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Palterer B, Vitiello G, Del Carria M, D'Onofrio B, Martinez-Prat L, Mahler M, Cammelli D, Parronchi P. Anti-protein arginine deiminase antibodies are distinctly associated with joint and lung involvement in rheumatoid arthritis. Rheumatology (Oxford) 2023; 62:2410-2417. [PMID: 36440916 DOI: 10.1093/rheumatology/keac667] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/04/2022] [Indexed: 07/20/2023] Open
Abstract
OBJECTIVES RA is a chronic inflammatory disease in which possible interstitial lung disease (ILD) is an extra-articular manifestation that carries significant morbidity and mortality. RF and ACPA are included in the RA classification criteria but prognostic and diagnostic biomarkers for disease endotyping and RA-ILD are lacking. Anti-protein arginine deiminase antibodies (anti-PAD) are a novel class of autoantibodies identified in RA. This study aimed to assess clinical features, ACPA and anti-PAD antibodies in RA patients with articular involvement and ILD. METHODS We retrospectively collected joint erosions, space narrowing, clinical features and lung involvement of a cohort of 71 patients fulfilling the 2010 ACR/EULAR RA classification criteria. Serum samples from these patients were tested for ACPA IgG (QUANTA Flash CCP3), and anti-PAD3 and anti-PAD4 IgG, measured with novel assays based on a particle-based multi-analyte technology (PMAT). RESULTS Anti-PAD4 antibodies were significantly associated with radiographic injury (P = 0.027) and erosions (P = 0.02). Similarly, ACPA levels were associated with erosive disease (P = 0.014). Anti-PAD3/4 double-positive patients displayed more joint erosions than patients with anti-PAD4 antibodies only or negative for both (P = 0.014 and P = 0.037, respectively). RA-ILD (15.5%, 11/71 patients) was associated with older age (P < 0.001), shorter disease duration (P = 0.045) and less erosive disease (P = 0.0063). ACPA were elevated in RA-ILD, while anti-PAD4 were negatively associated (P = 0.043). CONCLUSION Anti-PAD4 and anti-PAD3 antibodies identify RA patients with higher radiographic injury and bone erosions. In our cohort, ILD is associated with lower radiographic and erosive damage, as well as low levels of anti-PAD4 antibodies.
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Affiliation(s)
- Boaz Palterer
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Gianfranco Vitiello
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Marco Del Carria
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Bernardo D'Onofrio
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
| | | | | | - Daniele Cammelli
- Dipartimento Medico-Geriatrico, SOD Immunoallergologia, AOU Careggi, Florence, Italy
| | - Paola Parronchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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MRI of Hands with Early Rheumatoid Arthritis: Usefulness of Three-Point Dixon Sequences to Quantitatively Assess Disease Activity. J Belg Soc Radiol 2022; 106:1. [PMID: 35088027 PMCID: PMC8757386 DOI: 10.5334/jbsr.2692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/14/2021] [Indexed: 11/23/2022] Open
Abstract
The use of efficient treatment with a treat-to-target strategy combined with early detection of the disease completely changed the imaging presentation and outcome of newly diagnosed rheumatoid arthritis (RA) patients. Magnetic Resonance Imaging (MRI) has become the reference technique in clinical research to detect and quantify inflammatory involvement of the soft tissues (synovitis and tenosynovitis) and bone marrow (osteitis) along with structural damages of the bone (erosions) in hands of patients with RA. Three-point Dixon MRI may be a valuable alternative to the currently recommended sequences as it yields effective fat signal suppression, high imaging quality and reproducible assessment of disease activity.
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Bird A, Oakden-Rayner L, McMaster C, Smith LA, Zeng M, Wechalekar MD, Ray S, Proudman S, Palmer LJ. Artificial intelligence and the future of radiographic scoring in rheumatoid arthritis: a viewpoint. Arthritis Res Ther 2022; 24:268. [PMID: 36510330 PMCID: PMC9743640 DOI: 10.1186/s13075-022-02972-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 12/03/2022] [Indexed: 12/14/2022] Open
Abstract
Rheumatoid arthritis is an autoimmune condition that predominantly affects the synovial joints, causing joint destruction, pain, and disability. Historically, the standard for measuring the long-term efficacy of disease-modifying antirheumatic drugs has been the assessment of plain radiographs with scoring techniques that quantify joint damage. However, with significant improvements in therapy, current radiographic scoring systems may no longer be fit for purpose for the milder spectrum of disease seen today. We argue that artificial intelligence is an apt solution to further improve upon radiographic scoring, as it can readily learn to recognize subtle patterns in imaging data to not only improve efficiency, but can also increase the sensitivity to variation in mild disease. Current work in the area demonstrates the feasibility of automating scoring but is yet to take full advantage of the strengths of artificial intelligence. By fully leveraging the power of artificial intelligence, faster and more sensitive scoring could enable the ongoing development of effective treatments for patients with rheumatoid arthritis.
