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Carlsson AD, Wahlund K, Ghafouri B, Kindgren E, Frodlund M, Salé H, Klintström E, Johansson CS, Alstergren P. Parotid saliva and blood biomarkers in juvenile idiopathic arthritis in relation to temporomandibular joint magnetic resonance imaging findings. J Oral Rehabil 2024. [PMID: 39007294 DOI: 10.1111/joor.13806] [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: 09/20/2023] [Revised: 07/03/2024] [Accepted: 07/05/2024] [Indexed: 07/16/2024]
Abstract
BACKGROUND Juvenile idiopathic arthritis (JIA) often affects the temporomandibular joint (TMJ) caused by an abnormal immune system that includes overactive inflammatory processes. Salivary biomarkers may be a powerful tool that can help establishing diagnosis, prognosis and monitor disease progress. OBJECTIVE The objective was to investigate biomarkers in parotid saliva and blood plasma in relation to temporomandibular joint (TMJ) magnetic resonance imaging (MRI) findings in patients with JIA and healthy individuals. METHODS Forty-five children aged 6 to 16 years with JIA and 16 healthy age- and sex-matched controls were included. Unstimulated parotid saliva samples and venous blood were collected. Biochemical analyses were performed for the cytokine biomarkers. The participants underwent MR imaging of the TMJs, where changes in the inflammatory and the damage domains were assessed. RESULTS In the JIA patients, lower concentrations of IL-6R and gp130 were found in parotid saliva than in plasma. Higher concentrations of IL-6 were found in parotid saliva than in plasma. IL-6, IL-6R and gp130 in parotid saliva explained the presence of bone marrow oedema and effusion in the JIA patients. CONCLUSIONS This study suggests that the IL-6 family in parotid saliva is associated with TMJ bone marrow oedema and effusion in patients with JIA, suggesting that IL-6 has promising properties as a parotid saliva biomarker for TMJ inflammatory activity.
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Affiliation(s)
- Alexandra Dimitrijevic Carlsson
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
- Centre for Oral Rehabilitation, in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden
| | - Kerstin Wahlund
- Department of Orofacial Pain and Jaw Function, Kalmar County Hospital, Kalmar, Sweden
| | - Bijar Ghafouri
- Rehabilitation Medicine, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Erik Kindgren
- Department of Pediatrics, Västervik Hospital, Västervik, Sweden
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
- Department of Pediatrics, Skövde Hospital, Sweden
| | - Martina Frodlund
- Rheumatology/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Hanna Salé
- Department of Neuroradiology, Center of Medical Imaging and Physiology, Skåne University Hospital, Lund, Sweden
| | - Eva Klintström
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Radiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Carin Starkhammar Johansson
- Centre for Oral Rehabilitation, in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Per Alstergren
- Orofacial Pain and Jaw Function, Malmö University, Malmö, Sweden
- Scandinavian Center for Orofacial Neurosciences (SCON), Malmö, Sweden
- Skåne University Hospital, Specialized Pain Rehabilitation, Lund, Sweden
- Orofacial Pain Unit, Malmö University, Malmö, Sweden
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den Hollander NK, van der Helm-van Mil AHM, van Steenbergen HW. Improving our understanding of the paradoxical protective effect of obesity on radiographic damage: a large magnetic resonance imaging-study in early arthritis. Rheumatology (Oxford) 2024; 63:1007-1014. [PMID: 37389420 PMCID: PMC10986809 DOI: 10.1093/rheumatology/kead320] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 07/01/2023] Open
Abstract
OBJECTIVE Obesity conveys a risk for RA development, while paradoxically, associating with less radiographic progression after RA diagnosis. Using MRI we can study this surprising association in detail from MRI-detected synovitis and osteitis to MRI-detected erosive progression, which precedes radiographic progression. Previous research suggested obesity associates with less osteitis and synovitis. We therefore aimed to (i) validate the previously suggested association between BMI and MRI-detected osteitis/synovitis; (ii) study whether this is specific for ACPA-positive or ACPA-negative RA or also present in other arthritides; (iii) study whether MRI-detected osteitis associates with MRI-detected erosive progression; and (iv) study whether obesity associates with MRI-detected erosive progression. METHODS We studied 1029 early arthritis patients (454 RA, 575 other arthritides), consecutively included in Leiden Early Arthritis Clinic. At baseline patients underwent hand-and-foot MRI that were RAMRIS-scored, and 149 RA patients underwent follow-up MRIs. We studied associations between baseline BMI and MRI-detected osteitis/synovitis (using linear regression), and erosive progression (using Poisson mixed models). RESULTS In RA, higher BMI associated with less osteitis at disease onset (β = 0.94; 95% CI: 0.93, 0.96) but not with synovitis. Higher BMI associated with less osteitis in ACPA-positive RA (β = 0.95; 95% CI: 0.93, 0.97), ACPA-negative RA (β = 0.97; 95% CI: 0.95, 0.99) and other arthritides (β = 0.98; 95% CI: 0.96, 0.99). Over 2 years, overweight and obesity associated with less MRI-detected erosive progression (P = 0.02 and 0.03, respectively). Osteitis also associated with erosive progression over 2 years (P < 0.001). CONCLUSIONS High BMI relates to less osteitis at disease onset, which is not confined to RA. Within RA, high BMI and less osteitis associated with less MRI-detected erosive progression. This suggests that the protective effect of obesity on radiographic progression is exerted via a path of less osteitis and subsequently fewer MRI-detected erosions.
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Affiliation(s)
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Nicoara AI, Sas LM, Bita CE, Dinescu SC, Vreju FA. Implementation of artificial intelligence models in magnetic resonance imaging with focus on diagnosis of rheumatoid arthritis and axial spondyloarthritis: narrative review. Front Med (Lausanne) 2023; 10:1280266. [PMID: 38173943 PMCID: PMC10761482 DOI: 10.3389/fmed.2023.1280266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/04/2023] [Indexed: 01/05/2024] Open
Abstract
Early diagnosis in rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA) is essential to initiate timely interventions, such as medication and lifestyle changes, preventing irreversible joint damage, reducing symptoms, and improving long-term outcomes for patients. Since magnetic resonance imaging (MRI) of the wrist and hand, in case of RA and MRI of the sacroiliac joints (SIJ) in case of axSpA can identify inflammation before it is clinically discernible, this modality may be crucial for early diagnosis. Artificial intelligence (AI) techniques, together with machine learning (ML) and deep learning (DL) have quickly evolved in the medical field, having an important role in improving diagnosis, prognosis, in evaluating the effectiveness of treatment and monitoring the activity of rheumatic diseases through MRI. The improvements of AI techniques in the last years regarding imaging interpretation have demonstrated that a computer-based analysis can equal and even exceed the human eye. The studies in the field of AI have investigated how specific algorithms could distinguish between tissues, diagnose rheumatic pathology and grade different signs of early inflammation, all of them being crucial for tracking disease activity. The aim of this paper is to highlight the implementation of AI models in MRI with focus on diagnosis of RA and axSpA through a literature review.
