1
|
Corzo Garcia P, Garcia-Duitama I, Agustí Claramunt A, Duran Jordà X, Monfort J, Salman-Monte TC. Musculoskeletal involvement in systemic lupus erythematosus: a contrast-enhanced magnetic resonance imaging study in 107 subjects. Rheumatology (Oxford) 2024; 63:423-429. [PMID: 37208172 DOI: 10.1093/rheumatology/kead223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/17/2023] [Accepted: 05/03/2023] [Indexed: 05/21/2023] Open
Abstract
OBJECTIVE Joint involvement in SLE is the most frequent manifestation and shows a wide heterogeneity. It has not a valid classification and it is often underestimated. Subclinical inflammatory musculoskeletal involvement is not well known. We aim to describe the prevalence of joint and tendon involvement in hand and wrist of SLE patients, either with clinical arthritis, arthralgia or asymptomatic and compare it with healthy subjects using contrasted MRI. METHODS SLE patients fulfilling SLICC criteria were recruited and classified as follows: group (G) 1: hand/wrist arthritis, G2: hand/wrist arthralgia, G3: no hand/wrist symptoms. Jaccoud arthropathy, CCPa and RF positivity, hand OA or surgery were excluded. Healthy subjects (HS) were recruited as controls: G4. Contrasted MRI of non-dominant hand/wrist was performed. Images were evaluated following RAMRIS criteria extended to PIP, Tenosynovitis score for RA and peritendonitis from PsAMRIS. Groups were statistically compared. RESULTS A total of 107 subjects were recruited (G1: 31, G2:31, G3:21, G4:24). Any lesion: SLE patients 74.7%, HS 41.67%; P 0.002. Synovitis: G1: 64.52%, G2: 51.61%, G3: 45%, G4: 20.83%; P 0.013. Erosions: G1: 29.03%; G2: 54.84%, G3: 47.62%; G4: 25%; P 0.066. Bone marrow oedema: G1: 29.03%, G2: 22.58%, G3: 19.05%, G4: 0.0%; P 0.046. Tenosynovitis: G1: 38.71%; G2: 25.81%, G3: 14.29%, G4: 0.0%; P 0.005. Peritendonitis: G1: 12.90%; G2: 3.23%, G3: 0.0%, G4: 0.0%; P 0.07. CONCLUSION SLE patients have a high prevalence of inflammatory musculoskeletal alterations confirmed by contrasted MRI, even if asymptomatic. Not only tenosynovitis but peritendonitis is also present.
Collapse
Affiliation(s)
| | - Ivan Garcia-Duitama
- Musculoskeletal Radiology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | - Anna Agustí Claramunt
- Musculoskeletal Radiology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | | | - Jordi Monfort
- Rheumatology Department, Hospital del Mar-Parc de Salut Mar, Barcelona, Spain
| | | |
Collapse
|
2
|
Balulu G, Furer V, Wollman J, Levartovsky D, Aloush V, Elalouf O, Sarbagil-Maman H, Mendel L, Borok S, Paran D, Elkayam O, Polachek A. The association between sonographic enthesitis with sonographic synovitis and tenosynovitis in psoriatic arthritis patients. Rheumatology (Oxford) 2024; 63:190-197. [PMID: 37166435 DOI: 10.1093/rheumatology/kead202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/25/2023] [Accepted: 04/19/2023] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES To examine the association between sonographic enthesitis with sonographic synovitis and tenosynovitis in PsA patients, and the association between sonographic enthesitis and clinical characteristics. METHODS Consecutive PsA patients that fulfilled the ClASsification criteria for Psoriatic ARthritis (CASPAR) were prospectively recruited. Each patient was evaluated by comprehensive clinical and sonographic assessment (greyscale and Doppler), the latter including 52 joints, 40 tendons and 14 entheses [according to MAdrid Sonography Enthesitis Index (MASEI) plus lateral epicondyles] performed by an experienced sonographer blinded to the clinical data. The US enthesitis score was further categorized to inflammatory (hypoechogenicity, thickening, bursitis and Doppler) and structural (enthesophytes/calcifications and erosions) subcategories. Multivariate linear regression models assessed the association between enthesitis and the selected variables. RESULTS A total of 158 PsA patients [mean (s.d.) age 52.3 (13) years, 88 (55.7%) females] were analysed. Multivariate linear regression analyses showed a significant association between sonographic enthesitis and sonographic synovitis (β = 0.18, P = 0.008) and between sonographic enthesitis and sonographic tenosynovitis (β = 0.06, P = 0.02). These associations were derived from the enthesitis inflammatory subcategory of the MASEI (P < 0.05). Associations between enthesitis and synovitis were also demonstrated on the level of the elbow, knee and ankle joints (P < 0.05). In addition, sonographic enthesitis was significantly associated with older age, male sex, swollen joint count, CRP level and physical occupation. CONCLUSIONS Sonographic enthesitis is associated with sonographic synovitis and tenosynovitis. The severity of sonographic enthesitis may represent a marker for inflammatory activity in other musculoskeletal domains.
