 2021; 17:665-677. [PMID: 34561652 DOI: 10.1038/s41584-021-00685-0] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2021] [Indexed: 02/08/2023]
Abstract
Morphological and functional analysis of the microcirculation are objective outcome measures that are recommended for use in the presence of clinical signs of altered peripheral blood flow (such as Raynaud phenomenon), which can occur in systemic sclerosis (SSc) and other autoimmune rheumatic diseases. Several advanced non-invasive tools are available for monitoring the microcirculation, including nailfold videocapillaroscopy, which is the best-studied and most commonly used method for distinguishing and quantifying microvascular morphological alterations in SSc. Nailfold videocapillaroscopy can also be used alongside laser Doppler techniques to assist in the early diagnosis and follow-up of patients with dermatomyositis or mixed connective tissue disease. Power Doppler ultrasonography, which has been used for many years to evaluate the vascularity of synovial tissue in rheumatoid arthritis, is another promising tool for the analysis of skin and nailbed capillary perfusion in other autoimmune rheumatic diseases. Other emerging methods include raster-scanning optoacoustic mesoscopy, which offers non-invasive high-resolution 3D visualization of capillaries and has been tested in psoriatic arthritis and SSc. The principle functions and operative characteristics of several non-invasive tools for analysing microvascular changes are outlined in this Review, and the clinical roles of validated or tested imaging methods are discussed for autoimmune rheumatic diseases.
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12
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Tsen SWD, Springer LE, Sharmah Gautam K, Tang R, Liang K, Sudlow G, Kucharski A, Pham CTN, Achilefu S. Non-invasive monitoring of arthritis treatment response via targeting of tyrosine-phosphorylated annexin A2 in chondrocytes. Arthritis Res Ther 2021; 23:265. [PMID: 34696809 PMCID: PMC8543875 DOI: 10.1186/s13075-021-02643-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The development and optimization of therapies for rheumatoid arthritis (RA) is currently hindered by a lack of methods for early non-invasive monitoring of treatment response. Annexin A2, an inflammation-associated protein whose presence and phosphorylation levels are upregulated in RA, represents a potential molecular target for tracking RA treatment response. METHODS LS301, a near-infrared dye-peptide conjugate that selectively targets tyrosine 23-phosphorylated annexin A2 (pANXA2), was evaluated for its utility in monitoring disease progression, remission, and early response to drug treatment in mouse models of RA by fluorescence imaging. The intraarticular distribution and localization of LS301 relative to pANXA2 was determined by histological and immunohistochemical methods. RESULTS In mouse models of spontaneous and serum transfer-induced inflammatory arthritis, intravenously administered LS301 showed selective accumulation in regions of joint pathology including paws, ankles, and knees with positive correlation between fluorescent signal and disease severity by clinical scoring. Whole-body near-infrared imaging with LS301 allowed tracking of spontaneous disease remission and the therapeutic response after dexamethasone treatment. Histological analysis showed preferential accumulation of LS301 within the chondrocytes and articular cartilage in arthritic mice, and colocalization was observed between LS301 and pANXA2 in the joint tissue. CONCLUSIONS We demonstrate that fluorescence imaging with LS301 can be used to monitor the progression, remission, and early response to drug treatment in mouse models of RA. Given the ease of detecting LS301 with portable optical imaging devices, the agent may become a useful early treatment response reporter for arthritis diagnosis and drug evaluation.
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Affiliation(s)
- Shaw-Wei D Tsen
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Luke E Springer
- Division of Rheumatology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Krishna Sharmah Gautam
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Rui Tang
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Kexian Liang
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Gail Sudlow
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Amir Kucharski
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA
| | - Christine T N Pham
- Division of Rheumatology, Washington University School of Medicine, St Louis, MO, 63110, USA.
| | - Samuel Achilefu
- Departments of Radiology, Washington University School of Medicine, St Louis, MO, 63110, USA.
- Departments of Biochemistry and Molecular Biophysics, Washington University School of Medicine, St Louis, MO, 63110, USA.
- Departments of Biomedical Engineering, Washington University School of Medicine, St Louis, MO, 63110, USA.
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13
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de Pablo P, Dinnes J, Berhane S, Osman A, Lim Z, Coombe A, Raza K, Filer A, Deeks JJ. Systematic review of imaging tests to predict the development of rheumatoid arthritis in people with unclassified arthritis. Semin Arthritis Rheum 2021; 52:151919. [PMID: 34782180 DOI: 10.1016/j.semarthrit.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 09/16/2021] [Accepted: 10/18/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To estimate and compare the diagnostic accuracy of magnetic resonance imaging (MRI) and ultrasound, for the prediction of rheumatoid arthritis (RA) in unclassified arthritis (UA). METHODS MEDLINE, Embase and BIOSIS were searched from 1987 to May 2019. Studies evaluating any imaging test in participants with UA were eligible. Reference standards were RA classification criteria or methotrexate initiation. Two authors independently extracted data and assessed validity using QUADAS-2. Sensitivities and specificities were calculated for each imaging characteristic and joint area. Summary estimates with 95% confidence intervals (CI) were estimated where possible. RESULTS Nineteen studies were included; 13 evaluated MRI (n=1,143; 454 with RA) and 6 evaluated ultrasound (n=531; 205 with RA). Studies were limited by unclear recruitment procedures, inclusion of patients with RA at baseline, differential verification, lack of blinding and consensus grading. Study heterogeneity largely precluded meta-analysis, however summary sensitivity and specificity for MRI synovitis in at least one joint were 93% (95% CI 88%, 96%) and 25% (95% CI 13%, 41%) (3 studies). Specificities may be higher for other MRI characteristics but data are limited. Ultrasound results were difficult to synthesise due to different diagnostic thresholds and reference standards. CONCLUSION The evidence for MRI or ultrasound as single tests for predicting RA in people with UA is heterogeneous and of variable methodological quality. Larger studies using consensus grading and consistently defined RA diagnosis are needed to identify whether combinations of imaging characteristics, either alone or in combination with other clinical findings, can better predict RA in this population.
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Affiliation(s)
- Paola de Pablo
- Institute of Inflammation and Ageing, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK; Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jacqueline Dinnes
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | - Sarah Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Aya Osman
- Institute of Inflammation and Ageing, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - Zhia Lim
- Institute of Inflammation and Ageing, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK
| | - April Coombe
- Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Karim Raza
- Institute of Inflammation and Ageing, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK; Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Andrew Filer
- Institute of Inflammation and Ageing, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK; NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK
| | - Jonathan J Deeks
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK; Test Evaluation Research Group, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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14
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Ridha Ali SL, Glimm AM, Burmester GR, Hoff P, Schmittat G, Hermann S, Backhaus M, Klotsche J, Ohrndorf S. Is the fluorescence optical imaging (FOI) able to discriminate between rheumatoid arthritis patients with and without need of rituximab retherapy? A cohort study. BMJ Open 2021; 11:e047713. [PMID: 34344678 PMCID: PMC8336220 DOI: 10.1136/bmjopen-2020-047713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the ability of fluorescence optical imaging (FOI) Xiralite in the discrimination between rheumatoid arthritis (RA) patients with and without need of rituximab (RTX) retherapy-in comparison to clinical, laboratory and musculoskeletal ultrasound parameters. PATIENTS AND METHODS Patients with established RA were prospectively followed over 1 year by Disease Activity Score 28, patient's global disease activity (visual analogue scale 0-100 mm), C reactive protein and erythrocyte sedimentation rate, ultrasound seven joint (US7) score and FOI in phases 1-3 and automatically generated PrimaVista mode (PVM) at baseline (before RTX) and after 3, 6 and 12 months. The need for RTX retherapy was decided by the treating rheumatologist-blinded to imaging data. RESULTS 31 patients (female 77.4%, mean age 60.1±11.4, mean disease duration 14.9±7.1 years) were included. Fourteen (45.2%) patients received RTX retherapy within 12 months. In the group with RTX retherapy, FOI in PVM mode was the only parameter that presented significant increase over time (β: 0.40, 95% CI: 0.08 to 0.71, p=0.013)-compared with the group without retherapy. In the prediction model via ROC analysis, FOI in PVM reached the highest values of all imaging, clinical and laboratory parameters which was associated with retherapy over 1 year with an area under the curve (AUC) of 0.78 (OR: 0.84, 95% CI: 0.72 to 0.98, p=0.031). US7 GS synovitis score revealed similar association with an AUC of 0.73 (p=0.049). CONCLUSION US7 GS synovitis score and FOI in PVM are able to discriminate between patients with and without need for RTX retherapy better than clinical and laboratory parameters.
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Affiliation(s)
- Schahrasad Lisa Ridha Ali
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Anne-Marie Glimm
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Paula Hoff
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriela Schmittat
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sandra Hermann
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany
| | - Jens Klotsche
- Deutsches Rheumaforschungszentrum (DRFZ) Berlin, A Leibniz Institute, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
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15
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Ohrndorf S, Glimm AM, Ammitzbøll-Danielsen M, Ostergaard M, Burmester GR. Fluorescence optical imaging: ready for prime time? RMD Open 2021; 7:e001497. [PMID: 34088778 PMCID: PMC8183208 DOI: 10.1136/rmdopen-2020-001497] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 05/22/2021] [Indexed: 11/04/2022] Open
Abstract
The novel technique of fluorescence optical imaging (FOI, Xiralite), which is approved in the European Union and the USA for clinical use, has been the object of studies since 2009. Indocyanine green-based FOI can demonstrate an impaired microcirculation caused by inflammation in both hands in one examination. Several studies have investigated FOI for detection of joint inflammation by comparing FOI to magnetic resonance imaging (MRI) and/or musculoskeletal ultrasound (MSUS). The results have shown a generally good agreement (>80%) between FOI and clinical examination, MRI and MSUS by power Doppler in inflammatory joint diseases. Moreover, characteristic enhancements in skin and nails are seen in PsA, which potentially can be useful in the diagnostic process of early undifferentiated arthritis. Furthermore, FOI has been investigated for the visualisation of a disturbed microcirculation in the hands and fingers of patients with systemic sclerosis (SSc), highlighting the potential of monitoring vascular changes in SSc and other vasculopathies. The available data indicate that it is time to consider FOI as a useful part of the imaging repertoire in rheumatology clinical practice, particularly where MSUS and MRI are not easily available.