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Affiliation(s)
| | - Lorena-Mihaela Sas
- Radiology and Medical Imaging Laboratory, Craiova Emergency County Clinical Hospital, Craiova, Romania
- Department of Human Anatomy, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Cristina Elena Bita
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Stefan Cristian Dinescu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Florentin Ananu Vreju
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, Craiova, Romania
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Chi Z, Huang L, Wu D, Long X, Xu X, Jiang H. First assessment of thermoacoustic tomography for in vivo detection of rheumatoid arthritis in the finger joints detection of rheumatoid arthritis in the finger joints. Med Phys 2021; 49:84-92. [PMID: 34767650 DOI: 10.1002/mp.15340] [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: 08/17/2021] [Revised: 10/04/2021] [Accepted: 10/28/2021] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The diagnosis of rheumatoid arthritis (RA) is complicated because of the complexity of symptoms and joint structures. Current clinical imaging techniques for the diagnosis of RA have strengths and weaknesses. Emerging imaging techniques need to be developed for the diagnosis or auxiliary diagnosis of RA. PURPOSE This study aimed to demonstrate the potential of thermoacoustic tomography (TAT) for in vivo detection of RA in the finger joints. METHODS Finger joints were imaged by a TAT system using three different microwave illumination methods including pyramidal horn antenna, and parallel in-phase and anti-phase microwave illuminations. Both diseased and healthy joints were imaged and compared when the three microwave illumination methods were used. Magnetic resonance imaging (MRI) of all the joints was performed to validate the TAT findings. In addition, two diseased joints were imaged at two time points by the pyramidal horn antenna-based TAT to track/monitor the progression of RA during a time period of 16 months. Three-dimensional (3-D) TAT images of the joints were also obtained. RESULTS The TAT images of the diseased joints displayed abnormalities in bone and soft tissues compared to the healthy ones. The TAT images by pyramidal horn antenna and in-phase microwave illumination showed high similarity in image appearance, while the anti-phase-based TAT images provided different information about the disease. We found that the TAT findings matched well with the MRI images. The 3-D TAT images effectively displayed the stereoscopic effect of joint lesions. Finally, it was evident that TAT could detect the development of the lesions in 16 months. CONCLUSION TAT can noninvasively visualize bone lesions and soft tissue abnormalities in the joints with RA. This first in vivo assessment of TAT provides a foundation for its clinical application to the diagnosis and monitoring of RA in the finger joints.
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Affiliation(s)
- Zihui Chi
- School of Optoelectronic Engineering, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Lin Huang
- School of Electronic Science and Engineering, University of Electronic Science and Technology of China, Chengdu, China.,Center for Information in Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Dan Wu
- School of Optoelectronic Engineering, Chongqing University of Posts and Telecommunications, Chongqing, China
| | - Xiaojun Long
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xueliang Xu
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huabei Jiang
- Department of Medical Engineering, University of South Florida, Tampa, Florida, USA
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Marage L, Lasbleiz J, Fondin M, Lederlin M, Gambarota G, Saint-Jalmes H. Voxel-based mapping of five MR biomarkers in the wrist bone marrow. MAGMA (NEW YORK, N.Y.) 2021; 34:729-740. [PMID: 33709226 DOI: 10.1007/s10334-020-00901-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE MRI is a reliable and accurate technique to characterize rheumatoid arthritis. The aim of this study was to provide voxel-by-voxel 3D maps of the proton density fat fraction (PDFF), the T1 of water (T1W), the T1 of fat (T1F), the T2* of water (T2*W), the T2* of fat (T2*F) in the wrist bone marrow. MATERIALS AND METHODS The experiments were conducted on 14 healthy volunteers (mean age: 24 ± 4). The data were acquired at 1.5 T using two optimized four-echo 3D 1.2 × 1.2 × 1.2 mm3-isotropic spoiled gradient sequences. A repeatability study was carried out. The measurements were done using a homemade parametric viewer software. RESULTS The inter-volunteer results were, on average: PDFF = 86 ± 3%, T1W = 441 ± 113 ms, T1F = 245 ± 19 ms, T2*W = 6 ± 1 ms and T2*F = 16 ± 3 ms. The coefficients of variation were for fat based biomarkers CVPDFF < 5%, CVT1F < 15% and CVT2*F < 10% in the repeatability study. DISCUSSION The protocol and quantification tool proposed in this study provide high-resolution voxel-by-voxel 3D maps of five biomarkers in the wrist in less than 4 min of acquisition.
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Affiliation(s)
- Louis Marage
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France.
| | - Jeremy Lasbleiz
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France
| | - Maxime Fondin
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France
| | - Mathieu Lederlin
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France
| | - Giulio Gambarota
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France
| | - Hervé Saint-Jalmes
- CLCC Eugène Marquis, Inserm, LTSI - UMR 1099, Univ Rennes, CHU Rennes, 2 Av. du Professeur Léon Bernard, 35000, Rennes, France
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Quantification of bone marrow edema in rheumatoid arthritis by using high-speed T2-corrected multiecho acquisition of 1H magnetic resonance spectroscopy: a feasibility study. Clin Rheumatol 2021; 40:4639-4647. [PMID: 34155572 DOI: 10.1007/s10067-021-05764-x] [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: 10/31/2020] [Revised: 04/06/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether high-speed T2-corrected multiecho (HISTO) sequences can quantify bone marrow edema (BME) in the capitate bone in rheumatoid arthritis (RA), and whether the HISTO fat fraction (FF) reflects therapeutic effectiveness. METHODS In this prospective study, 25 RA patients (19 women; average age, 45.08 ± 13.48 years) underwent 3.0-T MRI with HISTO at the baseline and after 4, 8, and 12 weeks of treatment. Rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), platelet (PLT) count, and 28-joint Disease Activity Score using ESR (DAS28-ESR) were recorded on the day of each MRI examination by a rheumatologist blinded to the MRI findings. In addition, 21 healthy subjects (15 women; age, 49.17 ± 6.56 years) underwent only the HISTO sequence at a single time point. RESULTS HISTO FF values were significantly higher in the control group (74.5% ± 3.1%; range, 68.6-79.3%) than in the patient group (55.8% ± 17.7%; range, 15.6-79.0%) at the baseline (independent-samples t-test: t = 5.257, P = 0.000). The changes in HISTO FF and DAS28-ESR showed moderate negative correlations with each other at 4, 8, and 12 weeks, and all of them were statistically significant (P < 0.05). As the HISTO FF increased, the DAS28-ESR decreased. CONCLUSION The HISTO sequence can measure the bone marrow FF of the wrist joint bones in RA patients. The HISTO FF value increased as the DAS28-ESR decreased. The HISTO sequence may help quantify BME in RA and help monitor the effectiveness of RA treatment. Key Points •The HISTO sequence could measure the bone marrow FF of the wrist joint bones. •FF value increased as the DAS28-ESR decreased in RA patients. •The HISTO sequence can monitor the therapeutic effect of RA.