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Affiliation(s)
- Alix Bird
- grid.1010.00000 0004 1936 7304Australian Institute of Machine Learning, University of Adelaide, Corner Frome Road and North Terrace, Adelaide, SA 5000 Australia ,grid.1010.00000 0004 1936 7304School of Public Health, The University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Lauren Oakden-Rayner
- grid.1010.00000 0004 1936 7304Australian Institute of Machine Learning, University of Adelaide, Corner Frome Road and North Terrace, Adelaide, SA 5000 Australia ,grid.1010.00000 0004 1936 7304School of Public Health, The University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Christopher McMaster
- grid.410678.c0000 0000 9374 3516Department of Rheumatology, Austin Health, Heidelberg, VIC 3084 Australia
| | - Luke A. Smith
- grid.1010.00000 0004 1936 7304Australian Institute of Machine Learning, University of Adelaide, Corner Frome Road and North Terrace, Adelaide, SA 5000 Australia ,grid.1010.00000 0004 1936 7304School of Public Health, The University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Minyan Zeng
- grid.1010.00000 0004 1936 7304Australian Institute of Machine Learning, University of Adelaide, Corner Frome Road and North Terrace, Adelaide, SA 5000 Australia ,grid.1010.00000 0004 1936 7304School of Public Health, The University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
| | - Mihir D. Wechalekar
- grid.1014.40000 0004 0367 2697Department of Rheumatology, Flinders Medical Centre, and College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042 Australia
| | - Shonket Ray
- grid.418019.50000 0004 0393 4335Artificial Intelligence and Machine Learning, GlaxoSmithKline, South San Francisco, CA USA
| | - Susanna Proudman
- grid.416075.10000 0004 0367 1221Department of Rheumatology, Royal Adelaide Hospital, Adelaide, SA 5000 Australia
| | - Lyle J. Palmer
- grid.1010.00000 0004 1936 7304Australian Institute of Machine Learning, University of Adelaide, Corner Frome Road and North Terrace, Adelaide, SA 5000 Australia ,grid.1010.00000 0004 1936 7304School of Public Health, The University of Adelaide, North Terrace, Adelaide, SA 5000 Australia
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Finzel S, Aegerter P, Schett G, D'Agostino MA. Identification, localization and differentiation of erosions and physiological bone channels by ultrasound in rheumatoid arthritis patients. Rheumatology (Oxford) 2021; 59:3784-3792. [PMID: 32417898 DOI: 10.1093/rheumatology/keaa183] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/17/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Ultrasound (US) can detect cortical bone lesions in RA. However, not all cortical bone lesions are erosions. Herein, we aimed to define whether US can differentiate between physiological bone channels and pathological erosions in RA and to provide topographic description of their differential localization. METHODS RA patients and healthy controls (HC) received US examination of the metacarpophalangeal (MCPJ) and proximal inter-phalangeal (PIPJ) joints adjudicating cortical bone lesions as physiological bone channels or pathological erosions. In a subset of RA patients and HC, high-resolution peripheral quantitative computed tomography (HR-pQCT) of the hand was performed to validate the classification of lesions. RESULTS A total of 40 RA patients and 43 HC were enrolled and totally 771 MCPJ and 638 PIPJ were examined by US, and 94 and 51, respectively, by HR-pQCT. US-defined cortical bone lesions clustered in the lateral part of the MCP (50%) and the dorsal part of the PIPJ (66.7%) in RA. US-defined physiological bone channels clustered in the palmar parts of the MCPJ and PIPJ in both RA (78.8% and 100%, respectively) and HC (51.8% and 80%, respectively). HR-pQCT data confirmed US data with respect to adjudication of physiological bone channels and pathological erosions. Erosions were significantly (all P <0.000001) larger than physiological channels and preferentially localized at radial and ulnar sites, while physiological channels were clustered at palmar sites. Specificity of US was excellent for erosions in RA and for physiological bone channels in HC and RA. CONCLUSION US allows differentiation between physiological channels and bone erosions in RA.