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Affiliation(s)
- Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Anne-Marie Glimm
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Mads Ammitzbøll-Danielsen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Ostergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gerd R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt - Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
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16
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Danielsen MA, Glinatsi D, Terslev L, Østergaard M. A Novel Fluorescence Optical Imaging Scoring System for Hand Synovitis in Rheumatoid Arthritis - validity and agreement with ultrasound. Rheumatology (Oxford) 2021; 61:636-647. [PMID: 33890623 DOI: 10.1093/rheumatology/keab377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/15/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To develop and validate a new semiquantitative Fluorescence Optical Imaging (FOI) scoring system - the FOI Enhancement-Generated rheumatoid arthritis (RA) Score (FOIE-GRAS) for synovitis assessment in the hand. METHODS The development of FOIE-GRAS was based on consensus of 4 experts in musculoskeletal imaging. Forty-six RA patients, eligible for treatment intensification and with ≥1 clinically swollen joint in the hands and 11 healthy controls were included. FOI, ultrasound and clinical assessment of both hands were obtained at baseline and for RA patients after 3- and 6-months' follow-up. Twenty RA patients had an FOI rescan after 4 hours. Synovitis was scored using FOIE-GRAS and the OMERACT ultrasound synovitis scoring system. All FOI images were scored by 2 readers. Inter-scan, inter-and intra-reader reliability were determined. Furthermore, FOIE-GRAS agreement with ultrasound and responsiveness was assessed. RESULTS FOIE-GRAS synovitis was defined as early enhancement and scores based on the degree of coverage of the specific joint region after 3 seconds (0-3). Inter-scan, intra- and inter-reader intraclass correlations coefficients (ICC) were good-excellent for all baseline scores (0.76-0.98) and moderate-to-good for change (0.65-76).The FOIE-GRAS had moderate agreement with ultrasound (ICC 0.30-0.54) for total score, a good standardized response mean (>0.80), and moderate correlation with clinical joint assessment and DAS28-CRP. The median (IQR) reading time per FOI examination was 133 (109;161) seconds. Scores were significantly lower in controls 1(0;4) than RA patients 11(6;19). CONCLUSION The FOIE-GRAS offers a feasible and reliable assessment of synovitis in RA, with a moderate correlation with ultrasound and DAS28CRP, and good responsiveness.
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Affiliation(s)
- Mads Ammitzbøll Danielsen
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark.,Copenhagen Center for Arthritis Research, Rigshospitalet, Denmark
| | - Daniel Glinatsi
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark.,Department of Rheumatology, Skaraborg Hospital, Skövde, Sweden
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark.,Copenhagen Center for Arthritis Research, Rigshospitalet, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark.,Copenhagen Center for Arthritis Research, Rigshospitalet, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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17
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Maugesten Ø, Ohrndorf S, Slatkowsky-Christensen B, Kvien PTK, Uhlig PT, Haugen IK. Associations between Fluorescence Optical Imaging and Magnetic Resonance Imaging and symptoms in hand osteoarthritis. Rheumatology (Oxford) 2021; 61:764-769. [PMID: 33521807 DOI: 10.1093/rheumatology/keab085] [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: 10/06/2020] [Accepted: 01/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate whether Fluorescence Optical Imaging (FOI) enhancement and Magnetic Resonance Imaging (MRI)-defined synovitis are associated with pain and physical function in hand osteoarthritis (OA) patients. METHODS Bilateral FOI scans and MRI of the dominant hand were available for 221 patients. Finger joints were examined for tenderness on palpation. Pain in individual finger joints during the last 24 h and last 6 weeks and hand pain intensity by the Australian/Canadian hand index and Numeric Rating Scale were self-reported. On joint level, we applied logistic regression with generalized estimating equations to examine whether FOI enhancement and MRI-defined synovitis were associated with pain in the same joint. On subject level, we applied linear regression to assess whether FOI and MRI sum scores were associated with pain intensity and physical function. RESULTS Metacarpophalangeal and thumb base joints were excluded from analyses due to little/no FOI enhancement. Finger joints with FOI enhancement on the composite image had higher odds (95% confidence interval) of pain during the last 6 weeks (grade 1: 1.4 (1.2-1.6), grade 2-3: 2.1 (1.7-2.6)). Similar results were found for joint pain during the last 24 h and joint tenderness in fingers. Numerically stronger associations were found between MRI-defined synovitis and finger joint pain/tenderness. FOI and MRI sum scores demonstrated no/weak associations with hand pain and physical function. CONCLUSION FOI enhancement and MRI-defined synovitis were associated with pain in the same finger joint. None of the imaging modalities demonstrated consistent associations with pain, stiffness and physical function on subject level.
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Affiliation(s)
- Øystein Maugesten
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | | | - Prof Tore K Kvien
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Prof Till Uhlig
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida Kristin Haugen
- Diakonhjemmet Hospital, Division of Rheumatology and Research, Oslo, Norway
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18
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Kawashiri SY, Nishino A, Shimizu T, Takatani A, Umeda M, Koga T, Iwamoto N, Ichinose K, Tamai M, Nakamura H, Origuchi T, Maeda T, Kawakami A. Fluorescence optical imaging in patients with active rheumatoid arthritis: a comparison with ultrasound and an association with biomarkers. Scand J Rheumatol 2020; 50:95-103. [PMID: 33084461 DOI: 10.1080/03009742.2020.1794028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Objectives: This study compared indocyanine green (ICG)-enhanced fluorescence optical imaging (FOI) and musculoskeletal ultrasound (MSUS), and explored the significance of the FOI findings based on the association between the FOI and MSUS findings and serum biomarkers in patients with rheumatoid arthritis (RA). The study also explored the association between the FOI findings and patients' joint destruction at the joint-area level.Method: We enrolled 50 consecutive patients with active RA from among the patients hospitalized from May 2014 to March 2016 at Nagasaki University Hospital, Japan. FOI images were acquired with the Xiralite® fluorescence imaging system and compared with the patients' clinical examination results and MSUS findings. On the same day, the patients' clinical disease activity and levels of serum biomarkers (including vascular endothelial growth factor) were obtained.Results: Although the FOI detected synovitis with high sensitivity, the frequency of positive findings and the diagnostic performance with MSUS as the reference standard for FOI differed considerably among the phases of FOI as well as among the affected joint regions. The FOI scores were positively correlated with clinical disease activity, MSUS scores, and serum biomarkers. The severity of FOI-proven synovitis was associated with the presence of MSUS-proven bone erosion.Conclusion: FOI is effective for detecting joint inflammation in RA patients, with high accuracy. The severity of the FOI score was closely associated with the joint destruction at the joint-area level. However, the significance of positive FOI findings differed depending on not only the phase of FOI but also the affected joint regions.
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Affiliation(s)
- S-Y Kawashiri
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Nishino
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Shimizu
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Takatani
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Umeda
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Koga
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - N Iwamoto
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - K Ichinose
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - M Tamai
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - H Nakamura
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Origuchi
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - T Maeda
- Department of Community Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - A Kawakami
- Department of Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.,Department of Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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19
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Schmidt A, Glimm AM, Haugen IK, Hoff P, Schmittat G, Burmester GR, Klotsche J, Ohrndorf S. Detection of subclinical skin manifestation in patients with psoriasis and psoriatic arthritis by fluorescence optical imaging. Arthritis Res Ther 2020; 22:192. [PMID: 32811543 PMCID: PMC7433190 DOI: 10.1186/s13075-020-02277-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/26/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To investigate the frequency of subclinical skin inflammation in both hands by fluorescence optical imaging (FOI) in patients with psoriasis/psoriatic arthritis (Pso/PsA) vs. rheumatoid arthritis (RA) and healthy individuals, and to correlate these findings with cardiovascular (CV) risk factors. PATIENTS AND METHODS The FOI scans were analyzed retrospectively to detect clinically invisible skin enhancement (0-3 scale) in both hands without relationship to underlying joints or blood vessels. We further characterized the FOI patterns and sorted the scans into groups based on the assumed diagnosis (Pso/PsA, RA, and healthy controls), which was compared with the physician's diagnosis. Furthermore, the associations between CV risk factors and imaging findings were investigated by regression analyses. RESULTS We included FOI scans of patients with Pso/PsA (n = 80), RA (n = 78), and healthy controls (n = 25). Subclinical skin enhancement on the back of their hands was more common in Pso/PsA (72.5%) than in RA patients (20.5%) and healthy individuals (28.0%) (p < 0.001). Based on the FOI pattern, the majority of patients with Pso/PsA (72.5%), RA (76.9%), and healthy controls (68.0%) were classified correctly using the physician-based diagnosis as reference (overall agreement of 74%, kappa = 0.57). No CV risk factors except body weight (kg) were associated with subclinical skin enhancement (OR 1.04, 95% CI 1.02-1.06; p < 0.001). CONCLUSION Subclinical subdermal skin inflammation was common in Pso/PsA patients using FOI. Based on the FOI pattern, most patients with Pso/PsA and were classified with the correct diagnosis. We demonstrated an important influence of the body weight on our FOI results. FOI may be a helpful novel tool to study microcirculation in rheumatic diseases with skin involvement.