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Matthijssen XME, Niemantsverdriet E, Le Cessie S, van der Helm-van Mil AHM. Differing time-orders of inflammation decrease between ACPA subsets in RA patients suggest differences in underlying inflammatory pathways. Rheumatology (Oxford) 2021; 60:2969-2975. [PMID: 33164106 PMCID: PMC8213431 DOI: 10.1093/rheumatology/keaa658] [Citation(s) in RCA: 4] [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: 06/04/2020] [Revised: 09/15/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Advanced imaging modalities have shown that not only joints but also bones and tendon sheaths can be inflamed at diagnosis of RA. We aimed to better understand the time-order in which the inflamed tissues respond to DMARD treatment. Also, because ACPA status may reflect a different pathophysiology, differences in time-order of inflammation decrease were hypothesized between these disease types. METHODS A total of 216 consecutive patients presenting with RA (n = 176) or undifferentiated arthritis (n = 40), who all started with conventional synthetic DMARD treatment, were studied. 1.5T contrast-enhanced hand and foot MRIs were performed before treatment and after 4, 12 and 24 months. Cross-lagged models evaluated the influence of two time patterns: a simultaneous pattern ('change in one inflammatory feature associated with change in another feature') and a subsequent pattern ('change in one inflammatory feature preceded change in another feature'). ACPA stratification was performed. RESULTS The median symptom duration at presentation was 13 weeks. Forty-four percent of patients was ACPA-positive. All pairs of inflammatory features decreased simultaneously in all time intervals (0-4/4-12/12-24 months; P < 0.05). Moreover, time-orders were identified: synovitis decrease preceded tenosynovitis decrease (0-4 to >4-12 months; P = 0.02 and 4-12 to >12-24 months; P = 0.03). Largely similar results were obtained in both ACPA subgroups. Additionally, in ACPA-positive but not ACPA-negative patients, synovitis decrease preceded osteitis decrease (4-12 to >12-24 moths; P = 0.002). CONCLUSION This study increased the understanding of the response to treatment on the tissue level. In addition to simultaneous decrease of inflammation, synovitis decrease preceded tenosynovitis decrease. Differences in time-order of inflammation decrease between ACPA subgroups suggest differences in underlying inflammatory pathways.
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Affiliation(s)
- Xanthe M E Matthijssen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Correspondence to: Xanthe M.E. Matthijssen, Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. E-mail:
| | | | - Saskia Le Cessie
- Department of Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Biomedical Data Science, Leiden University Medical Center, Leiden, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
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Antibodies to Citrullinated Proteins (ACPA) Associate with Markers of Osteoclast Activation and Bone Destruction in the Bone Marrow of Patients with Rheumatoid Arthritis. J Clin Med 2021; 10:jcm10081778. [PMID: 33921836 PMCID: PMC8073027 DOI: 10.3390/jcm10081778] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 04/11/2021] [Accepted: 04/16/2021] [Indexed: 02/06/2023] Open
Abstract
Normalizing bone metabolism is a challenge in rheumatoid arthritis (RA). Studies in mice suggest that anti-citrullinated protein antibodies (ACPAs) can trigger osteoclast activation and bone resorption in the bone marrow. However, data on the presence and role of ACPAs in human bone marrow are scarce. We investigated whether ACPAs can contribute to osteoclast activation and bone erosion in RA bone marrow. Anti-cyclic citrullinated peptide antibodies (anti-CCP Abs), osteoclast activation indicators–the tartrate-resistant acid phosphatase 5b (TRAP5b) and cathepsin K, and bone degradation marker–C-terminal telopeptide of type I collagen (CTX-I) were measured in the bone marrow and peripheral blood of RA patients using ELISAs. We found that ACPAs present in RA bone marrow was associated with increased amounts of TRAP5b, cathepsin K and CTX-I in this location. Levels of IL-8, the key mediator of anti-citrullinated protein antibody (ACPA)-induced bone resorption, were also elevated in bone marrow containing anti-CCP Abs and positively correlated with TRAP5b and cathepsin K concentrations. Higher levels of TRAP5b, cathepsin K, CTX-I and IL-8 in bone marrow compared to peripheral blood indicate local generation of these molecules. Our results complement data from animal studies and highlight the relevance of ACPAs and bone marrow in bone resorption in RA.
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Park EH, Yoon CH, Kang EH, Baek HJ. Utility of Magnetic Resonance Imaging and Positron Emission Tomography in Rheumatic Diseases. JOURNAL OF RHEUMATIC DISEASES 2020. [DOI: 10.4078/jrd.2020.27.3.136] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Eun Hye Park
- Division of Rheumatology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Chong-Hyeon Yoon
- Division of Rheumatology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Han Joo Baek
- Division of Rheumatology, Department of Internal Medicine, Gachon University College of Medicine Gil Medical Center, Incheon, Korea
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Lim W, Saifuddin A. Review article: the differential diagnosis of bone marrow edema on wrist MRI. Skeletal Radiol 2019; 48:1525-1539. [PMID: 30903260 DOI: 10.1007/s00256-019-03204-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/01/2019] [Accepted: 03/05/2019] [Indexed: 02/02/2023]
Abstract
There is a large variety of conditions that can result in 'bone marrow edema' or 'bone marrow lesions' (BML) in the wrist on magnetic resonance imaging (MRI). The combination of clinical history and the distribution of the BML can serve as a valuable clue to a specific diagnosis. This article illustrates the different patterns of BML in the wrist to serve as a useful guide when reviewing wrist MRI studies. Imaging artefacts will also be briefly covered.
