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Ranganath VK, Ben-Artzi A, Brook J, Suliman Y, Floegel-Shetty A, Woodworth T, Taylor M, Ramrattan LA, Elashoff D, Kaeley GS. Optimizing Reliability of Real-Time Sonographic Examination and Scoring of Joint Synovitis in Rheumatoid Arthritis. Cureus 2022; 14:e31030. [DOI: 10.7759/cureus.31030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 11/01/2022] [Indexed: 11/06/2022] Open
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An update on novel therapeutic intervention in Rheumatoid arthritis. Int Immunopharmacol 2022; 109:108794. [DOI: 10.1016/j.intimp.2022.108794] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/11/2022] [Accepted: 04/19/2022] [Indexed: 12/15/2022]
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Coras R, Sturchio GA, Bru MB, Fernandez AS, Farietta S, Badia SC, Diez BR, de Agustín de Oro JJ. Analysis of the correlation between disease activity score 28 and its ultrasonographic equivalent in rheumatoid arthritis patients. Eur J Rheumatol 2020; 7:118-123. [PMID: 32716834 PMCID: PMC7431356 DOI: 10.5152/eurjrheum.2020.20038] [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: 03/06/2020] [Accepted: 03/24/2020] [Indexed: 10/11/2023] Open
Abstract
OBJECTIVE To study the differences between disease activity score 28 (DAS28) index and an ultrasound (US) approach using index echographic disease activity score (ECODAS). METHODS This was a cross-sectional study in patients diagnosed with rheumatoid arthritis (RA). Demographic, clinical, and laboratory data were collected. We created a US index (ECODAS) evaluating the joints with synovitis using gray scale US (GSUS) and power Doppler US (PDUS) and calculated the formula of DAS28 index with both variables substituting tender joint for GSUS and swollen joint for PDUS (ECODAS1) and vice versa (ECODAS2). RESULTS A total of 58 patients (65.5% women and 34.5% men) were included in the study. There was no significant difference between the 2 US indexes. We obtained a Pearson's correlation coefficient (Pearson's r) of 0.56 (p<0.00001) between DAS28 and ECODAS1 and of 0.57 (p<0.00001) between DAS28 and ECODAS2, respectively. However, for patients with a high disease activity [DAS28>5.1, tender joint count (TJC, high)], the correlation was poor (0.18) and ECODAS indexes were significantly lower (p=0.001). The correlation increased (0.86, p<0.001) when we excluded the tender joints and the joints with GS-positive synovitis in both the scores. CONCLUSION US reduces the bias in the evaluation of patients with RA with a high value in DAS28 index. We found a clear difference between DAS and ECODAS when TJC was high. The results suggest that joint tenderness reported by the patient is not a good reflection of inflammation. More studies are needed to find a new combined clinical and sonographic index that would better assess the disease activity in patients with RA.
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Affiliation(s)
- Roxana Coras
- Unit of Rheumatology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Mireia Barceló Bru
- Unit of Rheumatology, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | - Sandra Farietta
- Unit of Rheumatology, Vall d'Hebron University Hospital, Barcelona, Spain
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Color fraction as a useful method of imaging synovium vascularization in patients with high activity of rheumatoid arthritis. Reumatologia 2020; 58:42-47. [PMID: 32322123 PMCID: PMC7174790 DOI: 10.5114/reum.2020.93513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 02/20/2020] [Indexed: 01/05/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disease with joint inflammation and destruction as the main features that appears with prevalence of 1 to 2% of the general population. Women are three times more likely to suffer from RA than men. Rheumatoid arthritis occurs at any age but commonly over 40-50 years old. In the course of RA each joint may be involved but most frequently the proximal interphalangeal and metacarpophalangeal joints of the hands, wrists, and also small joints of the feet are affected. Symmetrical joint swelling with overgrowth of synovium and hypervascularization confirmed in power Doppler ultrasound imaging are very characteristic for RA. Quantification of vascularization with the color fraction index may be a useful tool to monitor disease activity and in evaluation of inflammation in scientific research. This article aims to present this imaging diagnostic method based on the literature.