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Affiliation(s)
- A Schmidt
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - A M Glimm
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
| | - P Hoff
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - G Schmittat
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - J Klotsche
- Deutsches Rheumaforschungszentrum (DRFZ) Berlin, A Leibnitz Institute, Berlin, Germany
- Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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20
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Maugesten Ø, Mathiessen A, Hammer HB, Hestetun SV, Kvien TK, Uhlig T, Ohrndorf S, Haugen IK. Validity and diagnostic performance of fluorescence optical imaging measuring synovitis in hand osteoarthritis: baseline results from the Nor-Hand cohort. Arthritis Res Ther 2020; 22:98. [PMID: 32357904 PMCID: PMC7193370 DOI: 10.1186/s13075-020-02185-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Fluorescence optical imaging (FOI) demonstrates enhanced microcirculation in finger joints as a sign of inflammation. We wanted to assess the validity and diagnostic performance of FOI measuring synovitis in persons with hand OA, comparing it with magnetic resonance imaging (MRI)- and ultrasound-detected synovitis. METHODS Two hundred and twenty-one participants with hand OA underwent FOI and ultrasound (gray-scale synovitis and power Doppler activity) of the bilateral hands and contrast-enhanced MRI examination of the dominant hand. Fifteen joints in each hand were scored on semi-quantitative scales (grade 0-3) for all modalities. Four FOI images were evaluated: one composite image (Prima Vista Mode (PVM)) and three images representing phases of fluorescent dye distribution. Spearman's correlation coefficients were calculated between sum scores of FOI, MRI, and ultrasound. Sensitivity, specificity, and area under the curve (AUC) were calculated for FOI using MRI or ultrasound as reference. RESULTS FOI did not demonstrate enhancement in the thumb base, and the joint was excluded from further analyses. FOI sum scores showed poor to fair correlations with MRI (rho 0.01-0.24) and GS synovitis sum scores (rho 0.12-0.25). None of the FOI images demonstrated both good sensitivity and specificity, and the AUC ranged from 0.50-0.61 and 0.51-0.63 with MRI and GS synovitis as reference, respectively. FOI demonstrated similar diagnostic performance with PD activity and GS synovitis as reference. CONCLUSION FOI enhancement correlated poorly with synovitis assessed by more established imaging modalities, questioning the value of FOI for the evaluation of synovitis in hand OA.
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Affiliation(s)
- Øystein Maugesten
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Alexander Mathiessen
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
| | - Hilde Berner Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigrid Valen Hestetun
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
| | - Tore Kristian Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Ida Kristin Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
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21
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Erdmann-Keding M, Ohrndorf S, Werner SG, Glimm AM, Burmester GR, Kokolakis G, Zuberbier T, Sterry W, Backhaus M, Philipp S. Fluorescence optical imaging for the detection of potential psoriatic arthritis in comparison to musculoskeletal ultrasound. J Dtsch Dermatol Ges 2020; 17:913-921. [PMID: 31538737 DOI: 10.1111/ddg.13931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/25/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Comparison of fluorescence optical imaging (FOI) with grayscale (GS) and power Doppler ultrasound (PDUS) to detect joint inflammation in patients with confirmed or suspected psoriatic arthritis (PsA). METHODS Patients (n = 60) with psoriasis and tenderness and/or swelling of joints were separated into two groups: diagnosis confirmed by the treating dermatologist before the start of the study (n = 26), and suspected PsA (n = 34). GS/PDUS of the hand most clinically affected was performed with a dorsal/palmar view (wrist, MCP, PIP, DIP2-5). FOI examination was carried out in a standardized manner by analyzing the predefined Phases 1-3. RESULTS FOI was found to be more sensitive than ultrasound (US) for detection of inflammation in PIP/DIP joints (p = 0.035). Confirmed PsA patients showed more findings in FOI P2 and P3, while suspected PsA patients showed more findings in P1. In the confirmed PsA group, most involved joints were MCP joints, while in the suspected PsA group, more involved wrist joints and DIP joints (p = 0.006) were detected with FOI. CONCLUSIONS The differences between the confirmed and suspected groups indicate that FOI is helpful in the detection of early PsA since P1 may correspond to acute inflammation, whereas P2 and P3 enhancement reflect chronic inflammation. Fluorescence optical imaging might therefore be a novel diagnostic tool for early PsA diagnosis.
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Affiliation(s)
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Anne-Marie Glimm
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georgios Kokolakis
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Torsten Zuberbier
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfram Sterry
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany
| | - Sandra Philipp
- Department of Dermatology and Allergy, Charité - Universitätsmedizin Berlin, Berlin, Germany
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22
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Maugesten Ø, Ohrndorf S, Glinatsi D, Ammitzbøll-Danielsen M, Kisten Y, Østergaard M, Terslev L, Uhlig T, Kvien T, Haugen I. Evaluation of three scoring methods for Fluorescence Optical Imaging in erosive hand osteoarthritis and rheumatoid arthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2020; 1:100017. [DOI: 10.1016/j.ocarto.2019.100017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 11/28/2019] [Indexed: 11/30/2022] Open
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23
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Glimm AM, Sprenger LI, Haugen IK, Mansmann U, Hermann S, Häupl T, Hoff P, Burmester GR, Backhaus M, Le L, Ohrndorf S. Fluorescence optical imaging for treatment monitoring in patients with early and active rheumatoid arthritis in a 1-year follow-up period. Arthritis Res Ther 2019; 21:209. [PMID: 31533820 PMCID: PMC6749637 DOI: 10.1186/s13075-019-1989-5] [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: 06/12/2019] [Accepted: 09/04/2019] [Indexed: 11/12/2022] Open
Abstract
Background Fluorescence optical imaging (FOI) enables visualization of inflammation in the hands in rheumatic joint diseases with currently a lack of long-term follow-up studies. Objective To investigate FOI for treatment monitoring in a homogenous cohort of patients with early (disease duration < 2 years) and active (DAS28 > 3.2) RA over a period of 12 months. Methods Thirty-five RA patients (24 (68.6%) females, mean age 53.3 years (SD 13.6)) were investigated clinically by DAS28, tender joint count (TJC) and swollen joint count (SJC) and by FOI in phases 1–3 and PrimaVistaMode (PVM) before therapy change and after 12 months. The FOI activity score (FOIAS) was calculated based on individual joint scores from 0 to 3 in 30 joints per patient, adding up to a sum score (0–90). Results We found a statistically significant reduction of FOIAS in phase 1 from baseline (median 5.0, IQR 24.96) to follow-up (median 1.0, IQR 4.0) in all patients (p = 0.0045), both in responders and non-responders according to EULAR response criteria by DAS28. Statistically significant reductions over 12 months were found for median DAS28(ESR) 5.61 to 3.31, TJC 7.0 to 1.0, and SJC 5.0 to 1.0 (each p < 0.001). No statistically significant correlations were detected between the FOIAS change in phase 1 and DAS28(ESR), TJC, or SJC. Correlations between the other phases and clinical outcomes were weak to moderate. Conclusion Reduced early enhancement in FOI phase 1 can be observed in clinically responding and non-responding early RA patients under treatment. Regarding potential marker performance, FOI probably shows a reduction of inflammation more objectively.
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Affiliation(s)
- Anne-Marie Glimm
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Lisa Ines Sprenger
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | | | - Ulrich Mansmann
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sandra Hermann
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Thomas Häupl
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Paula Hoff
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Innere Medizin - Bereich Rheumatologie und Klinische Immunologie, Park-Klinik Weißensee, Berlin, Germany
| | - Lien Le
- Institut für medizinische Informationsverarbeitung, Biometrie und Epidemiologie (IBE), Ludwig-Maximilians-Universität München, Munich, Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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24
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Erdmann‐Keding M, Ohrndorf S, Werner SG, Glimm A, Burmester G, Kokolakis G, Zuberbier T, Sterry W, Backhaus M, Philipp S. Fluoreszenzoptische Bildgebung zum Nachweis einer möglichen Psoriasisarthritis im Vergleich zum muskuloskelettalen Ultraschall. J Dtsch Dermatol Ges 2019; 17:913-922. [DOI: 10.1111/ddg.13931_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 02/25/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - Sarah Ohrndorf
- Med. Klinik mit SP Rheumatologie und Klin. ImmunologieCharité – Universitätsmedizin Berlin
| | | | - Anne‐Marie Glimm
- Med. Klinik mit SP Rheumatologie und Klin. ImmunologieCharité – Universitätsmedizin Berlin
| | - Gerd‐Rüdiger Burmester
- Med. Klinik mit SP Rheumatologie und Klin. ImmunologieCharité – Universitätsmedizin Berlin
| | - Georgios Kokolakis
- Klinik für DermatologieVenerologie und AllergologieCharité – Universitätsmedizin Berlin
| | - Torsten Zuberbier
- Klinik für DermatologieVenerologie und AllergologieCharité – Universitätsmedizin Berlin
| | - Wolfram Sterry
- Klinik für DermatologieVenerologie und AllergologieCharité – Universitätsmedizin Berlin
| | - Marina Backhaus
- Med. Klinik mit SP Rheumatologie und Klin. ImmunologieCharité – Universitätsmedizin Berlin
- Abteilung für Innere MedizinRheumatologie und Klinische Immunologie Park‐Klinik Weißensee Berlin
| | - Sandra Philipp
- Klinik für DermatologieVenerologie und AllergologieCharité – Universitätsmedizin Berlin
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25
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Go DJ, Lee SJ, Joo SH, Cheon GJ, Hong SH, Song YW. Potential clinical utility of a novel optical tomographic imaging for the quantitative assessment of hand rheumatoid arthritis. Rheumatol Int 2019; 39:2103-2110. [PMID: 31435753 DOI: 10.1007/s00296-019-04424-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/10/2019] [Indexed: 11/30/2022]
Abstract
Optical tomographic imaging (OTI) was reported to be a novel technique for the early diagnosis and disease activity assessment of rheumatoid arthritis (RA). This study aimed to evaluate the clinical utility of OTI for the detection of hand synovitis of RA patients. Manu-scan was used to perform imaging targeting the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints in 12 RA patients and three controls. The enrolled RA patients also underwent magnetic resonance imaging (MRI) and bone scintigraphy (BS) to provide reference images. Of the 181 joints feasible for OTI analysis, 140 joints (111 in RA patients and 29 in controls, 77.3%) in which the difference of the OTI indices in the two measurements was within 20% were evaluated. The OTI indices in RA joints were significantly lower than those in control joints (p < 0.001). Overall, the OTI indices in RA joints decreased as the synovitis grades on MRI or BS increased. Moreover, OTI was able to discriminate between RA and control joints (AUC = 0.815, 95% CI 0.739-0.891), even if RA joints were normal on physical examination (AUC = 0.714, 95% CI 0.594-0.834). OTI was in good agreement (kappa = 0.60) with MRI for evaluating synovitis in RA patients and showed positive results in 11.4% of clinically asymptomatic joints. OTI in this study showed the potential to be a supplementary imaging modality for the quantification of synovial inflammation in PIP and MCP joints of RA patients. Further large-scale trials are needed to confirm these findings.