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Affiliation(s)
- WanYin Lim
- Dr Jones and Partners Medical Imaging, 226 Greenhill Road, Eastwood, SA, 5063, Australia. .,Royal Adelaide Hospital, Port Rd, Adelaide, SA, 5000, Australia.
| | - Asif Saifuddin
- Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, HA7 4LP, UK.,Everlight Radiology, Level 6 West, Euston Road, London, NW1 3AX, UK
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Ahmad HA, Baker JF, Østergaard M, Ye J, Emery P, Conaghan PG. Determining MRI Inflammation Targets When Considering a Rheumatoid Arthritis Treat-to-Target Strategy: Results of a Randomized, Placebo-Controlled Trial. Adv Ther 2019; 36:2384-2393. [PMID: 31278695 PMCID: PMC6822846 DOI: 10.1007/s12325-019-01020-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Indexed: 11/26/2022]
Abstract
Introduction Magnetic resonance imaging (MRI) is increasingly used in patients with rheumatoid arthritis (RA) to determine residual inflammation after treatment and as a predictor of structural damage progression. Establishing an optimal threshold of inflammatory activity that predicts lower risk of structural damage progression may inform treatment decisions. This post hoc analysis investigated whether patients with RA at low risk of structural damage progression can be identified based on MRI inflammation thresholds. Methods Hand and wrist MRI was performed at baseline, and at months 6 and 12 in a phase 3b, randomized, active-controlled, double-blind trial of abatacept in early RA (AVERT). Pathologies were scored using the OMERACT RA MRI Score. Data were stratified into two risk subgroups (less and more severe inflammation) for structural damage progression (erosion change > 0.5) based on baseline inflammation. In this post hoc analysis, log odds ratios of probability of progression {adjusted for baseline Disease Activity Score in 28 joints [C-reactive protein; DAS28 (CRP)]} were compared between subgroups to test the performance of inflammation thresholds. Results There were 351 randomized and treated patients with baseline MRIs, of whom 276 (78.6%) and 235 (67.0%) had MRIs available at months 6 and 12, respectively. The DAS28 (CRP)-adjusted probabilities of progression from baseline to month 12 based on scores at baseline, and from months 6 to 12 based on month 6 scores, were significantly lower among patients with less inflammation (P < 0.0001–0.0459), independent of clinical disease activity. Predefined thresholds of synovitis ≤ 3 (total score 21), osteitis ≤ 3 (total score 69) and total inflammation score (osteitis double-weighted) ≤ 9 were associated with a lower likelihood of structural damage progression in unadjusted analyses. Conclusion Levels of MRI-determined inflammatory activity below defined thresholds were independently associated with a lower risk of structural damage progression in early RA, providing a potential trial endpoint for levels of inflammation not associated with progression. Trial Registration ClinicalTrials.gov identifier, NCT01142726. Funding Bristol-Myers Squibb. Electronic Supplementary Material The online version of this article (10.1007/s12325-019-01020-6) contains supplementary material, which is available to authorized users.
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Rubin DA. MR and ultrasound of the hands and wrists in rheumatoid arthritis. Part II. Added clinical value. Skeletal Radiol 2019; 48:837-857. [PMID: 30806723 DOI: 10.1007/s00256-019-03180-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 02/03/2019] [Accepted: 02/03/2019] [Indexed: 02/02/2023]
Abstract
Advanced imaging has become just as vital for diagnosing, staging, and monitoring disease in rheumatoid arthritis (RA) patients as it is for cancer patients. Part 1 of this review discussed synovitis, tenosynovitis, erosions, and osteitis-key imaging findings that occur in patients with RA. Part 2 will now show how these features, in combination with clinical and serologic data, can assist clinical decision-making at various stages of a patient's disease course. Specifically, assessing current disease activity and prognosticating future aggressiveness inform treatment decisions at initial presentation, during medical treatment, and at clinical remission. In addition to summarizing the current literature on advanced imaging in RA, clinical examples from different stages throughout the disease course will illustrate practical approaches for applying these research results. Last, this review will describe potential future roles of imaging in RA patients.
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Affiliation(s)
- David A Rubin
- Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd., St. Louis, MO, 63110, USA.
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Wang F, Luo A, Xuan W, Qi L, Wu Q, Gan K, Zhang Q, Zhang M, Tan W. The Bone Marrow Edema Links to an Osteoclastic Environment and Precedes Synovitis During the Development of Collagen Induced Arthritis. Front Immunol 2019; 10:884. [PMID: 31068949 PMCID: PMC6491763 DOI: 10.3389/fimmu.2019.00884] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/05/2019] [Indexed: 01/16/2023] Open
Abstract
Objectives: To determine the relationship between bone marrow edema (BME), synovitis, and bone erosion longitudinally using a collagen induced arthritis mice (CIA) model and to explore the potential pathogenic role of BME in bone erosion. Methods: CIA was induced in DBA/1J mice. BME and corresponding clinical symptoms of arthritis and synovitis during the different time points of CIA development were assayed by magnetic resonance imaging (MRI), arthritis sore, and histologic analyses. The expression of osteoclasts (OCs), OCs-related cytokines, and immune cells in bone marrow were determined by flow cytometry, immunohistochemistry, immunofluorescence staining, and real-time PCR. The OCs formation was estimated using in vitro assays. Results: MRI detected BME could emerge at day 25 in 70% mice after the first immunization (n = 10), when there were not any arthritic symptoms, histological or MRI synovitis. At day 28, BME occurred in 90% mice whereas the arthritic symptom and histological synovitis were only presented in 30 and 20% CIA mice at that time (n = 10). The emergence of BME was associated with an increased bone marrow OCs number and an altered distribution of OCs adherent to subchondral bone surface, which resulted in increased subchondral erosion and decreased trabecular bone number during the CIA process. Obvious marrow environment changes were identified after BME emergence, consisting of multiple OCs related signals, including highly expressed RANKL, increased proinflammatory cytokines and chemokines, and highly activated T cells and monocytes. Conclusions: BME reflects a unique marrow "osteoclastic environment," preceding the arthritic symptoms and synovitis during the development of CIA.