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Bradford CM, McDonnell T, Raj D, Robinson GA, Cole A, Ramakrishnan S, González-Serrano R, Mak J, Eskiocak YC, Isenberg DA, Ciurtin C, Jury EC, Manson JJ. Characterization of a Subset of Patients With Rheumatoid Arthritis for Whom Current Management Strategies are Inadequate. ACR Open Rheumatol 2019; 1:145-155. [PMID: 31777790 PMCID: PMC6857995 DOI: 10.1002/acr2.1021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objective A subset of patients with seropositive rheumatoid arthritis (RA) do not mount a C‐reactive protein (CRP) response during flares. We hypothesize that these patients are more likely to experience poor clinical care and less likely to respond to traditional therapy. This study questioned whether this presentation was associated with worse disease outcome and distinct immunological features. Methods Using Power Doppler ultrasound, 48 RA patients with active synovitis were recruited; 30 had normal (n)CRP (5 mg/L or less) and 18 had high (h)CRP (more than 5 mg/L) levels. All had equivalent disease burden assessed by other clinical and laboratory parameters. Results Time to diagnosis and time to first disease‐modifying antirheumatic drug were significantly longer in nCRP compared with hCRP patients (P < 0.05). Significantly more nCRP patients needed escalation to biologics after 2‐year follow‐up (P = 0.01). The inflammatory milieu was also different between the two subgroups. Synergy between inflammatory cytokines observed in hCRP patients was lost in nCRP patients, and nCRP patients had significantly increased regulatory T‐cell (Treg) frequencies that correlated positively with predictors of poor disease outcome. Conversely, hCRP but not nCRP patients demonstrated a significant upregulation of alternative complement pathway factors that correlated negatively with Treg frequency. Conclusion Patients with nCRP during flares of RA had an altered immunological profile compared with hCRP patients and experienced diagnostic delays and responded less favorably to conventional treatment.
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Affiliation(s)
| | | | | | | | - Andrew Cole
- University College London Hospital London UK
| | | | | | | | | | - David A Isenberg
- University College London and University College London Hospital London UK
| | - Coziana Ciurtin
- University College London and University College London Hospital London UK
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6
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Lighter D, Filer A, Dehghani H. Detecting inflammation in rheumatoid arthritis using Fourier transform analysis of dorsal optical transmission images from a pilot study. JOURNAL OF BIOMEDICAL OPTICS 2019; 24:1-12. [PMID: 31222990 PMCID: PMC6977034 DOI: 10.1117/1.jbo.24.6.066008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/30/2019] [Indexed: 05/25/2023]
Abstract
A clinical need exists for low-cost and noninvasive imaging tools capable of detecting inflammation in the joints of inflammatory arthritis patients. Previous studies have reported an optical contrast between inflamed and noninflamed joints resulting from distinct absorption and scattering properties. Accurate classification using nonocclusion-based continuous wave, transillumination imaging was limited to patient-specific changes during follow-up examination as opposed to single time-point examination, which was attributed to high intersubject variability. In distinction from previous work, optical images were acquired from the dorsal side with illumination on the palmar side and features about the spatial distribution of transmitted light along the joint were assessed using a normalized Fourier transform method. Results using this approach demonstrated an area under receiver operator curve of up to 0.888 for detecting inflammation in a pilot study involving single time-point examination of 144 joints from 21 rheumatology patients. This workflow may enable future development of clinically viable, low-cost devices for assessing inflammation in arthritis patients, without the need for cuff occlusion or comparison to baseline.