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Affiliation(s)
- Stephanie Finzel
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich Alexander University of Erlangen-Nurnberg and Universitaetsklinikum Erlangen, Erlangen.,Department of Rheumatology and Clinical Immunology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Philippe Aegerter
- Laboratoire Vieillissement et Maladies Chroniques, Approches Epidémiologique et de Santé Publiques, Université Paris-Saclay, UVSQ, Inserm U1168, Montigny-Le-Bretonneux
| | - Georg Schett
- Department of Internal Medicine 3, Rheumatology and Immunology, Friedrich Alexander University of Erlangen-Nurnberg and Universitaetsklinikum Erlangen, Erlangen
| | - Maria-Antonietta D'Agostino
- Department of Rheumatology, Université de Versailles St-Quentin-en Yvelines-Paris Saclay, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
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Carvajal Alegria G, Milin M, Gandjbakhch F, Saraux A, Bailly F, Jousse-Joulin S, Schaeverbeke T, Lukas C, Foltz V, Fautrel B, Devauchelle-Pensec V. A simplified radiographic score effectively predicts radiographic progression of early arthritis in a large nationwide French cohort. Rheumatology (Oxford) 2020; 59:1566-1573. [PMID: 31628807 DOI: 10.1093/rheumatology/kez450] [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: 03/27/2019] [Revised: 09/01/2019] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Evaluating radiographic progression is a key component of the follow-up of patients with RA. Existing scores are ill-suited to everyday clinical practice. The objective here was to validate a new simplified radiographic score (SRS) for evaluating radiographic progression in patients with early arthritis. METHODS Patients with arthritis of <6 months' duration were included in the large, prospective, nationwide, French ESPOIR cohort. Radiographs of the hands and feet were obtained at inclusion then 1 and 5 years later. The modified Sharp scores and SRS were determined by blinded readers. Interobserver reliability and intraobserver repeatability of each score, as well as agreement between the two scores, were assessed by computing the intraclass correlation coefficients. The rates of progression over the first year and the next 4 years were determined. RESULTS The 506 patients with complete data for the first 5 years were included. At inclusion, the intraclass correlation coefficient between the two scores was good for erosions (0.715, P < 0.001), joint space narrowing (0.892, P < 0.001) and the total score (0.896, P < 0.001). Agreement between the two scores was also good for radiographic progression after 1 year (0.781, P < 0.001). The SRS had good positive and negative predictive values for slow and for rapid progression. SRS determination was less time consuming. CONCLUSION The SRS is effective for monitoring radiographic progression in early arthritis and is easier to use and less time-consuming than the Sharp score. The usefulness of the SRS in clinical practice deserves further evaluation.
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Affiliation(s)
- Guillermo Carvajal Alegria
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
| | - Morgane Milin
- Rheumatology Department, Hôpital Yves Le Foll, Saint-Brieuc
| | - Frédérique Gandjbakhch
- Sorbonne Université, UMR S 1136, Institut Pierre Louis d'Epidémiologie et Santé publique, Paris.,APHP, Pitié Salpêtrière Hospital, Rheumatology Department Unit, Paris
| | - Alain Saraux
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
| | - Florian Bailly
- Sorbonne University, Paris.,Pitié Salpêtrière Hospital, APHP, Pain Unit, Paris
| | - Sandrine Jousse-Joulin
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
| | | | - Cédric Lukas
- Rheumatology Department, Montpellier University, Montpellier Hospital and EA2415, Montpellier, France
| | - Violaine Foltz
- Sorbonne Université, UMR S 1136, Institut Pierre Louis d'Epidémiologie et Santé publique, Paris.,APHP, Pitié Salpêtrière Hospital, Rheumatology Department Unit, Paris
| | - Bruno Fautrel
- Sorbonne Université, UMR S 1136, Institut Pierre Louis d'Epidémiologie et Santé publique, Paris.,APHP, Pitié Salpêtrière Hospital, Rheumatology Department Unit, Paris
| | - Valérie Devauchelle-Pensec
- UMR1227, Lymphocytes B et Autoimmunité, Université de Brest, Inserm, LabEx IGO, Brest.,Rheumatology Department, Cavale Blanche Hospital, Brest
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Barnabe C, Hazlewood G, Barr S, Martin L. Comparison of radiographic scoring methods in a cohort of RA patients treated with anti-TNF therapy. Rheumatology (Oxford) 2012; 51:878-81. [PMID: 22223704 DOI: 10.1093/rheumatology/ker418] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To compare the ability of the simple erosion narrowing score (SENS) to classify radiographic progression relative to the Sharp/van der Heijde score (SHS) in a prospective cohort of anti-TNF-treated RA patients. METHODS Radiographs of the hands, wrists and feet of patients enrolled in a pharmacovigilance programme are performed every 2 years. These radiographs were read in chronological order by three rheumatologists and scored using the SHS. SENS scores were derived from the SHS. Additionally, one rheumatologist scored the radiographs using the SENS method only. Patients with radiographic progression in excess of the smallest detectable change were classified as progressors. The probability of agreement and κ-value between the SHS and SENS methods for determining progression was calculated. RESULTS A sample of 25 patients was selected from the database. The annualized mean (s.d.) change in SHS score was 6.61 U (7.48 U) and in SENS score was 2.27 U (2.17 U). Five patients were classified as progressors using SHS and seven using SENS, with a probability of agreement of 84% (κ = 0.565). CONCLUSION The SENS method captures radiographic progression reliably compared with the more detailed SHS method. SENS is suitable for application in clinical practice or in observational cohorts.
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Affiliation(s)
- Cheryl Barnabe
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
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Forslind K. The usefulness of the Simplified Erosion Narrowing Score (SENS) in clinical practice for estimating joint damage in early rheumatoid arthritis. Scand J Rheumatol 2011; 40:497-8. [DOI: 10.3109/03009742.2011.617313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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