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Affiliation(s)
- Dong Jin Go
- Division of Rheumatology, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.,Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea
| | - Sang Jin Lee
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea.,Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang Hyun Joo
- Department of Internal Medicine, Bethesda Hospital, Yangsan, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Sung Hwan Hong
- Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Yeong Wook Song
- Department of Molecular Medicine and Biopharmaceutical Sciences, Graduate School of Convergence Science and Technology, and College of Medicine, Medical Research Institute, Seoul National University, Seoul, Korea. .,Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, 101, Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
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26
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Friedrich S, Lüders S, Glimm AM, Werner SG, Schmittat G, Burmester GR, Backhaus M, Riemekasten G, Ohrndorf S. Association between baseline clinical and imaging findings and the development of digital ulcers in patients with systemic sclerosis. Arthritis Res Ther 2019; 21:96. [PMID: 30987674 PMCID: PMC6466782 DOI: 10.1186/s13075-019-1875-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 03/25/2019] [Indexed: 01/29/2023] Open
Abstract
Objective Systemic sclerosis (SSc) can lead to ischemic complications such as digital ulcers (DUs). The aim of the study was to find predictors of DUs by clinical and new imaging methods. Patients and methods All 79 SSc patients included in the study received a clinical, colour Doppler ultrasound (CDUS), fluorescence optical imaging (FOI) and capillaroscopy examination at baseline, and their capacity to predict new DU development was analysed in 76 patients at 12 months follow-up. Results Twenty-two of 76 patients (28.9%) developed new ulcers during follow-up (diffuse SSc 48.1%; limited SSc 18.4%). Receiver operating characteristic (ROC) curve analysis revealed an area under the curve of 0.7576 for DU development, with a specificity of 87% and a sensitivity of 54.6% (p = 0.0003, OR = 8.1 [95%CI 2.5–25.6]) at a cut-off of ≥ 21 points (ACR/EULAR classification criteria for SSc). Capillaroscopy and CDUS had high sensitivity (100% and 95.5%) but low specificity (28.9% and 22.2%) for ulcer occurrence when used alone, but better specificity (46.3%) when combined (OR = 18.1 [95%CI 2.3–144.4]; p = 0.0004). Using FOI, fingers with pathologic staining had a higher risk for new ulcer development in the same finger (p = 0.0153). General future DU (i.e. DU also in other fingers) was associated with a missing FOI signal in the right digit III at baseline (p = 0.048). Conclusion New imaging modalities can predict digital ulcer development in SSc patients with high sensitivity for capillaroscopy and CDUS and enhanced specificity when combined. A missing signal of FOI in the right digit III at baseline was associated with general future DU.
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Affiliation(s)
- S Friedrich
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Lüders
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Gastroenterology and Rheumatology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A M Glimm
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S G Werner
- Department of Rheumatology, Helios St. Johannes Klinikum Duisburg, Duisburg, Germany
| | - G Schmittat
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - M Backhaus
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik Weißensee, Berlin, Germany
| | - G Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Schleswig-Holstein, Lübeck, Germany
| | - S Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany.
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27
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Bhatnagar S, Khera E, Liao J, Eniola V, Hu Y, Smith DE, Thurber GM. Oral and Subcutaneous Administration of a Near-Infrared Fluorescent Molecular Imaging Agent Detects Inflammation in a Mouse Model of Rheumatoid Arthritis. Sci Rep 2019; 9:4661. [PMID: 30858419 PMCID: PMC6411963 DOI: 10.1038/s41598-019-38548-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 12/31/2018] [Indexed: 12/17/2022] Open
Abstract
Rheumatoid arthritis (RA) is an inflammatory autoimmune disease that causes irreversible damage to the joints. However, effective drugs exist that can stop disease progression, leading to intense interest in early detection and treatment monitoring to improve patient outcomes. Imaging approaches have the potential for early detection, but current methods lack sensitivity and/or are time-consuming and expensive. We examined potential routes for self-administration of molecular imaging agents in the form of subcutaneous and oral delivery of an integrin binding near-infrared (NIR) fluorescent imaging agent in an animal model of RA with the long-term goal of increasing safety and patient compliance for screening. NIR imaging has relatively low cost, uses non-ionizing radiation, and provides minimally invasive spatial and molecular information. This proof-of-principle study shows significant uptake of an IRDye800CW agent in inflamed joints of a collagen antibody induced arthritis (CAIA) mouse model compared to healthy joints, irrespective of the method of administration. The imaging results were extrapolated to clinical depths in silico using a 3D COMSOL model of NIR fluorescence imaging in a human hand to examine imaging feasability. With target to background concentration ratios greater than 5.5, which are achieved in the mouse model, these probes have the potential to identify arthritic joints following oral delivery at clinically relevant depths.
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Affiliation(s)
- Sumit Bhatnagar
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Eshita Khera
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Jianshan Liao
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Victoria Eniola
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Yongjun Hu
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, 48109, United States
| | - David E Smith
- Department of Pharmaceutical Sciences, University of Michigan, Ann Arbor, MI, 48109, United States
| | - Greg M Thurber
- Department of Chemical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States.
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, 48109, United States.
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Wiemann O, Werner SG, Langer HE, Backhaus M, Chatelain R. The "green nail" phenomenon in ICG-enhanced fluorescence optical imaging - a potential tool for the differential diagnosis of psoriatic arthritis. J Dtsch Dermatol Ges 2019; 17:138-147. [PMID: 30702804 DOI: 10.1111/ddg.13747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/23/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Early diagnosis of psoriatic arthritis poses a particular challenge. A novel fluorescence optical imaging technique, the Xiralite® system is very useful in this regard as it allows for visualization of microvasculature and perfusion. The present study is the first to systematically examine fluorescence optical signals in a large psoriatic arthritis cohort. PATIENTS AND METHODS In the primary study, we reviewed and analyzed extra-articular fluorescence optical signal patterns in 241 imaging sequences obtained from 187 psoriatic arthritis patients; 36 fluorescence optical sequences from 31 patients with rheumatoid arthritis served as controls. In a follow-up study, 203 consecutive fluorescence optical sequences from 54 psoriatic arthritis patients and 149 control subjects with various inflammatory rheumatic disorders were retrospectively evaluated in order to validate the primary study results in terms of the patterns previously identified. RESULTS Psoriatic arthritis patients exhibited three different fluorescence optical signal patterns in projection of the nails that have not been previously described. One of these patterns was the "green nail" sign, which was highly specific (97 %) for psoriatic arthritis. In the follow-up study, the specificity of this phenomenon in psoriatic arthritis was 87 % in comparison to the control cohort. CONCLUSIONS In the present study, fluorescence optical signals in the nail region proved to be highly specific for psoriatic arthritis. The "green nail" phenomenon seems to be of particular diagnostic interest as a potential sign of impaired microcirculation of the nail bed.
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Affiliation(s)
- Oliver Wiemann
- RHIO (Rheumatology, Immunology, Osteology) Düsseldorf and RHIO Research Institute, Düsseldorf, Germany
| | - Stephanie G Werner
- Department of Medicine III, Rheumatology, Helios St. Johannes Medical Center, Duisburg, Germany
| | - Hans-Eckhard Langer
- RHIO (Rheumatology, Immunology, Osteology) Düsseldorf and RHIO Research Institute, Düsseldorf, Germany
| | - Marina Backhaus
- Department of Internal Medicine - Rheumatology and Clinical Immunology, Weißensee Medical Center, Berlin, Germany
| | - René Chatelain
- Department of Dermatology and Allergology, Evangelical Hospital, Düsseldorf, and Faculty of Health, Department of Medicine, University of Witten/Herdecke, Germany
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Wiemann O, Werner SG, Langer HE, Backhaus M, Chatelain R. Phänomen „grüner Nagel“ in der ICG-gestützten fluoreszenzoptischen Bildgebung - ein möglicher differenzialdiagnostischer Hinweis auf Psoriasisarthritis. J Dtsch Dermatol Ges 2019; 17:138-148. [DOI: 10.1111/ddg.13747_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 07/23/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Oliver Wiemann
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf und RHIO Forschungsinstitut; Düsseldorf
| | | | - Hans-Eckhard Langer
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf und RHIO Forschungsinstitut; Düsseldorf
| | - Marina Backhaus
- Abteilung für Innere Medizin - Rheumatologie und Klinische Immunologie Park-Klinik Weißensee; Berlin
| | - René Chatelain
- Klinik für Dermatologie und Allergologie; Evangelisches Krankenhaus Düsseldorf und Fakultät für Gesundheit; Department für Humanmedizin; Universität Witten/Herdecke
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Hirano F, Yokoyama-Kokuryo W, Yamazaki H, Tsutsumino M, Sakai R, Satoh S, Kimura T, Tojo N, Kohsaka H, Harigai M. Comparison of fluorescence optical imaging, ultrasonography and clinical examination with magnetic resonance imaging as a reference in active rheumatoid arthritis patients. Immunol Med 2018; 41:75-81. [PMID: 30938268 DOI: 10.1080/13497413.2018.1481578] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Fluorescence optical imaging with indocyanine-green enhancement (FOI) is a new imaging modality for the assessment of hand arthritis. The objective of this study was to compare performance profiles of clinical examination (CE), US and FOI using MRI as a reference in the same active rheumatoid arthritis (RA) patients. METHODS CE, US, FOI and MRI were performed on six subjects with active RA. Each sequence of FOI was divided into three phases based on indocyanine-green dynamics and the joints were graded semi-quantitatively. Sensitivities and specificities of CE, US and FOI were calculated using the RAMRIS synovitis score >0 as a reference in a total of 30 joints (the second to fifth metacarpophalangeal (MCP) joints and the wrist of the clinically dominant hand). RESULTS FOI showed sensitivities and specificities, respectively, of 85% and of 94% for Phase-1 and 69% and 94% for Phase-2. Sensitivities and specificities were 100% and 35% for CE (tender or swollen), 92% and 41% for gray scale US, and 77% and 100% for color-Doppler US. CONCLUSIONS The performance characteristics of FOI in detection of synovitis in patients with active RA are comparable to those of US and more specific than CE. FOI has a potential as an assessment modality of RA.