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Affiliation(s)
- Daniel Lighter
- University of Birmingham, Sci-Phy-4-Health Centre for Doctoral Training, Birmingham, United Kingdom
| | - Andrew Filer
- University of Birmingham, Rheumatology, Institute of Inflammation and Ageing, College of Medical and Dental Sciences, Birmingham, United Kingdom
| | - Hamid Dehghani
- University of Birmingham, School of Computer Science, Birmingham, United Kingdom
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Sweet K, Dasgupta B, de Vries D, Gourley I, Hsu B, Loza MJ, Taylor PC. Sirukumab and adalimumab reduce power Doppler ultrasound signal in patients with rheumatoid arthritis by 4 weeks in a phase III trial. Ann Rheum Dis 2019; 78:1439-1441. [PMID: 31018960 DOI: 10.1136/annrheumdis-2019-215183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 03/26/2019] [Accepted: 04/11/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Kristen Sweet
- Janssen Research & Development, Spring House, Pennsylvania, USA
| | | | - Dick de Vries
- Janssen Research & Development, Ambler, Pennsylvania, USA
| | - Ian Gourley
- Janssen Research & Development, Ambler, Pennsylvania, USA
| | - Benjamin Hsu
- Janssen Research & Development, Ambler, Pennsylvania, USA
| | - Matthew J Loza
- Janssen Research & Development, LLC, Spring House, Pennsylvania, USA
| | - Peter C Taylor
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
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Hensor EMA, McKeigue P, Ling SF, Colombo M, Barrett JH, Nam JL, Freeston J, Buch MH, Spiliopoulou A, Agakov F, Kelly S, Lewis MJ, Verstappen SMM, MacGregor AJ, Viatte S, Barton A, Pitzalis C, Emery P, Conaghan PG, Morgan AW. Validity of a two-component imaging-derived disease activity score for improved assessment of synovitis in early rheumatoid arthritis. Rheumatology (Oxford) 2019; 58:kez049. [PMID: 30824919 PMCID: PMC6649844 DOI: 10.1093/rheumatology/kez049] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 12/21/2018] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Imaging of joint inflammation provides a standard against which to derive an updated DAS for RA. Our objectives were to develop and validate a DAS based on reweighting the DAS28 components to maximize association with US-assessed synovitis. METHODS Early RA patients from two observational cohorts (n = 434 and n = 117) and a clinical trial (n = 59) were assessed at intervals up to 104 weeks from baseline; all US scans were within 1 week of clinical exam. There were 899, 163 and 183 visits in each cohort. Associations of combined US grey scale and power Doppler scores (GSPD) with 28 tender joint count and 28 swollen joint count (SJC28), CRP, ESR and general health visual analogue scale were examined in linear mixed model regressions. Cross-validation evaluated model predictive ability. Coefficients learned from training data defined a re-weighted DAS28 that was validated against radiographic progression in independent data (3037 observations; 717 patients). RESULTS Of the conventional DAS28 components only SJC28 and CRP were associated with GSPD in all three development cohorts. A two-component model including SJC28 and CRP outperformed a four-component model (R2 = 0.235, 0.392, 0.380 vs 0.232, 0.380, 0.375, respectively). The re-weighted two-component DAS28CRP outperformed conventional DAS28 definitions in predicting GSPD (Δtest log-likelihood <-2.6, P < 0.01), Larsen score and presence of erosions. CONCLUSION A score based on SJC28 and CRP alone demonstrated stronger associations with synovitis and radiographic progression than the original DAS28 and should be considered in research on pathophysiological manifestations of early RA. Implications for clinical management of RA remain to be established.