Collapse
Affiliation(s)
- Gavriel Balulu
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Victoria Furer
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Wollman
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - David Levartovsky
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Valerie Aloush
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofir Elalouf
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagit Sarbagil-Maman
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Liran Mendel
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sara Borok
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Daphna Paran
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Elkayam
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari Polachek
- Department of Rheumatology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
3
|
Mo H, Su ZH, Zheng ZY, Gao L, Ma ZB, Li FX. Screening for early rheumatoid arthritis using high-frequency ultrasound, serum RANKL, and OPG detection. Clin Rheumatol 2024; 43:159-166. [PMID: 38051416 DOI: 10.1007/s10067-023-06830-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/12/2023] [Accepted: 11/22/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVE To conduct a comparative study of high-frequency ultrasound and magnetic resonance imaging (MRI) combined with serum RANKL and OPG detection, and assess the efficacy of high-frequency ultrasound with RANKL and OPG detection in screening early rheumatoid arthritis (RA). METHOD High-frequency ultrasound and MRI were performed on both carpal joints of 60 patients with early RA, and the frequencies of synovitis, joint effusion, tenosynovitis, and bone erosion detected by high-frequency ultrasound and MRI were observed. The serum levels of receptor activator for nuclear factor-κB ligand (RANKL) and osteoclastogenesis inhibitory factor (OPG) were also detected. The serum levels of RANKL and OPG were also detected in 80 normal healthy examinees. The data were recorded and statistically analyzed. RESULTS The detection rates of carpal synovitis, joint effusion, tenosynovitis, and bone erosion in RA patients by high-frequency ultrasound were 81.66%, 69.16%, 63.33%, and 1.66%, respectively, while the detection rates by MRI were 80.00%, 71.66%, 65.00%, and 15.00%, respectively. There was no significant difference between high-frequency ultrasound and MRI in the detection rates of carpal synovitis, joint effusion, and tenosynovitis in RA patients (P > 0.05), while the detection rate of bone erosion by high-frequency ultrasound was significantly lower than that by MRI. The serum levels of RANKL and OPG in RA patients were 231.47 and 68.71, respectively, while the serum levels of RANKL and OPG in normal healthy examinees were 123.51 and 385.05, respectively. The serum RANKL levels of RA patients were significantly higher than those of healthy examinees, while the serum OPG levels of RA patients were significantly lower than those of healthy examinees, which were statistically significant (P < 0.01). The AUC values of the ROC curves obtained by high-frequency ultrasound and MRI combined with serum RANKL and OPG detection in Synovitis modeling were 0.955 and 0.954, respectively. The AUC values of the ROC curves obtained from the joint fusion modeling using high-frequency ultrasound and MRI combined with serum RANKL and OPG detection were 0.949 and 0.950, respectively. The AUC values of the ROC curves obtained from modeling Tenosynovitis using high-frequency ultrasound and MRI combined with serum RANKL and OPG detection were 0.941 and 0.949, respectively. The AUC values of ROC curves obtained by combining high-frequency ultrasound and MRI with serum RANKL and OPG detection in Bone erosion modeling were 0.908 and 0.923, respectively. CONCLUSION High-frequency ultrasound combined with serum RANKL and OPG detection has comparable effects to MRI on screening early RA, providing a safe, simple, and cost-effective screening method for the early detection of RA patients. Key Points • High-frequency ultrasound and MRI can effectively detect early lesions of the wrist joints in RA patients. • Ultrasound diagnosis has the advantages of being quick, inexpensive, and repeatable, making it the preferred choice of imaging examination for RA patients at an early stage.