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Affiliation(s)
- Fang Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Aishu Luo
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenhua Xuan
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang Qi
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Wu
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ke Gan
- Department of Traditional Chinese Medicine, Nanjing Traditional Chinese Medicine University, Nanjing, China
| | - Qiande Zhang
- Department of Chinese Medicine, Nanjing Medicine University Institute of Integration of Traditional Chinese and Western Medicine, Nanjing, China
| | - Miaojia Zhang
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Wenfeng Tan
- Department of Rheumatology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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14
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Xiao F, Griffith JF, Hilkens AL, Leung JCS, Yue J, Lee RKL, Yeung DKW, Tam LS. ERAMRS: a new MR scoring system for early rheumatoid arthritis of the wrist. Eur Radiol 2019; 29:5646-5654. [PMID: 30874879 DOI: 10.1007/s00330-019-06060-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/04/2019] [Accepted: 02/01/2019] [Indexed: 11/24/2022]
Abstract
PURPOSE To (i) devise a new semi-quantitative scoring system known as Early Rheumatoid Arthritis Magnetic Resonance Score (ERAMRS) to assess inflammation of the wrist on magnetic resonance imaging in early rheumatoid arthritis and to (ii) test ERAMRS and other MR scoring systems against everyday used clinical scorings. MATERIALS AND METHODS One hundred six treatment-naïve patients (81 females, 25 males, mean age 53 ± 12 years) with early rheumatoid arthritis (ERA) underwent clinical/serological testing as well as 3-T MRI examination of the most symptomatic wrist. Clinical assessment included Disease Activity Score-28 and Health Assessment Questionnaire; erythrocyte sedimentation rate and C-reactive protein were measured. MR imaging data was scored in all patients using three devised MR semi-quantitative scoring systems, namely, the (a) ERAMRS system, (b) Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) system, and the (c) McQueen Score system. RESULTS Synovitis was present in 106 (100%), tenosynovitis in 98 (92%), and bone marrow edema in 84 (79%) of 106 ERA wrists. ERAMRS had the highest correlation with clinical disease activity scores (r = 0.476, p < 0.001) and serological parameters (r = 0.562, p < 0.001). RAMRIS system had the lowest correlation (r = 0.369, p < 0.001 for clinical disease activity; r = 0.436, p < 0.001 for serological parameters). RAMRIS synovitis subscore had a lower correlation than ERAMRS for clinical disease activity (r = 0.410, p < 0.001) and for serological parameters (r = 0.456, p < 0.001). CONCLUSION The ERAMRS system, designed to grade inflammation on wrist MRI in ERA, provided the best correlation with all clinical scoring systems and serological parameters, indicating its improved clinical relevance over other MR scoring systems. KEY POINTS • We devised a clinically relevant, easy-to-use semi-quantitative scoring system for scoring inflammation on MRI of the wrist in patients with early rheumatoid arthritis. • ERAMRS system showed better correlation with all clinical and serological assessment of inflammation in patients with early rheumatoid arthritis indicating its improved clinical relevance over other MR scoring systems.
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Affiliation(s)
- Fan Xiao
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
| | - James F Griffith
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong.
| | - Andrea L Hilkens
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
| | - Jason C S Leung
- Department of Jockey Club Centre for Osteoporosis Care and Control, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
| | - Jiang Yue
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
| | - Ryan K L Lee
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
| | - David K W Yeung
- Department of Imaging & Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Shatin, N.T., Hong Kong
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15
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Burke CJ, Alizai H, Beltran LS, Regatte RR. MRI of synovitis and joint fluid. J Magn Reson Imaging 2019; 49:1512-1527. [PMID: 30618151 DOI: 10.1002/jmri.26618] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/03/2018] [Accepted: 12/03/2018] [Indexed: 12/20/2022] Open
Abstract
Synovitis and joint effusion are common manifestations of rheumatic disease and play an important role in the disease pathophysiology. Earlier detection and accurate assessment of synovial pathology, therefore, can facilitate appropriate clinical management and hence improve prognosis. Magnetic resonance imaging (MRI) allows unparalleled assessment of all joint structures and associated pathology. It has emerged as a powerful tool, which enables not only detection of synovitis and effusion, but also allows quantification, detailed characterization, and noninvasive monitoring of synovial processes. The purpose of this article is to summarize the pathophysiology of synovitis and to review the role of qualitative, semiquantitative, and quantitative MRI in the assessment of synovitis and joint fluid. We also discuss the utility of MRI as an outcome measure to assess treatment response, particularly with respect to osteoarthritis and rheumatoid arthritis. Emerging applications such as hybrid positron emission tomography / MRI and molecular imaging are also briefly discussed. Level of Evidence: 5 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019.
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Affiliation(s)
| | - Hamza Alizai
- Department of Radiology, NYU Langone Health, New York, New York, USA
| | - Luis S Beltran
- Department of Radiology, NYU Langone Health, New York, New York, USA
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16
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Ten Brinck RM, van Steenbergen HW, van der Helm-van Mil AHM. Sequence of joint tissue inflammation during rheumatoid arthritis development. Arthritis Res Ther 2018; 20:260. [PMID: 30463603 PMCID: PMC6249752 DOI: 10.1186/s13075-018-1756-z] [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: 09/12/2018] [Accepted: 10/31/2018] [Indexed: 05/30/2023] Open
Abstract
Objective Subclinical joint inflammation in patients with arthralgia is predictive for progression to rheumatoid arthritis (RA). However, the time course of progression for bone marrow edema (osteitis), synovitis, and/or tenosynovitis is unsettled. This longitudinal study assessed the course of magnetic resonance imaging (MRI)-detected subclinical joint inflammation during progression to RA. Methods Patients that progressed from clinically suspect arthralgia (CSA) to RA underwent 1.5-T MRI of the metacarpophalangeal (MCP), wrist, and metatarsophalangeal (MTP) joints at presentation with arthralgia and at first identification of synovitis assessed through physical examination (n = 31). MRIs were evaluated for osteitis, synovitis, tenosynovitis, and erosions by two readers, blinded for clinical data and order in time. To estimate changes in MRI scores between the asymptomatic state and CSA onset, scores of MRI features at CSA baseline were compared with scores from age-matched symptom-free persons. Results At presentation with CSA, synovitis and tenosynovitis scores were higher than scores from age-matched symptom-free persons (p = 0.004 and p = 0.001, respectively). Anti-citrullinated protein antibody (ACPA)-positive arthralgia patients also had increased osteitis scores (p = 0.04). Median duration between presentation with arthralgia and RA development was 17 weeks. During progression to RA, synovitis and osteitis increased significantly (p = 0.001 and p = 0.036, respectively) in contrast to tenosynovitis and erosion scores. This pattern was similar in both ACPA subsets, although statistical significance was reached for synovitis and osteitis in ACPA-negative but not ACPA-positive RA. Conclusion Increased tenosynovitis and synovitis scores at CSA onset and the increase in synovitis and osteitis during progression to RA suggest an ‘outside-in’ temporal relationship of arthritis development, in particular for ACPA-negative RA. For ACPA-positive RA, further studies are needed. Electronic supplementary material The online version of this article (10.1186/s13075-018-1756-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- R M Ten Brinck
- Department of Rheumatology C1-R, Leiden University Medical Centre, PO Box 9600, Leiden, 2300RC, the Netherlands.