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Affiliation(s)
- Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Paul McKeigue
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh
| | - Stephanie F Ling
- Arthritis Research UK Centre for Genetics and Genomics, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester
| | - Marco Colombo
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh
| | - Jennifer H Barrett
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
- Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, Leeds
| | - Jackie L Nam
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Jane Freeston
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Athina Spiliopoulou
- Usher Institute for Population Health Sciences and Informatics, University of Edinburgh, Edinburgh
- Pharmatics Limited, Edinburgh
| | | | - Stephen Kelly
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Myles J Lewis
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Suzanne M M Verstappen
- Arthritis Research UK Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester
| | | | - Sebastien Viatte
- Arthritis Research UK Centre for Genetics and Genomics, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester
| | - Anne Barton
- Arthritis Research UK Centre for Genetics and Genomics, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester
- NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester
| | - Costantino Pitzalis
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London
| | - Paul Emery
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
| | - Ann W Morgan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds
- NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds
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Sarzi-Puttini P, Filippucci E, Adami S, Meroni PL, Batticciotto A, Idolazzi L, De Lucia O, Talavera P, Kumke T, Grassi W. Clinical, Ultrasound, and Predictability Outcomes Following Certolizumab Pegol Treatment (with Methotrexate) in Patients with Moderate-to-Severe Rheumatoid Arthritis: 52-Week Results from the CZP-SPEED Study. Adv Ther 2018; 35:1153-1168. [PMID: 30043210 PMCID: PMC6096970 DOI: 10.1007/s12325-018-0751-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Indexed: 12/12/2022]
Abstract
Introduction To assess the impact of certolizumab pegol (CZP) treatment on clinical, patient-reported, and musculoskeletal ultrasound outcomes and to determine the treatment response time point most predictive of long-term outcomes in Italian patients with rheumatoid arthritis (RA). Methods CZP-SPEED (NCT01443364) was a 52-week, open-label, prospective, interventional, multicenter study. Biologic-naïve patients with moderate-to-severe active RA, who had failed at least one DMARD treatment, received CZP (400 mg at weeks 0, 2, and 4, then 200 mg every 2 weeks) concomitantly with methotrexate. The primary objective was to identify the time point of clinical response {decrease in 28-joint Disease Activity Score [DAS28(ESR)] ≥ 1.2} most predictive of a clinical response at week 52. Additional clinical and patient-reported outcomes were measured. Power Doppler (PD) ultrasound was used to assess synovial effusion, synovial proliferation, PD signal, cartilage damage, and bone erosion according to international guidelines. Results A total of 132 patients were enrolled and received CZP; 91/132 (69%) completed to week 52. Predicted 52-week responses for early responders (week 2 onwards) were between 65% and 70%. Rapid improvements in joint cavity widening and PD signal were observed to week 8 and maintained to week 52. Cartilage damage and bone erosion were stable over 52 weeks. No new safety signals were identified. Conclusion In Italian CZP-treated patients with moderate-to-severe RA, week 12 clinical responses may be predictive of long-term response at week 52. Rapid improvements in clinical, patient-reported, and musculoskeletal ultrasound outcomes were maintained to week 52. These data may aid rheumatologists to make earlier treatment decisions. Trial Registration ClinicalTrials.gov identifier, NCT01443364. Funding UCB Pharma. Electronic supplementary material The online version of this article (10.1007/s12325-018-0751-8) contains supplementary material, which is available to authorized users.
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10
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A new quantitative 3D approach to imaging of structural joint disease. Sci Rep 2018; 8:9280. [PMID: 29915245 PMCID: PMC6006324 DOI: 10.1038/s41598-018-27486-y] [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: 10/26/2017] [Accepted: 05/09/2018] [Indexed: 12/14/2022] Open
Abstract
Imaging of joints with 2D radiography has not been able to detect therapeutic success in research trials while 3D imaging, used regularly in the clinic, has not been approved for this purpose. We present a new 3D approach to this challenge called joint space mapping (JSM) that measures joint space width in 3D from standard clinical computed tomography (CT) data, demonstrating its analysis steps, technical validation, and reproducibility. Using high resolution peripheral quantitative CT as gold standard, we show a marginal over-estimation in accuracy of +0.13 mm and precision of ±0.32 mm. Inter-operator reproducibility bias was near-zero at −0.03 mm with limits of agreement ±0.29 mm and a root mean square coefficient of variation 7.5%. In a technical advance, we present results from across the hip joint in 3D with optimum validation and reproducibility metrics shown at inner joint regions. We also show JSM versatility using different imaging data sets and discuss potential applications. This 3D mapping approach provides information with greater sensitivity than reported for current radiographic methods that could result in improved patient stratification and treatment monitoring.