Collapse
Affiliation(s)
- Hong Mo
- Department of Rheumatology and Immunology, The First People's Hospital of Nanning, Nanning, 530000, China.
| | - Zhi-Hua Su
- Clinical Laboratory, The First People's Hospital of Nanning, Nanning, 53000, China
| | - Zhong-Ying Zheng
- Department of Rheumatology and Immunology, The First People's Hospital of Nanning, Nanning, 530000, China
| | - Ling Gao
- Department of Ultrasonography, The First People's Hospital of Nanning, Nanning, 530000, China
| | - Zong-Bo Ma
- Department of Rheumatology and Immunology, The First People's Hospital of Nanning, Nanning, 530000, China
| | - Feng-Xia Li
- Department of Rheumatology and Immunology, The First People's Hospital of Nanning, Nanning, 530000, China
| |
Collapse
|
4
|
Colberg RE, Maisel BC, Fleisig GS. Treatment of Chronic Extensor Carpi Ulnaris Stenosing Tenosynovitis Using Ultrasound-Guided Retinaculum Release: A Case Report. JBJS Case Connect 2024; 14:01709767-202403000-00013. [PMID: 38241430 DOI: 10.2106/jbjs.cc.23.00461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
CASE A 65-year-old man with chronic extensor carpi ulnaris (ECU) stenosing tenosynovitis who had failed treatments for 3 years was successfully treated with an ultrasound-guided retinaculum release of the sixth dorsal compartment. CONCLUSION There are limited options in the literature for treating chronic, recalcitrant ECU tenosynovitis. We describe a novel technique in which the retinaculum overlying the ECU tendon was successfully incised under ultrasound guidance to release the sixth dorsal compartment stenosis. There was no recurrence of symptoms in the following 2 years of follow-up.
Collapse
Affiliation(s)
- Ricardo E Colberg
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama
- American Sports Medicine Institute, Birmingham, Alabama
| | - B C Maisel
- Andrews Sports Medicine and Orthopaedic Center, Birmingham, Alabama
- American Sports Medicine Institute, Birmingham, Alabama
| | | |
Collapse
|
5
|
Hammad R, Eldosoky MA, Lambert C, Sack U, Kujumdshiev S, Abd Elhamed SS, Elfishawi S, Mohamed EF, Kandeel EZ, Lotfy AW, Abulsoud MI, Abo-Elkheir OI, Hamdy NM, Farhoud H, Seddik M. Hsa-miR-21-5p reflects synovitis and tenosynovitis components of musculoskeletal ultrasonography Seven-joint scores in rheumatoid arthritis disease and predicts the disease flare. Pathol Res Pract 2024; 253:154960. [PMID: 38043193 DOI: 10.1016/j.prp.2023.154960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/13/2023] [Accepted: 11/16/2023] [Indexed: 12/05/2023]
Abstract
Rheumatoid arthritis (RA) is characterized by progressive joint destruction with subsequent serious disability. Objective biomarkers of RA course progression are lacking, which necessitates the discovery of activity indicators and predictors of the disease outcome. Musculoskeletal Ultrasound Seven-joint Score (MSUS7) is proposed as a reliable technique to evaluate radiographic RA progression. Homo sapiens-microRNA-21-5p (hsa-miR-21-5p) plays an important role during joint remodeling and the pro-inflammatory process driving RA progression. We aimed to evaluate plasma hsa-miR-21-5p as a noninvasive RA activity biomarker and to investigate if hsa-miR-21-5p is linked to MSUS7 components in the context of RA activity. This cross-sectional study included 71 RA patients classified into inactive (n = 36) and active (n = 35) groups according to the Disease Activity Score 28-joint count with ESR (DAS28-ESR). Joints were assessed by MSUS7. Gray-scale ultrasound (GSUS) and power Doppler ultrasound (PDUS) were used to rate the synovitis, tenosynovitis, and erosion in the joints. Plasma hsa-miR-21-5p expression was measured by real-time PCR. The absolute count of regulatory T cell (Treg) was calculated after Treg frequency was assessed by flow cytometry. Results: Hsa-miR-21 expression was significantly up-regulated in the active RA group with a median fold change of 51.6 in comparison to the inactive cases with a median fold change of 7.7 (p < 0.001). Hsa-miR-21-5p was positively correlated with DAS28-ESR, C reactive protein (CRP), and rheumatoid factor (r = 0.7, p < 0.001, r = 0. 0.6, p < 0.001, and r = 0.4, p = 0.002, respectively), while negatively correlated with Treg absolute count (r = -0.4, p < 0.001). Hsa-miR-21-5p levels were correlated with synovitis and tenosynovitis in GSUS (r = 0.4, p < 0.001, r = 0.3, p = 0.025, respectively) and in PDUS (r = 0.5, p < 0.001 and 0.4, p = 0.001, respectively). The hsa-miR-21-5p accurately distinguished RA activity [AUC 0.933, 94.3% sensitivity, and 86.1% specificity]. Logistic regression analysis revealed hsa-miR-21-5p as an independent predictor for RA flare (OR = 1.228, p = 0.004). Hsa-miR-21-5p was linked to synovitis and tenosynovitis components of the MSUS7. Up-regulated hsa-miR-21-5p can be utilized as a predictor for RA disease flare.