| | - H W van Steenbergen
- Department of Rheumatology C1-R, Leiden University Medical Centre, PO Box 9600, Leiden, 2300RC, the Netherlands
| | - A H M van der Helm-van Mil
- Department of Rheumatology C1-R, Leiden University Medical Centre, PO Box 9600, Leiden, 2300RC, the Netherlands.,Department of Rheumatology, Erasmus Medical Centre, Rotterdam, The Netherlands
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17
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Kgoebane K, Ally MMTM, Duim-Beytell MC, Suleman FE. The role of imaging in rheumatoid arthritis. SA J Radiol 2018; 22:1316. [PMID: 31754498 PMCID: PMC6837821 DOI: 10.4102/sajr.v22i1.1316] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 04/29/2018] [Indexed: 12/02/2022] Open
Abstract
Conventional radiographs of the hands and feet have traditionally been used in the diagnosis, management and monitoring of patients with rheumatoid arthritis (RA). However, they are not sensitive enough to detect changes early in the disease process. Erosions may only be visible up to two years after the onset of disease, and soft tissue involvement may not be detected at all. Early diagnosis can also be made challenging as markers such as erythrocyte sedimentation rate and C-reactive protein may be normal in up to 20% - 25% of cases. The latest classification criteria (American College of Rheumatology/European League Against Rheumatism [ACR/EULAR] Rheumatoid Arthritis Classification criteria 2010), often used to diagnose RA, incorporate the role of ultrasound and magnetic resonance imaging detection of synovitis, enabling earlier diagnosis and correct classification of patients. This article looks at the role of the various imaging modalities used in the diagnosis and management of RA.
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18
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Zhang H, Xu H, Chen S, Mao X. The application value of MRI in the diagnosis of subclinical inflammation in patients with rheumatoid arthritis in remission. J Orthop Surg Res 2018; 13:164. [PMID: 29970124 PMCID: PMC6029344 DOI: 10.1186/s13018-018-0866-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/14/2018] [Indexed: 02/07/2023] Open
Abstract
Background To explore the value of MRI in the diagnosis of subclinical inflammation in patients with early rheumatoid arthritis (RA) in remission and to predict the radiographic progression. Methods A total of 76 of 156 patients with early RA in remission at 1 year and with available magnetic resonance imaging (MRI) data at baseline and at 12 months were included. Complete clinical and laboratory evaluations were conducted for the patients. MRI images were assessed according to the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring (RAMRIS) system. Progression of bone erosions was defined as an increase of 1 or more units in annual RAMRIS score for erosions compared to baseline. Results At 1 year, the majority of patients with RA in sustained remission showed some inflammatory activity on MRI (43.4% synovitis, 39.5% bone marrow edema (BME), and 9.2% tenosynovitis), and 25 of the 76 patients (32.9%) showed MRI progression of bone erosions. A significant difference was observed in MRI BME and bone erosion at 1 year, with higher mean score in patients with progression compared to non-progression of erosions (BME, 4.8 ± 3.6 vs 3.1 ± 2.1, P = 0.01; bone erosion, 13.5 ± 9.6 vs 4.4 ± 3.6, P < 0.001). Conclusion Persistent subclinical inflammations were shown in patients with sustained remission; BME in MRI may be a strong predictor of future radiographic progression of bone erosions in patients with persistent clinical remission.
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Affiliation(s)
- Huimei Zhang
- Department of Radiology, Huzhou Central Hospital, Huzhou, 313000, Zhejiang, People's Republic of China
| | - Huajun Xu
- Department of Ultrasound, Huzhou Central Hospital, No. 198 Hongqi Road of Wuxing District, Huzhou, 313000, Zhejiang, People's Republic of China.
| | - Shifang Chen
- Department of Rheumatology and Immunology, Huzhou Central Hospital, Huzhou, 313000, Zhejiang, People's Republic of China
| | - Xinfeng Mao
- Department of Radiology, Huzhou Central Hospital, Huzhou, 313000, Zhejiang, People's Republic of China
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19
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Burgers LE, Boeters DM, Reijnierse M, van der Helm-van Mil AHM. Does the presence of magnetic resonance imaging-detected osteitis at diagnosis with rheumatoid arthritis lower the risk for achieving disease-modifying antirheumatic drug-free sustained remission: results of a longitudinal study. Arthritis Res Ther 2018; 20:68. [PMID: 29636084 PMCID: PMC5894211 DOI: 10.1186/s13075-018-1553-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/25/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although infrequent, some rheumatoid arthritis (RA) patients achieve disease-modifying antirheumatic drug (DMARD)-free sustained remission. The absence of RA-specific autoantibodies, such as anticitrullinated protein antibodies (ACPA), is known to be associated with this outcome but further mechanisms underlying the chronic nature of RA are largely unknown. Magnetic resonance imaging (MRI)-detected bone marrow edema (BME), or osteitis, strongly predicts erosive progression and is associated with ACPA positivity. Therefore, we hypothesized that the presence of MRI-detected osteitis is also predictive of not achieving DMARD-free sustained remission and that the presence of osteitis mediates the association between ACPA and DMARD-free sustained remission. METHODS A 1.5 T unilateral hand and foot MRI was performed at disease presentation in 238 RA patients, evaluating BME, synovitis, and tenosynovitis (summed as MRI inflammation score). DMARD-free sustained remission, defined as the absence of clinical synovitis after DMARD cessation that persisted during the total follow-up, was assessed (median follow-up 3.8 years). Associations between the different MRI-detected inflammatory features and this outcome were studied. A mediation analysis was performed to study whether the presence of BME mediated the association between ACPA and DMARD-free sustained remission. Finally, patterns of MRI-detected inflammation with regard to DMARD-free sustained remission were studied using partial least squares (PLS) regression. RESULTS Forty-six (19.3%) patients achieved DMARD-free sustained remission. ACPA positivity associated independently with remission (hazard ratio (HR) 0.16, 95% confidence interval (CI) 0.06-0.39). In contrast, no associations were observed between MRI-detected BME (HR 0.99, 95% CI 0.94-1.03), or other MRI inflammatory features, and achieving DMARD-free sustained remission. Thus, the presence of BME did not mediate the association between ACPA and DMARD-free sustained remission. Furthermore, a PLS analysis revealed that patients who did or did not achieve remission could not be distinguished by patterns of MRI-detected inflammation. CONCLUSIONS At disease presentation, osteitis, as well as other MRI-detected inflammatory features, was not associated with achieving DMARD-free sustained remission over time. Thus, imaging predictors for joint damage and disease persistence differ. The processes mediating RA chronicity remain largely unsolved.