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11
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Lazaar H, Lhoste-Trouilloud A, Pereira B, Couderc M, Mathieu S, Soubrier M. Does rheumatoid synovitis activity vary during the day? Evaluation with color doppler sonography. BMC Musculoskelet Disord 2017; 18:98. [PMID: 28257635 PMCID: PMC5336684 DOI: 10.1186/s12891-017-1450-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 02/13/2017] [Indexed: 11/26/2022] Open
Abstract
Background Clinical symptoms of rheumatoid arthritis (RA) improve in the course of the day, as can synovitis activity, reported via doppler ultrasound (US). The aim of the study was to establish whether the Color Doppler (CD) scores of synovitis in RA changes throughout the day. Methods In total, 27 patients with active RA, including 14 patients receiving corticosteroids were studied. US evaluation was performed twice in each patient, at 9 a.m. (T0) and after 4 p.m. (T1) on the same day by a single radiologist and using the same instrument. Overall, 30 joints were assessed, including grey scale and CD (S0 = no flow [no detectable CD)]; S1 = mild [CD <1/3 of the synovium]; S2 = moderate [CD <2/3]; S3 = pronounced [CD >2/3]). Results In the total population, synovitis was detected more often in the evening than in the morning (39% vs. 33%, p = 0.02). The difference remained significant only in patients without corticosteroid administration (44% vs. 37%, p = 0.04). Moreover, a greater number of CD-positive joints were likewise found (S0 vs. S1 + S2 + S3) in the evening (57% vs. 51%, p = 0.04) in patients not receiving corticosteroids (67% vs. 41%, p = 0.002). More moderate (S2) and pronounced (S3) than mild (S1) synovitis was observed at T1 vs. T0 (39% vs. 24%, p = 0.03) in patients not receiving corticosteroids. More synovitis (40% vs 36% p = 0.02) in the dominant hand were found in the evening than in the morning. Conclusion Synovitis and CD activity increase during the day in RA patients, especially in joints of the dominant hands and in patients without corticosteroids.
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Affiliation(s)
- Hakim Lazaar
- Clermont-Ferrand Teaching Hospital, Radiology A Department, Place H. DUNANT, Clermont-Ferrand, 63000, France.
| | - Agnes Lhoste-Trouilloud
- Clermont-Ferrand Teaching Hospital, Radiology A Department, Place H. DUNANT, Clermont-Ferrand, 63000, France
| | - Bruno Pereira
- Clermont-Ferrand Teaching Hospital, Biostatistics Unit, Clermont-Ferrand, 63003, France
| | - Marion Couderc
- Clermont-Ferrand Teaching Hospital, Rheumatology Department, Place H. DUNANT, Clermont-Ferrand, 63000, France
| | - Sylvain Mathieu
- Clermont-Ferrand Teaching Hospital, Rheumatology Department, Place H. DUNANT, Clermont-Ferrand, 63000, France
| | - Martin Soubrier
- Clermont-Ferrand Teaching Hospital, Rheumatology Department, Place H. DUNANT, Clermont-Ferrand, 63000, France.