Collapse
Affiliation(s)
- Reham Hammad
- Clinical Pathology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mona A Eldosoky
- Clinical Pathology Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Claude Lambert
- Cytometry Unit, Immunology Laboratory, Saint-Etienne University Hospital, France
| | - Ulrich Sack
- Institute for Clinical Immunology, Leipzig University Hospital, Germany
| | - Sandy Kujumdshiev
- Institute for Clinical Immunology, Leipzig University Hospital, Germany; German University of Applied Sciences for Health and Sports, Berlin, Germany
| | - Sally S Abd Elhamed
- Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Sally Elfishawi
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Eman F Mohamed
- Internal Medicine Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Eman Z Kandeel
- Clinical Pathology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Abdel Wahab Lotfy
- Internal Medicine Department, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Mohamed I Abulsoud
- Orthopedic Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt
| | - Omaima I Abo-Elkheir
- Community Medicine and Public Health Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Nadia M Hamdy
- Biochemistry Department, Faculty of Pharmacy, Ain Shams University, Abbasia, Cairo, Egypt.
| | - Hesham Farhoud
- Orthopedic Surgery Department, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Mahmoud Seddik
- Orthopedic Surgery Department, Faculty of Medicine for Boys, Al-Azhar University, Cairo, Egypt; Al-Azhar University for Post graduate and Research, Egypt
| |
Collapse
|
6
|
Chen CC, Tsai CF, Chen SC. Consensus and agreements on the sonographic definitions of pediatric tenosynovitis: comment on the article by Collado et al. Arthritis Care Res (Hoboken) 2023; 75:2544-2545. [PMID: 37382037 DOI: 10.1002/acr.25185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 06/21/2023] [Indexed: 06/30/2023]
Affiliation(s)
- Chun-Chieh Chen
- Chung Shan Medical University School of Medicine and Chung Shan Medical University Hospital Health Management Center, Taichung, Taiwan
| | - Chin-Feng Tsai
- Chung Shan Medical University School of Medicine and Chung Shan Medical University Hospital Health Management Center, Taichung, Taiwan
| | - Shiuan-Chih Chen
- Chung Shan Medical University School of Medicine and Chung Shan Medical University Hospital Health Management Center, Taichung, Taiwan
| |
Collapse
|
7
|
Collado P, Martire MV, Lanni S, De Lucia O, Balint P, Guillaume-Czitrom S, Hernandez-Diaz C, Sande NK, Magni-Manzoni S, Malattia C, Rossi-Semerano L, Roth J, Ting T, Vega-Fernandez P, Windschall D, D'Agostino MA, Naredo E. OMERACT International Consensus for Ultrasound Definitions of Tenosynovitis in Juvenile Idiopathic Arthritis: Systematic Literature Review and Delphi Process. Arthritis Care Res (Hoboken) 2023; 75:2277-2284. [PMID: 37221153 DOI: 10.1002/acr.25159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/27/2023] [Accepted: 05/16/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Synovitis and tenosynovitis are present in juvenile idiopathic arthritis (JIA), both as joint pain and/or inflammation, making them difficult to detect on physical examination. Although ultrasonography (US) allows for discrimination of the 2 entities, only definitions and scoring of synovitis in children have been established. This study was undertaken to produce consensus-based US definitions of tenosynovitis in JIA. METHODS A systematic literature search was performed. Selection criteria included studies focused on US definition and scoring systems for tenosynovitis in children, as well as US metric properties. Through a 2-step Delphi process, a panel of international US experts developed definitions for tenosynovitis components (step 1) and validated them by testing their applicability on US images of tenosynovitis in several age groups (step 2). A 5-point Likert scale was used to rate the level of agreement. RESULTS A total of 14 studies were identified. Most used the US definitions developed for adults to define tenosynovitis in children. Construct validity was reported in 86% of articles using physical examination as a comparator. Few studies reported US reliability and responsiveness in JIA. In step 1, experts reached a strong group agreement (>86%) by applying adult definitions in children after one round. After 4 rounds of step 2, the final definitions were validated on all tendons and at all locations, except for biceps tenosynovitis in children <4 years old. CONCLUSION The study shows that the definition of tenosynovitis used in adults is applicable to children with minimal modifications agreed upon through a Delphi process. Further studies are required to confirm our results.