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Affiliation(s)
- Fumio Hirano
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Waka Yokoyama-Kokuryo
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Hayato Yamazaki
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Michi Tsutsumino
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Ryoko Sakai
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Shiro Satoh
- c Department of Diagnostic Imaging , Ochanomizu Surugadai Clinic , Tokyo , Japan
| | - Tomo Kimura
- c Department of Diagnostic Imaging , Ochanomizu Surugadai Clinic , Tokyo , Japan
| | - Naoko Tojo
- d Department of Clinical Laboratory , Medical Hospital, Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Hitoshi Kohsaka
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
| | - Masayoshi Harigai
- a Department of Rheumatology , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan.,b Department of Pharmacovigilance , Tokyo Medical and Dental University (TMDU) , Tokyo , Japan
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Malattia C, Rinaldi M, Martini A. The role of imaging in juvenile idiopathic arthritis. Expert Rev Clin Immunol 2018; 14:681-694. [PMID: 29972659 DOI: 10.1080/1744666x.2018.1496019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The prognosis of juvenile idiopathic arthritis (JIA) has changed dramatically due to the availability of novel drugs. Prompt diagnosis and treatment are essential to prevent permanent joint damage. As a result, methods to improve JIA diagnosis and prognosis are of high priority to tailor treatment strategies and maximize their efficacy. Musculoskeletal ultrasound and magnetic resonance imaging are more sensitive than clinical examination and radiography in the detection of joint involvement and might play a substantial role to optimize the management of JIA. Areas covered: This review compiles an inventory of potential uses of imaging studies in the modern practice of pediatric rheumatology, together with a critical analysis of the major challenges that are still to be addressed. Imaging appearance of normal growth-related changes of the musculoskeletal system will be discussed. Expert commentary: Knowledge of the evolving patterns of skeletal maturity is paramount to define pathological findings and avoid misinterpretations. Establishing a novel radiological algorithm for a rational use of imaging in JIA is of high priority to allow a speedier integration of imaging into the clinical workflow and decision-making process.
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Affiliation(s)
- Clara Malattia
- a Clinica Pediatrica e Reumatologia , Istituto Giannina Gaslini , Genova , Italy.,b Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze Materno-Infantili , Università degli studi di Genova , Italy
| | - Mariangela Rinaldi
- a Clinica Pediatrica e Reumatologia , Istituto Giannina Gaslini , Genova , Italy
| | - Alberto Martini
- c Direzione Scientifica Istituto Giannina Gaslini , Genova Italy
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Wu H, Wu H, He Y, Gan Z, Xu Z, Zhou M, Liu S, Liu H. Synovitis in mice with inflammatory arthritis monitored with quantitative analysis of dynamic contrast-enhanced NIR fluorescence imaging using iRGD-targeted liposomes as fluorescence probes. Int J Nanomedicine 2018; 13:1841-1850. [PMID: 29615837 PMCID: PMC5870656 DOI: 10.2147/ijn.s155475] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a common inflammatory disorder characterized primarily by synovitis and pannus formation in multiple joints, causing joints destruction and irreversible disability in most cases. Early diagnosis and effective therapy monitoring of RA are of importance for achieving the favorable prognosis. METHODS We first prepared the targeted fluorescence probes, and then explored the feasibility of near-infrared (NIR) fluorescence molecular imaging to detect and evaluate the RA via the targeted fluorescence probes by quantitative analysis in this study. RESULTS The targeted fluorescence probes (indocyanine green-liposomes decorated with iRGD peptide [iLPs]) was successfully prepared. The quantitative analysis found that strong fluorescence signal was detected in inflamed paws and the fluorescence signal in iLPs group was 3.03-fold higher than that in non-targeted (indocyanine green-liposomes decorated without iRGD peptide [LPs]) group (P<0.01) at 15 min after injection, whereas the fluorescence signal from iLPs signal can almost not be observed in the non-inflamed paws, showing the high sensitivity and accuracy for arthritis by the NIR fluorescence imaging based on iLPs. CONCLUSION The NIR fluorescence imaging by iLPs may facilitate improved arthritis diagnosis and early assessment of the disease progression by providing an in vivo characterization of angiogenesis in inflammatory joint diseases.
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Affiliation(s)
- Hao Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Haohan Wu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yanni He
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
| | - Zhen Gan
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Zhili Xu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Meijun Zhou
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Sai Liu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
- Department of Ultrasonography, The Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Hongmei Liu
- Department of Ultrasonography, Guangdong Second Provincial General Hospital Affiliated to Southern Medical University, Guangzhou, China
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An Y, Kang Y, Lee J, Ahn C, Kwon K, Choi C. Blood flow characteristics of diabetic patients with complications detected by optical measurement. Biomed Eng Online 2018; 17:25. [PMID: 29466988 PMCID: PMC5822764 DOI: 10.1186/s12938-018-0457-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Accepted: 02/16/2018] [Indexed: 12/12/2022] Open
Abstract
Background Diabetes mellitus (DM) is one of the most common diseases worldwide. Uncontrolled and prolonged hyperglycemia can cause diabetic complications, which reduce the quality of life of patients. Diabetic complications are common in DM patients. Because it is impossible to completely recover from diabetic complications, it is important for early detection. In this study, we suggest a novel method of determining blood flow characteristics based on fluorescence image analysis with indocyanine green and report that diabetic complications have unique blood flow characteristics. Methods We analyzed time-series fluorescence images obtained from controls, DM patients, and DM patients with complications. The images were segmented into the digits and the dorsum of the feet and hands, and each part has been considered as arterial and capillary flow. We compared the blood flow parameters in each region among the three groups. Results The DM patients with complications showed similar blood flow parameters to the controls, except the area under the curve and the maximum intensity, which indicate the blood flow volume. These parameters were significantly decreased in DM patients with complications. Although some blood flow parameters in the feet of DM patients with complications were close to normal blood flow, the vascular response of the macrovessels and microvessels to stimulation of the hands was significantly reduced, which indicates less reactivity in DM patients with complications. Conclusions Our results suggest that DM patients, and DM patients with complications, have unique peripheral blood flow characteristics.
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Affiliation(s)
- Yuri An
- Department of Bio and Brain Engineering, KAIST, Daejeon, Republic of Korea
| | - Yujung Kang
- R&D Center, Vieworks Co., Anyang-si, Gyeonggi-do, Republic of Korea
| | - Jungsul Lee
- Cellex Life Sciences, Inc, Daejeon, Republic of Korea
| | - Chulwoo Ahn
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Kihwan Kwon
- Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Republic of Korea
| | - Chulhee Choi
- Department of Bio and Brain Engineering, KAIST, Daejeon, Republic of Korea. .,Cellex Life Sciences, Inc, Daejeon, Republic of Korea.
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Celeng C, de Keizer B, Merkely B, de Jong P, Leiner T, Takx RAP. PET Molecular Targets and Near-Infrared Fluorescence Imaging of Atherosclerosis. Curr Cardiol Rep 2018; 20:11. [PMID: 29435774 PMCID: PMC5809554 DOI: 10.1007/s11886-018-0953-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW With this review, we aim to summarize the role of positron emission tomography (PET) and near-infrared fluorescence imaging (NIRF) in the detection of atherosclerosis. RECENT FINDINGS 18F-FDG is an established measure of increased macrophage activity. However, due to its low specificity, new radiotracers have emerged for more specific detection of vascular inflammation and other high-risk plaque features such as microcalcification and neovascularization. Novel NIRF probes are engineered to sense endothelial damage as an early sign of plaque erosion as well as oxidized low-density lipoprotein (oxLDL) as a prime target for atherosclerosis. Integrated NIRF/OCT (optical coherence tomography) catheters enable to detect stent-associated microthrombi. Novel radiotracers can improve specificity of PET for imaging atherosclerosis. Advanced NIRF probes show promise for future application in human. Intravascular NIRF might play a prominent role in the detection of stent-induced vascular injury.
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Affiliation(s)
- Csilla Celeng
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
| | - Bart de Keizer
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Gaál József street 9, Budapest, 1122, Hungary
| | - Pim de Jong
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Tim Leiner
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Richard A P Takx
- Department of Radiology and Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
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Mikecz K. Editorial: Ratiometric Optical Imaging of Subclinical Inflammation With a Thrombin-Cleavable Probe: A Future Tool for the In Vivo Visualization of Clinically Silent Synovitis? Arthritis Rheumatol 2018; 70:4-6. [PMID: 28898572 PMCID: PMC5745257 DOI: 10.1002/art.40315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 09/01/2017] [Indexed: 11/09/2022]
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Beck MC, Glimm AM, Ohrndorf S, Minden K, Trauzeddel R, Werner SG, Horneff G, Backhaus M, Burmester GR, Kallinich T, Girschick H, Klotsche J. Fluorescence optical imaging in pediatric patients with inflammatory and non-inflammatory joint diseases: a comparative study with ultrasonography. Arthritis Res Ther 2017; 19:233. [PMID: 29041986 PMCID: PMC5646108 DOI: 10.1186/s13075-017-1440-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/21/2017] [Indexed: 11/15/2022] Open
Abstract
Background Valid detection of arthritis is essential in differential diagnosis of joint pain. Indocyanin green (ICG)-enhanced fluorescence optical imaging (FOI) is a new imaging method that visualizes inflammation in wrist and finger joints. Objectives of this study were to compare FOI with ultrasonography (US, by gray-scale (GS) and power Doppler (PD)) and clinical examination (CE) and to estimate the predictive power of FOI for discrimination between inflammatory and non-inflammatory juvenile joint diseases. Methods FOI and GSUS/PDUS were performed in both hands of 76 patients with joint pain (53 with juvenile idiopathic arthritis (JIA), 23 with non-inflammatory joint diseases). Inflammation was graded by a semiquantitative score (grades 0–3) for each imaging method. Joints were defined clinically active if swollen or tender with limited range of motion. Sensitivity and specificity of FOI in three phases dependent on ICG enhancement (P1–P3) were analyzed with CE and GSUS/PDUS as reference. Results For JIA patients, FOI had an overall sensitivity of 67.3%/72.0% and a specificity of 65.0%/58.8% with GSUS/PDUS as reference; specificity was highest in P3 (GSUS 94.3%/PDUS 91.7%). FOI was more sensitive for detecting clinically active joints than GSUS/PDUS (75.2% vs 57.3%/32.5%). In patients with non-inflammatory joint diseases both FOI and US showed positive (i.e., pathological) findings (25% and 14% of joints). The predictive value for discrimination between inflammatory and non-inflammatory joint diseases was 0.79 for FOI and 0.80/0.85 for GSUS/PDUS. Conclusions Dependent on the phase evaluated, FOI had moderate to good agreement with CE and US. Both imaging methods revealed limitations and should be interpreted cautiously. FOI may provide an additional diagnostic method in pediatric rheumatology. Trial registration Deutsches Register Klinischer Studien DRKS00012572. Registered 31 July 2017.