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Hull DN, Cooksley H, Chokshi S, Williams RO, Abraham S, Taylor PC. Increase in circulating Th17 cells during anti-TNF therapy is associated with ultrasonographic improvement of synovitis in rheumatoid arthritis. Arthritis Res Ther 2016; 18:303. [PMID: 28010726 PMCID: PMC5180397 DOI: 10.1186/s13075-016-1197-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/28/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Anti-TNF agents have revolutionised rheumatoid arthritis (RA) treatment; however, a third of patients fail to achieve therapeutic responses. Unexpectedly, studies in murine and human arthritis have indicated that anti-TNF treatment can increase circulating T helper 17 (Th17) cells, but the relationship to treatment response is unclear. To identify immune correlates of anti-TNF treatment response, we conducted a longitudinal study using clinical, ultrasound and T cell assessments. METHODS Patients with RA (n = 25) were studied at protocol visits during the initial 12 weeks of anti-TNF treatment. Improvement in the disease activity score of 28 joints (DAS28) >1.2 defined treatment responders (n = 16) and non-responders (n = 9). Changes in synovial thickening and vascularity of 10 metacarpophalangeal joints were quantitatively assessed by grey scale and power Doppler ultrasound. The frequency of circulating Th17 cells was determined by IL17 enzyme-linked immunospot assay (Elispot) and flow cytometry (fluorescence-activated cell sorting (FACS)). RESULTS The frequency of circulating IL17-producing cells increased significantly 12 weeks after anti-TNF initiation (Elispot median (range) specific spot forming cells (spSFC)/106 360 (280-645) vs 632 (367 - 1167), p = 0.003). The increase in CD4 + IL17+ cells at 12 weeks was confirmed by FACS (median (range) %, 0.7 (0.5-0.9) vs 1.05 (0.6-1.3); p = 0.01). The increase in circulating Th17 cells inversely correlated with reduction in synovial vascularity (r = -0.68, p = 0.007) and thickening (r = -0.39; p = 0.04). Higher frequencies of circulating Th17 cells at baseline were associated with poorer anti-TNF treatment response defined by ultrasonographic measures. CONCLUSIONS These results demonstrate a link between changes in circulating Th17 cells with resolution of ultrasonographic features of synovial inflammation and vascularity during anti-TNF treatment. The findings may reflect redistribution of Th17 cells from inflamed joints or TNF-driven regulation of Th17 cell production. TRIAL REGISTRATION ClinicalTrials.gov: NCT01060098 . Registered 29 January 2010.
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Affiliation(s)
- Dobrina N Hull
- Department of Medicine, Imperial College London, London, UK.,Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - Helen Cooksley
- Institute of Hepatology, The Foundation for Liver Research, 111 Coldharbour Lane, London, SE5 9NT, UK
| | - Shilpa Chokshi
- Institute of Hepatology, The Foundation for Liver Research, 111 Coldharbour Lane, London, SE5 9NT, UK
| | - Richard O Williams
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - Sonya Abraham
- Department of Medicine, Imperial College London, London, UK
| | - Peter C Taylor
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Windmill Road, Headington, Oxford, OX3 7LD, UK.
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Baker JF, Tan YK, Conaghan PG. Monitoring in established RA: Role of imaging and soluble biomarkers. Best Pract Res Clin Rheumatol 2015; 29:566-79. [DOI: 10.1016/j.berh.2015.09.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Schmidt WA, Schönau V, Reiche BE, Oberdorfer PD, Ohrndorf S, Backhaus M. Grading of ultrasound Doppler signals in synovitis: does it need an update? Rheumatology (Oxford) 2015; 54:1897-903. [DOI: 10.1093/rheumatology/kev205] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Indexed: 11/14/2022] Open
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15
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Epis O, Paoletti F, d'Errico T, Favalli E, Garau P, Mancarella L, Pomponio G, Sandri G, Scioscia C, Selvi E, Tirri E. Ultrasonography in the diagnosis and management of patients with inflammatory arthritides. Eur J Intern Med 2014; 25:103-11. [PMID: 24041708 DOI: 10.1016/j.ejim.2013.08.700] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 07/04/2013] [Accepted: 08/14/2013] [Indexed: 11/28/2022]
Abstract
In primary care and internal medicine settings clinicians are often reluctant to take advantage of the resources that ultrasonography (US) offers as a diagnostic tool in the initial management of patients with inflammatory arthritis, despite the recognised importance of an accurate and timely diagnosis of rheumatoid arthritis (RA) and of early referral to ensure optimal patient management. Both grey-scale (GS) and power Doppler (PD) imaging have been extensively used in early detection of synovitis and bone erosions in patients with inflammatory arthritides. We reviewed the main data on the clinical use of US in the initial management of patients with inflammatory arthritis, focusing on RA diagnosis in patients with undifferentiated arthritis, prediction of disease severity, differential diagnoses and assessment of synovitis in children with juvenile idiopathic arthritis (JIA). The role of US in assessing treatment response and monitoring disease activity in clinical remission was also briefly evaluated. The reliability of US as a diagnostic tool in rheumatological diseases has greatly advanced in the last years and the use of this imaging technique, in association with conventional assessments such as physical examination and serological tests, should be considered more often also in primary care settings.