Collapse
Affiliation(s)
- Paz Collado
- Hospital Universitario Severo Ochoa and Universidad Internacional Alfonso X El Sabio, Madrid, Spain
| | | | - Stefano Lanni
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Orazio De Lucia
- ASST Centro Traumatologico Ortopedico G. Pini-CTO, Milan, Italy
| | - Peter Balint
- National Institute of Musculoskeletal Diseases, Budapest, Hungary
| | | | - Cristina Hernandez-Diaz
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra and Hospital Juárez de México, Ciudad de México, Mexico
| | | | | | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, and University of Genoa, Genoa, Italy
| | - Linda Rossi-Semerano
- Centre Hospitalier Universitaire de Bicêtre, APHP, National Reference Centre for Auto-Inflammatory Diseases and Amyloidosis of Inflammatory origin, Le Kremlin-Bicêtre, France
| | - Johannes Roth
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Tracy Ting
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Patricia Vega-Fernandez
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, Ohio
| | - Daniel Windschall
- Clinic of Paediatric and Adolescent Rheumatology, St.-Josef-Stift Sendenhorst, Northwest German Center for Rheumatology, Sendenhorst, Germany, and Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Maria Antonietta D'Agostino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Esperanza Naredo
- Hospital General Universitario Gregorio Marañón and Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
8
|
Myers DM, Goubeaux C, Skura B, Warmoth PJ, Taylor BC. Contrast Enhanced Computed Tomography in the Diagnosis of Acute Pyogenic Flexor Tenosynovitis. Hand (N Y) 2023; 18:1323-1329. [PMID: 35611491 PMCID: PMC10617475 DOI: 10.1177/15589447221092058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The diagnosis of infectious flexor tenosynovitis (FTS) has historically been made based on physical exam using Kanavel's signs. The specificity of these findings has come into question. We looked to evaluate the use of contrast-enhanced computed tomography (CT) in increasing the successful diagnosis of FTS. METHODS Two adult cohorts were formed, one of patients with FTS confirmed in the operating room and the second of patients with ICD.10 identified finger cellulitis (FC), without concomitant FTS. Demographics, laboratory values, CT scans, and examination findings were evaluated. Axial CTs were evaluated in the coronal and sagittal planes and tendon sheath/tendon width were measured. The tendon sheath/tendon was recorded as a ratio in the coronal (CR) and sagittal (SR) planes. Continuous and dichotomous variables were analyzed and measures of sensitivity, specificity, and predictivity were calculated. Seventy patients were included, 35 in the FTS cohort and 35 with FC. RESULT A higher number of Kanavel signs were present in the FTS group (2.9 vs. 0.5, P < .05), with CR and SR both being significantly larger in the FTS group (P < .05). CR and SR cutoffs ≥ 1.3 provided high sensitivity, specificity, and positive predictive value (PPV) for FTS. Likelihood of FTS increased 5.9% and 5.5% for every 0.1 increase in CR and SR, respectively, with a 14% increase for every additional Kanavel sign. CONCLUSION In conclusion, CT ratios are useful in identifying FTS; and when used on their own or in combination with Kanavel's signs, CR and SR objectively improve the diagnosis of FTS.