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Affiliation(s)
- Marisa Christin Beck
- German Rheumatism Research Center, a Leibniz Institute, Program Area Epidemiology, Charitéplatz 1, 10117, Berlin, Germany. .,Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany.
| | - Anne-Marie Glimm
- Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany
| | - Sarah Ohrndorf
- Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany
| | - Kirsten Minden
- German Rheumatism Research Center, a Leibniz Institute, Program Area Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany
| | - Ralf Trauzeddel
- Department of Pediatric Rheumatology, Helios Hospital Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany
| | | | - Gerd Horneff
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Arnold-Janssen-Straße 29, 53757, Sankt Augustin, Germany
| | - Marina Backhaus
- Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany.,Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Schönstraße 80, 13086, Berlin, Germany
| | - Gerd Rüdiger Burmester
- Charité University Medicine Berlin, Rheumatology and Clinical Immunology, Charitéplatz 1, 10117, Berlin, Germany
| | - Tilmann Kallinich
- Charité University Medicine Berlin, Pediatric Pneumology and Immunology, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Hermann Girschick
- Children's Hospital, Vivantes Hospital im Friedrichshain, Landsberger Allee 49, 10249, Berlin, Germany
| | - Jens Klotsche
- German Rheumatism Research Center, a Leibniz Institute, Program Area Epidemiology, Charitéplatz 1, 10117, Berlin, Germany.,Institute for Social Medicine, Epidemiology and Health Economics, Charité University Berlin, Luisenstraße 57, 10117, Berlin, Germany
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Gløersen M, Mulrooney E, Mathiessen A, Hammer HB, Slatkowsky-Christensen B, Faraj K, Isaksen T, Neogi T, Kvien TK, Magnusson K, Haugen IK. A hospital-based observational cohort study exploring pain and biomarkers in patients with hand osteoarthritis in Norway: The Nor-Hand protocol. BMJ Open 2017; 7:e016938. [PMID: 28947452 PMCID: PMC5623515 DOI: 10.1136/bmjopen-2017-016938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION We have limited knowledge about the underlying disease mechanisms and causes of pain in hand osteoarthritis (OA). Consequently, no disease-modifying drug exists, and more knowledge about the pathogenesis of hand OA is needed, as well as a validation of different outcome measures. Our first aim of this study is to explore the validity of various imaging modalities for the assessment of hand OA. Second, we want to gain a better understanding of the disease processes, with a special focus on pain mechanisms. METHODS AND ANALYSIS The Nor-Hand study is a hospital-based observational study including 300 patients with evidence of hand OA by ultrasound and/or clinical examination. The baseline examination consists of functional tests and joint assessment of the hands, medical assessment, pain sensitisation tests, ultrasound (hands, acromioclavicular joint, hips, knees and feet), CT and MRI of the dominant hand, conventional radiographs of the hands and feet, fluorescence optical imaging of the hands, collection of blood and urine samples as well as self-reported demographic factors and OA-related questionnaires. Two follow-up examinations are planned. Cross-sectional analyses will be used to investigate agreements and associations between different relevant measures at the baseline examination, whereas the longitudinal data will be used for evaluation of predictors for clinical outcomes. ETHICS AND DISSEMINATION The protocol is approved by the Norwegian Regional Committee for Medical and Health Research Ethics (Ref. no: 2014/2057). The participants receive oral and written information about the project and sign a consent form before participation. They can, whenever they want, withdraw from the study, and all de-identified data will be safely stored on the research server at Diakonhjemmet Hospital. Results will be presented at international and national congresses and in peer-reviewed rheumatology journals. TRIAL REGISTRATION NUMBER NCT03083548; Pre-results.
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Affiliation(s)
- Marthe Gløersen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | | | | | - Karwan Faraj
- Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway
| | - Thore Isaksen
- Department of Radiology, Volvat Medical Center, Oslo, Norway
| | - Tuhina Neogi
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, USA
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- The Medical Faculty, Institute for Clinical Medicine, University of Oslo, Olso, Norway
| | - Karin Magnusson
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Klein A, Just GW, Werner SG, Oommen PT, Minden K, Becker I, Langer HE, Klee D, Horneff G. Fluorescence optical imaging and musculoskeletal ultrasonography in juvenile idiopathic polyarticular disease before and during antirheumatic treatment - a multicenter non-interventional diagnostic evaluation. Arthritis Res Ther 2017; 19:147. [PMID: 28666454 PMCID: PMC5493121 DOI: 10.1186/s13075-017-1355-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Valid detection of inflamed joints is essential for correct classification, therapeutic decisions, prognosis and assessment of treatment efficacy in juvenile idiopathic arthritis (JIA). Fluorescence optical imaging (FOI) enables visualization of inflammation in arthritis of finger and hand joints and might be used for monitoring. Methods A 24-week observational study in polyarticular JIA patients newly starting treatment with methotrexate or an approved biologic was performed in three centers. Patients were evaluated clinically, by gray-scale ultrasonography (GSUS), power-Doppler ultrasonography (PDUS) and FOI at baseline, week 12 and week 24. Results Of 37 patients enrolled, 24 patients started methotrexate and 13 patients a biologic for the first time (etanercept n = 11, adalimumab and tocilizumab n = 1 each). Mean JADAS 10 decreased significantly from 17.7 at baseline to 12.2 and 7.2 at week 12 and 24 respectively. PedACR 30/50/70/100 response rates at week 24 were 85%/73%/50%/27%. The total number of clinically active joints in hand and fingers at baseline/week 12/week 24 was 262 (23.6%)/162 (16.4%)/162 (9.0%). By GSUS, at baseline/week 12/week 24, 192 (19.4%)/135 (16.1%)/83 (11.5%) joints showed effusions and 186 (18.8%)/107 (12.7%)/69 (9.6%) showed synovial thickening, and by PDUS 68 (6.9%)/15 (1.8%)/36 (5%) joints showed hyperperfusion. Any sign of arthritis was detected by US in a total of 243 joints (24.5%) at baseline, 161 joints (19.2%) at week 12 and 123 joints (17%) at week 24. By FOI at baseline/week 12/week 24, 430 (38.7%)/280 (29.2%)/215 (27.6%) showed a signal enhancement in at least one phase. Summarizing all three points of time, the highest numbers of signals were detected by FOI with 32% of joints, especially in phase 2, while by US 20.7% and by clinical examination 17.5% of joints were active. A high number of joints (21.1%) had FOI signals but were inactive by clinical examination. A total 20.1% of joints with signals in FOI did not show effusion, synovial thickening or hyperperfusion by US. Because of the high number of negative results, specificity of FOI compared with clinical examination/US/PD was high (84–95%), and sensitivity was only moderate. Conclusion FOI and US could detect clinical but also subclinical inflammation. FOI detected subclinical inflammation to a higher extent than US. Improvement upon treatment with either methotrexate or a biologic can be visualized by FOI and US. Trial registration Deutsches Register Klinischer Studien DRKS00011579. Registered 10 January 2017.
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Affiliation(s)
- Ariane Klein
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Arnold-Janssen-Strasse 29, 53757, Sankt Augustin, Germany.
| | - Georg Werner Just
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Arnold-Janssen-Strasse 29, 53757, Sankt Augustin, Germany
| | | | - Prasad T Oommen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Kirsten Minden
- Charité University Medicine and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Ingrid Becker
- Institute of Medical Statistics, University of Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Hans-Eckhard Langer
- RHIO (Rheumatologie, Immunologie, Osteologie) Düsseldorf, Düsseldorf, Germany
| | - Dirk Klee
- Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Gerd Horneff
- Centre for Paediatric Rheumatology, Department of Paediatrics, Asklepios Clinic Sankt Augustin, Arnold-Janssen-Strasse 29, 53757, Sankt Augustin, Germany
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Friedrich S, Lüders S, Werner SG, Glimm AM, Burmester GR, Riemekasten G, Backhaus M, Ohrndorf S. Disturbed microcirculation in the hands of patients with systemic sclerosis detected by fluorescence optical imaging: a pilot study. Arthritis Res Ther 2017; 19:87. [PMID: 28482872 PMCID: PMC5422953 DOI: 10.1186/s13075-017-1300-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/12/2017] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Utilising fluorescence optical imaging (FOI), the distribution of an intravenously applied colouring agent indocyanine green (ICG) can be analysed with the potential to identify malperfusion by little to no tissue enhancement. Systemic sclerosis (SSc) is characterised by the presence of digital ulcers reflecting progressive vasculopathy. The objective was to investigate the potential of FOI in the detection of disturbed microcirculation in the hands and fingers of patients with SSc and to link FOI findings to clinical signs of ischemia such as digital ulcers and pitting scars. METHODS In this cross-sectional study, 63 patients with SSc and 26 healthy subjects were examined. FOI was performed in all 89 individuals and compared to clinical data and capillaroscopic findings assembled for the SSc cohort. RESULTS Healthy subjects showed initial ICG signals in their fingertips in 93.6%, SSc patients in 78.5% (limited SSc) and 43.2% (diffuse SSc). Moreover, in SSc patients, FOI findings were significantly associated with a late capillaroscopic pattern, disseminated SSc features, a diffuse SSc subtype, and the presence of digital ulcers or pitting scars. Intra- and inter-reader reliability for FOI amounted to κ = 0.786 and κ = 0.834, respectively. CONCLUSIONS FOI is able to detect areas of reduced microcirculation in patients with SSc with high association to capillaroscopic findings. The results pave the way for future FOI investigations into its role in the prediction of complications due to an impaired acral perfusion.