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Affiliation(s)
- Oscar Epis
- S.C. Reumatologia, A.O. Ospedale Niguarda Ca' Granda, Milano, Italy.
| | - Franco Paoletti
- U.O. Reumatologia, Ospedale 'S. Francesco Caracciolo', Agnone, Italy
| | - Tito d'Errico
- Ambulatiorio di Reumatologia, P.O. 'S.M.d.P degli Incurabili', Napoli, Italy
| | - Ennio Favalli
- Divisione di Reumatologia, Istituto Ortopedico G. Pini, Milano, Italy
| | - Pietro Garau
- Struttura Complessa di Reumatologia, A.O.U. Cagliari, Italy
| | | | | | - Gilda Sandri
- Dipartimento di Medicina Diagnostica, Clinica e di Sanità Pubblica, Università degli Studi di Modena e Reggio Emilia, Italy
| | | | - Enrico Selvi
- Sezione di Reumatologia, A.O.U. Senese, Siena, Italy
| | - Enrico Tirri
- U.O. Reumatologia, Ospedale 'S. Giovanni Bosco', Napoli, Italy
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Witt MN, Mueller F, Weinert P, Nigg AP, Reindl CS, Proft F, Schulze-Koops H, Grunke M. Ultrasound of synovitis in rheumatoid arthritis: advantages of the dorsal over the palmar approach to finger joints. J Rheumatol 2014; 41:422-8. [PMID: 24488415 DOI: 10.3899/jrheum.131027] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To compare the dorsal and palmar ultrasound (US) examination of finger joints in early rheumatoid arthritis (RA) with regard to the concurrence of greyscale (GSUS) and power Doppler (PDUS) positivity, and to correlate both approaches with clinical variables. METHODS Patients with newly diagnosed RA were assessed by clinical examination and US. GSUS and PDUS of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were performed using the dorsal and palmar approach. Findings of synovitis in GSUS and PDUS were graded semiquantitatively from 0 to 3. Clinical and sonographic reevaluation was performed after 6 months. RESULTS With 44.6% versus 32.2% positive findings, palmar GSUS identified significantly more joints with synovitis than did dorsal GSUS. With 22.1% versus 8.9%, PDUS abnormalities were detected significantly more often from the dorsal side. With 71.2% versus 21.8% for the MCP and 57.5% versus 17.4% for the PIP joints, significantly more GSUS and PDUS double-positive joints were found with the dorsal as opposed to the palmar approach. These differences remained significant at Month 6. Both palmar and dorsal GSUS and PDUS correlated with comparable strength with clinical variables such as the Disease Activity Score 28, Clinical Disease Activity Index, and Simple Disease Activity Index. CONCLUSION Although the dorsal approach detected fewer GSUS findings than the palmar approach, PDUS signals were significantly more frequently detected by dorsal US. In addition, the prevalence of double-positive joints with concurrent GSUS and PDUS findings was significantly higher with the dorsal approach. These data argue in favor of the dorsal US approach to finger joints in RA.
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Affiliation(s)
- Matthias N Witt
- From the Division of Rheumatology, Medizinische Klinik und Poliklinik IV, University of Munich, Munich; Leibniz-Rechenzentrum, Bavarian Academy of Sciences and Humanities, Garching, Germany
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Senna MK, Machaly SA, Foda M, Eid N. Baseline angiopoietin-2/angiopoietin-1 (Ang2/Ang1) ratio is correlated with the synovial vascularity measured 1 month later in rheumatoid arthritis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2013. [DOI: 10.4103/1110-161x.123797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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