Collapse
Affiliation(s)
| | | | - Brian Skura
- OhioHealth Grant Medical Center, Columbus, USA
| | | | | |
Collapse
|
9
|
van Dijk BT, Reijnierse M, van der Helm-van Mil AHM. Association of Interosseous Tendon Inflammation in the Hand With Different Early Arthritides in a 10-Year Magnetic Resonance Imaging Study. Arthritis Rheumatol 2023; 75:1935-1946. [PMID: 37289575 PMCID: PMC7615886 DOI: 10.1002/art.42626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/25/2023] [Accepted: 06/06/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Inflammation around the tendons of the hand interosseous muscles (interosseous tendon inflammation [ITI]) was recently identified on magnetic resonance imaging (MRI) in a set of patients with rheumatoid arthritis (RA) and arthralgia. We conducted a large MRI study to assess the prevalence of ITI at diagnosis of RA and of other arthritides, as well as its relationship with clinical signs. METHODS A total of 1,205 patients presenting with various types of early arthritis between 2010 and 2020 underwent contrast-enhanced hand MRI as part of the prospective Leiden Early Arthritis Cohort. MRI was evaluated with blinding for clinical data, for ITI lateral of metacarpophalangeal (MCP) joints 2-5, and for synovitis/tenosynovitis/osteitis. We assessed ITI presence at baseline per diagnosis and its relationship with clinical characteristics (ie, presence of hand arthritis, increased acute phase reactants, and local joint swelling and tenderness). Logistic regression and generalized estimating equations were used with adjustment for age and established local inflammation features (synovitis/tenosynovitis/osteitis). RESULTS A total of 36% of patients with early RA (n = 532) had ITI; this was similar in patients with anti-citrullinated protein antibody (ACPA)-negative RA (37%) and those with ACPA-positive RA (34%; P = 0.53). ITI occurred regularly in remitting seronegative symmetrical synovitis with pitting edema (60%) and connective tissue diseases (44%) and less frequently in undifferentiated arthritis (14%), psoriatic arthritis (14%), inflammatory osteoarthritis (8%), reactive arthritis (7%), crystal arthritis (7%), and peripheral spondylarthritis (4%). ITI occurred more often in diagnoses with frequent arthritis of the hands (P < 0.001) and increased acute-phase reactants (P < 0.001). Within RA, ITI occurred together with local MCP joint synovitis (odds ratio [OR] 2.4, 95% confidence interval [95% CI] 1.7-3.4), tenosynovitis (OR 2.4, 95% CI 1.8-3.3), and osteitis (OR 2.2, 95% CI 1.6-3.1) on MRI. Moreover, ITI presence was associated with local MCP joint tenderness (OR 1.6, 95% CI 1.2-2.1) and swelling (OR 1.8, 95% CI 1.3-2.6), independent of age and MRI-detected synovitis/tenosynovitis/osteitis. CONCLUSION ITI occurs regularly in RA and other arthritides with preferential involvement of hand joints and increased acute-phase reactants. At the MCP joint level, ITI associates independently with joint tenderness and swelling. Hence, ITI is a newly identified inflamed tissue mainly found in arthritides with particularly extensive and symptomatic inflammation.
Collapse
|
10
|
Dede BT, Oğuz M, Bulut B, Bağcıer F, Aytekin E. Carpal tunnel syndrome evaluation with ultrasound in rheumatoid arthritis patients. ARP Rheumatol 2023; 2:330-337. [PMID: 38174753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
AIM In this study, our primary aim was to compare ultrasound (US) findings of the median nerve between rheumatoid arthritis (RA) with carpal tunnel syndrome (CTS) (RA(+)CTS), RA without CTS (RA(-)CTS) and healthy controls (HC) and to determine the optimal US parameters to detect the presence of CTS in RA patients. METHODS 65 RA patients and 25 HC patients were included in this study. The diagnosis of CTS was made according to the clinical history and physical examination of the participants. Median nerve cross-sectional area(CSA) was measured at the carpal tunnel inlet(CTI), outlet(CTO), and forearm level by the US. In addition, anteroposterior(AP) and mediolateral(ML) diameters of the median nerve were measured. After the measurements, wrist-to-forearm ratio, wrist-to-forearm difference, and flattening ratio were calculated. The presence of tenosynovitis was investigated. RESULTS CTS was detected in 26(40.0%) of 65 RA patients who participated in the study. CTS was detected in 43(35.2%) of 122 wrists of 65 RA patients. CTI CSA, CTO CSA, forearm CSA, anteroposterior/mediolateral diameter, wrist-to-forearm ratio, wrist-to-forearm difference, and flattening ratio were significantly higher in RA(+)CTS than in RA(-)CTS and HC(p<0.01). In addition, CDAI and CTI CSA(r=0.322, p<0.01), CTO CSA(r=0.301, p<0.01), CTI-to-forearm ratio(r=0.345, p<0.001), CTI-to-forearm difference(r=0.362, p<0.01) and CTO-Forearm difference(r=0.304, p<0.01) moderate correlation was found between. The frequency of tenosynovitis was higher in wrists with CTS than in wrists without CTS (p<0.05). CONCLUSION While the presence of CTS in RA patients is sonographically evaluated, it may be useful to evaluate parameters such as CTI-to-forearm difference, ratio, and CTI ML diameter rather than just sticking to CTI CSA during diagnosis. Correlations of these parameters with disease activity can also be noted.