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Affiliation(s)
- L E Burgers
- Department of Rheumatology, Leiden University Medical Center, C-01-046, PO Box 9600, 2300 RC, Leiden, The Netherlands.
| | - D M Boeters
- Department of Rheumatology, Leiden University Medical Center, C-01-046, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - M Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - A H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, C-01-046, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Department of Rheumatology, Erasmus Medical Center, Rotterdam, the Netherlands
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20
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Aizenberg E, Roex EAH, Nieuwenhuis WP, Mangnus L, van der Helm-van Mil AHM, Reijnierse M, Bloem JL, Lelieveldt BPF, Stoel BC. Automatic quantification of bone marrow edema on MRI of the wrist in patients with early arthritis: A feasibility study. Magn Reson Med 2017; 79:1127-1134. [PMID: 28480581 PMCID: PMC5811824 DOI: 10.1002/mrm.26712] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 02/03/2023]
Abstract
Purpose To investigate the feasibility of automatic quantification of bone marrow edema (BME) on MRI of the wrist in patients with early arthritis. Methods For 485 early arthritis patients (clinically confirmed arthritis of one or more joints, symptoms for less than 2 years), MR scans of the wrist were processed in three automatic stages. First, super‐resolution reconstruction was applied to fuse coronal and axial scans into a single high‐resolution 3D image. Next, the carpal bones were located and delineated using atlas‐based segmentation. Finally, the extent of BME within each bone was quantified by identifying image intensity values characteristic of BME by fuzzy clustering and measuring the fraction of voxels with these characteristic intensities within each bone. Correlation with visual BME scores was assessed through Pearson correlation coefficient. Results Pearson correlation between quantitative and visual BME scores across 485 patients was r=0.83, P<0.001. Conclusions Quantitative measurement of BME on MRI of the wrist has the potential to provide a feasible alternative to visual scoring. Complete automation requires automatic detection and compensation of acquisition artifacts. Magn Reson Med 79:1127–1134, 2018. © 2017 The Authors Magnetic Resonance in Medicine published by Wiley Periodicals, Inc. on behalf of International Society for Magnetic Resonance in Medicine. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
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Affiliation(s)
- Evgeni Aizenberg
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Edgar A H Roex
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - Wouter P Nieuwenhuis
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lukas Mangnus
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johan L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Boudewijn P F Lelieveldt
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.,Intelligent Systems Department, Delft University of Technology, Delft, The Netherlands
| | - Berend C Stoel
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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21
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Issa SF, Duer A, Østergaard M, Hørslev-Petersen K, Hetland ML, Hansen MS, Junker K, Lindegaard HM, Møller JM, Junker P. Increased galectin-3 may serve as a serologic signature of pre-rheumatoid arthritis while markers of synovitis and cartilage do not differ between early undifferentiated arthritis subsets. Arthritis Res Ther 2017; 19:80. [PMID: 28446218 PMCID: PMC5407000 DOI: 10.1186/s13075-017-1282-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Accepted: 03/24/2017] [Indexed: 01/01/2023] Open
Abstract
Background Undifferentiated arthritis (UA) is a label applied to patients with joint complaints which cannot be classified according to current criteria, which implies a need for precision diagnostic technologies. We studied serum galectin-3, a proinflammatory mediator, and seromarkers of structural joint elements in patients with early, UA and their associations with disease profile and biochemical and imaging findings. Methods One hundred and eleven UA patients were followed-up for at least 12 months and reclassified according to appropriate criteria (TUDAR). At baseline, demographics and laboratory and clinical disease measures, as well as wrist magnetic resonance imaging (MRI) synovitis, erosion, and bone marrow edema scorings, were recorded. Galectin-3, the type IIA collagen N-terminal propeptide (PIIANP), which is a marker of regenerative cartilage formation, and hyaluronan (HYA), which is prevalent in synovial tissue swellings, were measured by enzyme-linked immunosorbent assay (ELISA). Receiver operating characteristic (ROC) curve analysis was carried out to assess the discriminant capacity of galectin-3 against arthritis subsets. Results Galectin-3 was increased in pre-rheumatoid arthritis (RA) (4.6 μg/l, interquartile range (IQR) 3.8–5.5) versus non-RA (4.0 μg/l, IQR 3.1–4.9; p = 0.03) and controls (3.8 μg/l, IQR 3.0–4.8; p = 0.009). PIIANP was equally depressed in either subset (p < 0.01). Galectin-3 in non-RA and HYA in UA did not differ from healthy controls. In the entire UA cohort, galectin-3 correlated with the MRI bone marrow edema score, while PIIANP correlated with the MRI erosion score, and HYA with the synovitis and erosion scores. ROC curve analysis showed that baseline galectin-3 discriminated well between pre-RA and non-RA with univariate area under the curve (AUC) of 0.64 (95% confidence interval (CI) 0.53–0.76) while AUC for galectin-3 + anti-CCP increased to 0.71 (95% CI 0.59–0.83). Conclusions Galectin-3 in serum was increased in patients with early UA of pre-RA origin. Cartilage remodeling assessed by PIIANP was diminished in UA irrespective of subsequent clinical differentiation, while HYA did not differ from controls. ROC analysis showed a potential for galectin-3 to discriminate between pre-RA and non-RA. Trial registration KF 11 315829. Registered 25 July 2006.