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Affiliation(s)
- Stefanie Friedrich
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Susanne Lüders
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Stephanie Gabriele Werner
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
- Rheumatologie, Immunologie und Osteologie mit, Schwerpunkt für Rheumatologie, Klinische Immunologie und Osteologie am Ev. Krankenhaus Düsseldorf, Düsseldorf, Germany
| | - Anne-Marie Glimm
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | - Gerd-Rüdiger Burmester
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
| | | | - Marina Backhaus
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
- Department of Internal Medicine - Rheumatology and Clinical Immunology, Park-Klinik, Weißensee, Berlin Germany
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin, Germany
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Fluorescence optical imaging and 3T-MRI for detection of synovitis in patients with rheumatoid arthritis in comparison to a composite standard of reference. Eur J Radiol 2017; 90:6-13. [DOI: 10.1016/j.ejrad.2017.02.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2016] [Revised: 01/16/2017] [Accepted: 02/12/2017] [Indexed: 11/22/2022]
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Witt M, Frielinghausen J, Mueller R, Mueller F, Proft F, Schulze-Koops H, Grunke M, Clevert DA. Evaluation of a Novel Semi-Automated Ultrasound System for the Detection of Synovitis: A Prospective Study involving 45 Patients with Rheumatoid Arthritis. Ultrasound Int Open 2016; 2:E117-E123. [PMID: 27921093 DOI: 10.1055/s-0042-115774] [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: 04/17/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022] Open
Abstract
Background: Arthrosonography has proven to be more sensitive and reliable for the detection of synovitis than clinical examination, but a comprehensive examination of small joints is time-consuming. The automated breast volume scanner (ABVS) has been developed to allow automatic and reproducible series of consecutive B-mode pictures of the female breast. Objectives: To analyze the comparability of ABVS and conventional manual ultrasonography (mUS) for the detection of synovitis in hands and feet of patients with rheumatoid arthritis (RA). Methods: 45 patients with early and established active rheumatoid arthritis were recruited for this trial. All subjects were assessed clinically and by manual (Esaote MyLab70) and automated ultrasound (ACUSON S2000™ ABVS). The wrists, the metacarpophalangeal and proximal interphalangeal joints of the hands and the metatarsophalangeal joints of the feet were examined. Results: A total of 2 340 joint aspects were examined with both methods. ABVS detected 291 grade 1, 124 grade 2, 100 grade 3 cases of synovitis (515 in total) compared to 267, 180 and 145 cases of synovitis (592 in total) with mUS. 242 erosions and 52 cases of tenosynovitis were found by ABVS compared to 244 erosions and 99 cases of tenosynovitis found by mUS. Kappa coefficients for the agreement between both methods ranged from 0.51 in PIP joints to 0.71 in MCP joints. The correlations with clinical parameters as well as interrater agreements were comparable for both ultrasound methods. Conclusion: Based on the results, ABVS seems to be a promising technology for the comprehensive and time-saving assessment of synovitis in RA.
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Affiliation(s)
- M Witt
- Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
| | - J Frielinghausen
- Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
| | - R Mueller
- Division of Rheumatology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - F Mueller
- Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
| | - F Proft
- Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
| | - H Schulze-Koops
- Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
| | - M Grunke
- Division of Rheumatology, Med. Klinik und Poliklinik IV, University of Munich, Munich, Germany
| | - D-A Clevert
- Department of Clinical Radiology, University of Munich, Munich, Germany
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Porcu EP, Salis A, Gavini E, Rassu G, Maestri M, Giunchedi P. Indocyanine green delivery systems for tumour detection and treatments. Biotechnol Adv 2016; 34:768-789. [PMID: 27090752 DOI: 10.1016/j.biotechadv.2016.04.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 03/31/2016] [Accepted: 04/01/2016] [Indexed: 01/16/2023]
Abstract
Indocyanine green (ICG) is a cyanine compound that displays fluorescent properties in the near infrared region. This dye is employed for numerous indications but nowadays its major application field regards tumour diagnosis and treatments. Optical imaging by near infrared fluorescence provides news opportunities for oncologic surgery. The imaging of ICG can be useful for intraoperative identification of several solid tumours and metastases, and sentinel lymph node detection. In addition, ICG can be used as an agent for the destruction of malignant tissue, by virtue of the production of reactive oxygen species and/or induction of a hyperthermia effect under irradiation. Nevertheless, ICG shows several drawbacks, which limit its clinical application. Several formulative strategies have been studied to overcome these problems. The rationale of the development of ICG containing drug delivery systems is to enhance the in vivo stability and biodistribution profile of this dye, allowing tumour accumulation and resulting in better efficacy. In this review, ICG containing nano-sized carriers are classified based on their chemical composition and structure. In addition to nanosystems, different formulations including hydrogel, microsystems and others loaded with ICG will be illustrated. In particular, this report describes the preparation, in vitro characterization and in vivo application of ICG platforms for cancer imaging and treatment. The promising results of all systems confirm their clinical utility but further studies are required prior to evaluating the formulations in human trials.
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Affiliation(s)
- Elena P Porcu
- PhD in Experimental Medicine, Department of Diagnostic, Paediatric, Clinical and Surgical Science, Pavia, Italy
| | - Andrea Salis
- University of Sassari, Department of Chemistry and Pharmacy, Sassari, Italy
| | - Elisabetta Gavini
- University of Sassari, Department of Chemistry and Pharmacy, Sassari, Italy
| | - Giovanna Rassu
- University of Sassari, Department of Chemistry and Pharmacy, Sassari, Italy
| | | | - Paolo Giunchedi
- University of Sassari, Department of Chemistry and Pharmacy, Sassari, Italy.
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Haugen IK, Hammer HB. A need for new imaging modality to detect inflammation in rheumatoid arthritis and osteoarthritis? Ann Rheum Dis 2015; 75:479-80. [PMID: 26698851 DOI: 10.1136/annrheumdis-2015-208661] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Accepted: 11/30/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Scales HE, Ierna M, Smith KM, Ross K, Meiklejohn GR, Patterson-Kane JC, McInnes IB, Brewer JM, Garside P, Maffia P. Assessment of murine collagen-induced arthritis by longitudinal non-invasive duplexed molecular optical imaging. Rheumatology (Oxford) 2015; 55:564-72. [PMID: 26475798 DOI: 10.1093/rheumatology/kev361] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE In the present study we evaluated the use of four commercially available fluorescent probes to monitor disease activity in murine CIA and its suppression during glucocorticoid therapy. METHODS Arthritis was induced in male DBA/1 mice by immunization with type II collagen in Complete Freund's Adjuvant, followed by a boost of collagen in PBS. Four fluorescent probes from PerkinElmer in combination [ProSense 750 fluorescent activatable sensor technology (FAST) with Neutrophil Elastase 680 FAST and MMPSense 750 FAST with CatK 680 FAST] were used to monitor disease development from day 5 through to day 40 post-immunization. Fluorescence generated in vivo by the probes was correlated with clinical and histological score and paw measurements. RESULTS The fluorescence intensity emitted by each probe was shown to correlate with the conventional measurements of disease. The highest degree of correlation was observed with ProSense 750 FAST in combination with Neutrophil Elastase 680 FAST; these probes were then used to successfully assess CIA suppression during dexamethasone treatment. CONCLUSION We have demonstrated that longitudinal non-invasive duplexed optical fluorescence imaging provides a simple assessment of arthritic disease activity within the joints of mice following the induction of CIA and may represent a powerful tool to monitor the efficacy of drug treatments in preclinical studies.
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Affiliation(s)
- Hannah E Scales
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, MD Biosciences
| | | | | | - Kirsty Ross
- Strathclyde Institute of Pharmacy & Biomedical Sciences, University of Strathclyde, Glasgow, UK and
| | | | - Janet C Patterson-Kane
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Iain B McInnes
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - James M Brewer
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Paul Garside
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - Pasquale Maffia
- Centre for Immunobiology, Institute of Infection, Immunity and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Department of Pharmacy, University of Naples Federico II, Naples, Italy
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van Onna M, Ten Cate DF, Tsoi KL, Meier AJL, Jacobs JWG, Westgeest AAA, Meijer PBL, van Beek MC, Rensen WHJ, Bijlsma JWJ. Assessment of disease activity in patients with rheumatoid arthritis using optical spectral transmission measurements, a non-invasive imaging technique. Ann Rheum Dis 2015; 75:511-8. [PMID: 26452538 PMCID: PMC4789697 DOI: 10.1136/annrheumdis-2015-207315] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 09/20/2015] [Indexed: 01/30/2023]
Abstract
Objectives In rheumatoid arthritis (RA), treat-to-target strategies require instruments for valid detection of joint inflammation. Therefore, imaging modalities are increasingly used in clinical practice. Optical spectral transmission (OST) measurements are non-invasive and fast and may therefore have benefits over existing imaging modalities. We tested whether OST could measure disease activity validly in patients with RA. Methods In 59 patients with RA and 10 patients with arthralgia, OST, joint counts, Disease Activity Score (DAS) 28 and ultrasonography (US) were performed. Additionally, MRI was performed in patients with DAS28<2.6. We developed and validated within the same cohort an algorithm for detection of joint inflammation by OST with US as reference. Results At the joint level, OST and US performed similarly inproximal interphalangeal-joints (area under the receiver-operating curve (AUC) of 0.79, p<0.0001) andmetacarpophalangeal joints (AUC 0.78, p<0.0001). Performance was less similar in wrists (AUC 0.62, p=0.006). On the patient level, OST correlated moderately with clinical examination (DAS28 r=0.42, p=0.001), and US scores (r=0.64, p<0.0001). Furthermore, in patients with subclinical and low disease activity, there was a correlation between OST and MRI synovitis score (RAMRIS (Rheumatoid Arthritis MRI Scoring) synovitis), r=0.52, p=0.005. Conclusions In this pilot study, OST performed moderately in the detection of joint inflammation in patients with RA. Further studies are needed to determine the diagnostic performance in a new cohort of patients with RA.