Collapse
Affiliation(s)
- Burak Tayyip Dede
- Physical Medicine and Rehabilitation Clinic, Istanbul Training and Research Hospital
| | - Muhammed Oğuz
- Physical Medicine and Rehabilitation Clinic, Istanbul Training and Research Hospital
| | - Berat Bulut
- Physical Medicine and Rehabilitation Clinic, Istanbul Training and Research Hospital
| | - Fatih Bağcıer
- Physical Medicine and Rehabilitation Clinic, Istanbul Cam and Sakura City Hospital
| | - Ebru Aytekin
- Physical Medicine and Rehabilitation Clinic, Istanbul Training and Research Hospital
| |
Collapse
|
11
|
Krijbolder DI, Matthijssen XME, van Dijk BT, van Steenbergen HW, Boeters DM, Willemze A, Schouffoer AA, van der Helm-van Mil AHM. The Natural Sequence in Which Subclinical Inflamed Joint Tissues Subside or Progress to Rheumatoid Arthritis: A Study of Serial MRIs in the TREAT EARLIER Trial. Arthritis Rheumatol 2023; 75:1512-1521. [PMID: 37094363 PMCID: PMC7615887 DOI: 10.1002/art.42527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 03/23/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE The natural trajectory of clinical arthritis progression at the tissue level remains elusive. We hypothesized that subclinical inflammation in different joint tissues (synovitis, tenosynovitis, osteitis) increases in a distinct temporal order in patients with clinically suspect arthralgia (CSA) who develop rheumatoid arthritis (RA) and subsides in a different sequence when CSA spontaneously resolves. METHODS We studied 185 serial magnetic resonance images (MRIs) from CSA patients with subclinical joint inflammation from the placebo arm of the TREAT EARLIER trial: 52 MRIs from 21 RA progressors (MRIs conducted at 1 year before, at 4 months before, and upon RA development), and 133 MRIs from 35 patients with spontaneous resolution of pain (MRIs conducted at baseline and at 4, 12, and 24 months). MRIs were scored for osteitis, synovitis, and tenosynovitis. We used cross-lagged models to evaluate 2 types of time patterns between pairs of inflamed tissues: a simultaneous pattern (coinciding changes) and a subsequent pattern (inflammatory changes in 1 tissue preceding changes in another tissue). RESULTS In patients who developed RA, synovitis, tenosynovitis, and osteitis increased simultaneously. Increasing osteitis occurred in the final 4 months before RA diagnosis, following incremental tenosynovitis and synovitis changes during the 1 year to 4 months before diagnosis (P < 0.01). In anti-citrullinated protein antibody (ACPA)-positive and ACPA-negative patients who progressed to RA, osteitis increased just before RA development. In patients with pain resolution, simultaneous decreases in synovitis, tenosynovitis, and osteitis occurred, with tenosynovitis decreasing in the first 4 months after CSA onset preceding decreasing synovitis and osteitis during 4-12 months (P = 0.02 and P < 0.01). CONCLUSION We identified natural sequences of subclinical inflammation in different joint tissues, which deepens our understanding of clinical arthritis and RA development. During RA progression, increasing osteitis followed previous increases in tenosynovitis and synovitis. During pain resolution, tenosynovitis decreased first, followed by decreasing synovitis and osteitis.