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Affiliation(s)
- Saida Farah Issa
- Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - Anne Duer
- Department of Radiology, Copenhagen University Hospital at Herlev, Herlev, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kim Hørslev-Petersen
- Research Unit at King Christian X Hospital for Rheumatic Diseases, Graasten, Denmark
| | - Merete L Hetland
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Kirsten Junker
- The Institute of Molecular Medicine, Cancer and Inflammation, University of Southern Denmark, Odense, Denmark
| | - Hanne M Lindegaard
- Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Jakob M Møller
- Department of Radiology, Copenhagen University Hospital at Herlev, Herlev, Denmark
| | - Peter Junker
- Department of Rheumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark, Odense, Denmark
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22
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Mangnus L, Nieuwenhuis WP, van Steenbergen HW, Huizinga TWJ, Reijnierse M, van der Helm-van Mil AHM. Body mass index and extent of MRI-detected inflammation: opposite effects in rheumatoid arthritis versus other arthritides and asymptomatic persons. Arthritis Res Ther 2016; 18:245. [PMID: 27770823 PMCID: PMC5075146 DOI: 10.1186/s13075-016-1146-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 10/04/2016] [Indexed: 11/19/2022] Open
Abstract
Background In the population a high body mass index (BMI) has been associated with slightly increased inflammatory markers. Within rheumatoid arthritis (RA), however, a high BMI has been associated with less radiographic progression; this phenomenon is unexplained. We hypothesized that the phenomenon is caused by an inverse relationship between BMI and inflammation in hand and foot joints with RA. To explore this hypothesis, local inflammation was measured using magnetic resonance imaging (MRI) in early arthritis patients presenting with RA or other arthritides and in asymptomatic volunteers. Methods A total of 195 RA patients, 159 patients with other inflammatory arthritides included in the Leiden Early Arthritis Clinic, and 193 asymptomatic volunteers underwent a unilateral contrast-enhanced 1.5 T MRI scan of metacarpophalangeal, wrist, and metatarsophalangeal joints. Each MRI scan was scored by two readers on synovitis, bone marrow edema (BME), and tenosynovitis; the sum yielded the total MRI inflammation score. Linear regression on log-transformed MRI data was used. Results A higher BMI was associated with higher MRI inflammation scores in arthritides other than RA (β = 1.082, p < 0.001) and in asymptomatic volunteers (β = 1.029, p = 0.040), whereas it was associated with lower MRI inflammation scores in RA (β = 0.97, p = 0.005). Evaluating the different types of inflammation, a higher BMI was associated with higher synovitis, BME, and tenosynovitis scores in arthritides other than RA (respectively β = 1.084, p < 0.001, β = 1.021, p = 0.24, and β = 1.054, p = 0.003), but with lower synovitis and BME scores in RA (respectively β = 0.98, p = 0.047 and β = 0.95, p = 0.002). Conclusions Increased BMI is correlated with less severe MRI-detected synovitis and BME in RA. This might explain the paradox in RA where obesity correlates with less severe radiographic progression. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1146-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lukas Mangnus
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300 RC, The Netherlands.
| | - Wouter P Nieuwenhuis
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300 RC, The Netherlands
| | - Hanna W van Steenbergen
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300 RC, The Netherlands
| | - Tom W J Huizinga
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, Leiden, 2300 RC, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
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Boeters DM, Nieuwenhuis WP, Verheul MK, Newsum EC, Reijnierse M, Toes REM, Trouw LA, van der Helm-van Mil AHM. MRI-detected osteitis is not associated with the presence or level of ACPA alone, but with the combined presence of ACPA and RF. Arthritis Res Ther 2016; 18:179. [PMID: 27485323 PMCID: PMC4971651 DOI: 10.1186/s13075-016-1076-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 07/14/2016] [Indexed: 11/12/2022] Open
Abstract
Background In rheumatoid arthritis (RA) bone marrow edema (BME, osteitis) and anti-citrullinated protein antibodies (ACPA) are associated with radiographic progression. ACPA have been associated with BME, but it is unknown if this association is confined to ACPA and BME. We performed cross-sectional analysis of the association of ACPA, rheumatoid factor (RF) and anti-carbamylated protein (anti-CarP) antibodies with BME and other types of inflammation (synovitis, tenosynovitis) detected by magnetic resonance imaging (MRI). Methods Disease-modifying antirheumatic drug (DMARD)-naïve patients with early arthritis (n = 589), included in the Leiden Early Arthritis Clinic cohort, underwent contrast-enhanced 1.5 T MRI of unilateral wrist, metacarpophalangeal and metatarsophalangeal-joints at baseline. BME, synovitis and tenosynovitis were scored by two readers. ACPA, rheumatoid factor (RF) and anti-CarP were determined at baseline. Results In univariable analyses ACPA-positive patients had higher BME scores than ACPA-negative patients (median 4.5 vs. 2.0, p < 0.001), but not more synovitis and tenosynovitis. Also RF (median 3.75 vs. 2.0, p < 0.001) and anti-CarP antibodies (median 3.5 vs. 2.5, p = 0.012) were associated with higher BME scores. Because the autoantibodies were concomitantly present, analyses were stratified for the presence of different autoantibody combinations. ACPA-positive (ACPA+), RF-negative (RF-), anti-CarP-negative (anti-CarP-) patients did not have higher BME-scores than ACPA-negative (ACPA-), RF-, anti-CarP- patients. However ACPA+, RF-positive (RF+), anti-CarP- patients and ACPA+, RF+, anti-CarP-positive (anti-CarP+) patients had higher BME scores than ACPA-, RF-, anti-CarP- patients (median 5.0 and 4.5 vs. 2.0, p < 0.001 and p < 0.001). ACPA levels were not associated with BME scores. Analyses within RA- and UA-patients revealed similar results. Conclusions The presence of ACPA alone or ACPA level was not statistically significantly associated with BME scores, but the combined presence of ACPA and RF was associated with more BME. This suggests an additive role of RF to ACPA in mediating osteitis. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1076-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Debbie M Boeters
- Department of Rheumatology C1-R, Leiden University Medical Center, PO Box 9600, Leiden, 2300, RC, The Netherlands.
| | - Wouter P Nieuwenhuis
- Department of Rheumatology C1-R, Leiden University Medical Center, PO Box 9600, Leiden, 2300, RC, The Netherlands
| | - Marije K Verheul
- Department of Rheumatology C1-R, Leiden University Medical Center, PO Box 9600, Leiden, 2300, RC, The Netherlands
| | - Elize C Newsum
- Department of Rheumatology C1-R, Leiden University Medical Center, PO Box 9600, Leiden, 2300, RC, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - René E M Toes
- Department of Rheumatology C1-R, Leiden University Medical Center, PO Box 9600, Leiden, 2300, RC, The Netherlands
| | - Leendert A Trouw
- Department of Rheumatology C1-R, Leiden University Medical Center, PO Box 9600, Leiden, 2300, RC, The Netherlands
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24
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Mavrogeni SI, Poulos G, Sfikakis PP, Kitas GD, Kolovou G, Theodorakis G. Is there a place for cardiovascular magnetic resonance conditional devices in systemic inflammatory diseases? Expert Rev Cardiovasc Ther 2016; 14:677-82. [DOI: 10.1586/14779072.2016.1154458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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