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Affiliation(s)
- M van Onna
- Department of Clinical Immunology and Rheumatology, Academic Medical Center, Amsterdam, The Netherlands
| | - D F Ten Cate
- Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K L Tsoi
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A J L Meier
- Department of Rheumatology, Regional Rheumatology Center, Eindhoven, The Netherlands
| | - J W G Jacobs
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A A A Westgeest
- Department of Rheumatology, Regional Rheumatology Center, Eindhoven, The Netherlands
| | | | | | | | - J W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Glimm AM, Werner SG, Burmester GR, Backhaus M, Ohrndorf S. Analysis of distribution and severity of inflammation in patients with osteoarthitis compared to rheumatoid arthritis by ICG-enhanced fluorescence optical imaging and musculoskeletal ultrasound: a pilot study. Ann Rheum Dis 2015; 75:566-70. [PMID: 26311723 PMCID: PMC4789689 DOI: 10.1136/annrheumdis-2015-207345] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 07/14/2015] [Indexed: 01/24/2023]
Abstract
Background In rheumatoid arthritis (RA), hand synovitis appears especially in wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. In hand osteoarthritis (OA), potential inflammatory changes are mainly present in PIP and distal interphalangeal (DIP) joints. Joint inflammation can be visualised by fluorescence optical imaging (FOI) and musculoskeletal ultrasound (US). Objective Comparison of the amount and distribution of inflammatory signs in wrist and finger joints of the clinically dominant hand in patients with OA and RA by FOI and gray-scale (GSUS) and power Doppler US (PDUS). Methods FOI and GSUS/PDUS were performed in 1.170 joints (wrists, MCP, PIP, DIP) in 90 patients (67 RA, 23 OA). Joint inflammation was graded by a semiquantitative score (0–3) for each imaging method. Results GSUS/PDUS showed wrist and MCP joints mostly affected in RA. DIP joints were graded higher in OA. In FOI, RA and OA featured inflammatory changes in the respective joint groups depending on the phase of fluorescence dye flooding. Conclusions US and FOI detected inflammation in both RA and OA highlighting the inflammatory component in the course of OA. The different inflammatory patterns and various shapes of fluorescence enhancement in FOI may offer opportunities to distinguish and determine the inflammatory status in both diseases.
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Affiliation(s)
- A-M Glimm
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S G Werner
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - G R Burmester
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - M Backhaus
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
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The Application of Fluorescence Optical Imaging in Systemic Sclerosis. BIOMED RESEARCH INTERNATIONAL 2015; 2015:658710. [PMID: 26357658 PMCID: PMC4555360 DOI: 10.1155/2015/658710] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 04/03/2015] [Indexed: 01/30/2023]
Abstract
Objective. The aim of this study was to visualize soft tissue inflammation using FOI on patients with Systemic Sclerosis (SSc) characterized by SSc-related Raynaud's phenomenon and to detect the therapeutic response to treatment with iloprost or alprostadil. Methods. Twenty-one patients with SSc and Raynaud's phenomenon and twenty-six healthy controls were prospectively included. The SSc patients were intravenously treated with iloprost or alprostadil over seven days. FOI was performed at baseline and after seven days using an intravenous application of indocyanine green (ICG). The hands were divided into nineteen segments per hand. All segments were quantitatively evaluated to determine changes in ICG. Results. The sensitivity and specificity of FOI in the detection of ICG enhancement in patients with SSc were 95% versus 96%. At baseline, 31.5% hand segments showed ICG enhancement. After seven days of either iloprost or alprostadil therapy a significant reduction in the ICG was observed which ranged from 40.9% to 24.7%. Conclusion. The study demonstrates that the FOI technique is able to visualize soft-tissue inflammation with both high sensitivity and specificity. The anti-inflammatory therapeutic effects of iloprost were slightly stronger than alprostadil. FOI offers promising benefits in the diagnosis and therapy of patients with SSc-associated Raynaud's phenomenon.
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Predicting Response to Therapy for Autoimmune and Inflammatory Diseases Using a Folate Receptor-Targeted Near-Infrared Fluorescent Imaging Agent. Mol Imaging Biol 2015; 18:201-8. [DOI: 10.1007/s11307-015-0876-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kisten Y, Györi N, Af Klint E, Rezaei H, Levitsky A, Karlsson A, van Vollenhoven R. Detection of clinically manifest and silent synovitis in the hands and wrists by fluorescence optical imaging. RMD Open 2015; 1:e000106. [PMID: 26535142 PMCID: PMC4612680 DOI: 10.1136/rmdopen-2015-000106] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 01/11/2023] Open
Abstract
Objectives The correct identification of synovitis is critical for achieving optimal therapy results. Fluorescence optical imaging (FOI) is a novel modality based on the use of an intravenous fluorophore, which enables fluorescent imaging of the hands and wrists with increased focal optical signal intensities in areas of high perfusion and/or capillary leakage. The study objective was to determine the diagnostic utility of FOI in detecting apparent and clinically non-apparent active synovitis. Methods Bilateral hand and wrist joints (n=872) of 26 patients with inflammatory arthritis assessed by standard clinical examination, musculoskeletal ultrasound (MSUS) and FOI were studied. Synovitis was defined as tender and swollen joints on clinical examination, presence of synovial thickening and intra-articular Doppler signals on MSUS, and abnormal focal optical signal intensities on FOI, respectively. Subclinical synovitis was defined as being clinically non-apparent, but positively inflamed on MSUS. Results Depending on the standard used to define inflammation, FOI ranged from 73–83% sensitive and 83–95% specific for detecting manifest synovitis. For detecting clinically silent synovitis, the sensitivity, specificity and positive and negative predictive values of FOI were 80%, 96%, 77% and 97%, respectively. Conclusions The high degree of agreement between MSUS and FOI suggest its use in clinical practice, especially when MSUS is not available, in order to identify synovitis earlier and with greater confidence. FOI may be particularly useful in identifying patients with clinically non-apparent joint inflammation of the hands and/or wrists.
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Affiliation(s)
- Yogan Kisten
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Noémi Györi
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Erik Af Klint
- The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Hamed Rezaei
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden ; The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Adrian Levitsky
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden
| | - Anna Karlsson
- The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
| | - Ronald van Vollenhoven
- Unit for Clinical Therapy Research, Inflammatory Diseases (ClinTRID), Karolinska Institute, Karolinska University Hospital , Stockholm , Sweden ; The Rheumatology Clinic, Karolinska University Hospital , Stockholm , Sweden
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Krohn M, Ohrndorf S, Werner SG, Schicke B, Burmester GR, Hamm B, Backhaus M, Hermann KGA. Near-infrared Fluorescence Optical Imaging in Early Rheumatoid Arthritis: A Comparison to Magnetic Resonance Imaging and Ultrasonography. J Rheumatol 2015; 42:1112-8. [PMID: 25934821 DOI: 10.3899/jrheum.141244] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Near-infrared fluorescence optical imaging (FOI) is a novel imaging technology in the detection and evaluation of different arthritides. FOI was validated in comparison to magnetic resonance imaging (MRI), greyscale ultrasonography (GSUS), and power Doppler ultrasonography (PDUS) in patients with early rheumatoid arthritis (RA). METHODS Hands of 31 patients with early RA were examined by FOI, MRI, and US. In each modality, synovitis of the wrist, metacarpophalangeal joints (MCP) 2-5, and proximal interphalangeal joints (PIP) 2-5 were scored on a 4-point scale (0-3). Sensitivity and specificity of FOI were analyzed in comparison to MRI and US as reference methods, differentiating between 3 phases of FOI enhancement (P1-3). Intraclass correlation coefficients (ICC) were calculated to evaluate the agreement of FOI with MRI and US. RESULTS A total of 279 joints (31 wrists, 124 MCP and 124 PIP joints) were evaluated. With MRI as the reference method, overall sensitivity/specificity of FOI was 0.81/0.00, 0.49/0.84, and 0.86/0.38 for wrist, MCP, and PIP joints, respectively. Under application of PDUS as reference, sensitivity was even higher, while specificity turned out to be low, except for MCP joints (0.88/0.15, 0.81/0.76, and 1.00/0.27, respectively). P2 appears to be the most sensitive FOI phase, while P1 showed the highest specificity. The best agreement of FOI was shown for PDUS, especially with regard to MCP and PIP joints (ICC of 0.57 and 0.53, respectively), while correlation with MRI was slightly lower. CONCLUSION FOI remains an interesting diagnostic tool for patients with early RA, although this study revealed limitations concerning the detection of synovitis. Further research is needed to evaluate its full diagnostic potential in rheumatic diseases.
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Affiliation(s)
- Michaela Krohn
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Sarah Ohrndorf
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Stephanie G Werner
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Bernd Schicke
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Gerd-Rüdiger Burmester
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Bernd Hamm
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Marina Backhaus
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital
| | - Kay-Geert A Hermann
- From the Department of Radiology, and the Department of Rheumatology and Clinical Immunology, Charité University Hospital, Berlin; RHIO - Rheumatology, Immunology, Osteology Center, Düsseldorf; Berlin Cancer Center (Tumorzentrum Berlin), Berlin, Germany.M. Krohn, MD, Department of Radiology, Charité University Hospital; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; S.G. Werner, MD, RHIO; B. Schicke, Berlin Cancer Center (Tumorzentrum Berlin); G.R. Burmester, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; B. Hamm, MD, PhD, Department of Radiology, Charité University Hospital; M. Backhaus, MD, PhD, Department of Rheumatology and Clinical Immunology, Charité University Hospital; K.G. Hermann, MD, PhD, Department of Radiology, Charité University Hospital.
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