Collapse
Affiliation(s)
- Doortje I. Krijbolder
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Bastiaan T. van Dijk
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Debbie M. Boeters
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Annemiek Willemze
- Department of Rheumatology and Clinical Immunology, Maasstad Hospital, Rotterdam, The Netherlands
| | - Anne A. Schouffoer
- Department of Rheumatology, Leiden University Medical Center, Leiden, and Department of Rheumatology, Haga Hospital, The Hague, The Netherlands
| | - Annette H. M. van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, Leiden, and Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
12
|
Abdelghani KB, Boussaa H, Miladi S, Zakraoui L, Fazaa A, Laatar A. Value of Hands Ultrasonography in the Differential Diagnosis Between Psoriatic Arthritis and Rheumatoid Arthritis. J Ultrasound Med 2023; 42:1987-1995. [PMID: 36880692 DOI: 10.1002/jum.16215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 02/01/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Psoriatic arthritis (PsA) can mimic rheumatoid arthritis (RA) at an early stage, especially when psoriasis is lacking. In the absence of specific radiological and immunological markers, the differential diagnosis between these two diseases can be challenging. We aimed to determine whether hands ultrasonography (US) may be useful in the differential diagnosis between PsA and RA. METHODS We conducted a cross-sectional study including patients with PsA and RA. All wrists and small joints of the hands were examined using gray-scale and Power Doppler US. The evaluated US lesions were: synovitis, tenosynovitis of extensor carpi ulnaris, extensor communis and flexor tendons, enthesitis of extensor tendons at distal interphalangeal joints, peritendon inflammation of extensor tendons, and soft tissue edema. RESULTS Six hundred joints in 20 PsA patients and 900 joints in 30 RA patients were assessed. Extensor enthesitis was significantly more observed in PsA compared with RA (39.4 vs 26.3%, P = .006) with a significant higher frequency of enthesophytes and calcifications (P = .022 and P = .002, respectively). Peritendon inflammation of extensor digitorum tendons was observed in 13% of metacarpophalangeal joints in PsA patients versus 3% in RA patients with a significant difference (P < .001). Soft tissue edema was exclusively observed in PsA (1.5 vs 0%, P = .033). Power Doppler synovitis was significantly more frequent in RA (9.2 vs 5%, P = .002). Extensor carpi ulnaris tenosynovitis was significantly more frequent in RA (18.3 vs 2.5%, P = .017). CONCLUSION Extrasynovial US findings may be helpful to distinguish PsA from RA especially in patients with immunonegative polyarthritis and no evidence of psoriasis.
Collapse
Affiliation(s)
- Kawther Ben Abdelghani
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Rheumatology, Mongi Slim University Hospital, La Marsa, Tunisia
| | - Hiba Boussaa
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Rheumatology, Mongi Slim University Hospital, La Marsa, Tunisia
| | - Saoussen Miladi
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Rheumatology, Mongi Slim University Hospital, La Marsa, Tunisia
| | - Leith Zakraoui
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Rheumatology, Mongi Slim University Hospital, La Marsa, Tunisia
| | - Alia Fazaa
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Rheumatology, Mongi Slim University Hospital, La Marsa, Tunisia
| | - Ahmed Laatar
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
- Department of Rheumatology, Mongi Slim University Hospital, La Marsa, Tunisia
| |
Collapse
|
13
|
Izumiyama T, Miyazawa M. Importance of tenosynovitis in preventing the progression through rheumatoid arthritis continuum. Mod Rheumatol 2023; 33:868-874. [PMID: 36124933 DOI: 10.1093/mr/roac109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/20/2022] [Accepted: 09/01/2022] [Indexed: 11/12/2022]
Abstract
Rheumatoid arthritis (RA) has long been characterized by synovitis and bone erosions typically developing symmetrically in small joints. However, recent advances in imaging modalities have indicated frequent association of tenosynovitis with RA, and some consider tenosynovitis to be not just a complication but a major trait of RA. Furthermore, as there are cases with tenosynovitis preceding the clinical detection of inflammatory arthritis in predisposed individuals, tenosynovitis may constitute an important biomarker in defining the pre-RA phase of disease development. Tenosynovitis itself must be treated as it causes functional impairment and physical as well as socioeconomic burden, and its treatment may result in effective prevention of RA development at a pre-arthritic stage. Thus, further efforts need to be taken in detecting and treating tenosynovitis in the pre-RA stage, which can be facilitated by ultrasonography and magnetic resonance imaging.
Collapse
Affiliation(s)
| | - Masaaki Miyazawa
- Department of Immunology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan
| |
Collapse
|
14
|
Tamai M, Grundeken V, Arima K, Brinck RT, Mil AHMVDHV, Ohki N, Uetani M, Kawakami A. Predictive Value of Magnetic Resonance Imaging-detected Tenosynovitis of the Metacarpophalangeal and Wrist Joints for the Development of Rheumatoid Arthritis among Patients with Undifferentiated Arthritis. Intern Med 2023; 62:2329-2334. [PMID: 36631087 PMCID: PMC10484776 DOI: 10.2169/internalmedicine.0077-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 11/24/2022] [Indexed: 01/13/2023] Open
Abstract
Objective The early diagnosis of rheumatoid arthritis (RA) improves disease outcomes. Using bilateral magnetic resonance imaging (MRI), we investigated whether or not tenosynovitis at the level of the metacarpophalangeal (MCP) and wrist joints, as well as non-symmetrical versus symmetrical involvement, predicts RA development in undifferentiated arthritis (UA) patients. Methods We collected the clinical and serological findings as well as bilateral gadolinium-enhanced 1.5-T MRI data of UA patients after 1 year. A multivariate logistic regression analysis was used to determine the association of tenosynovitis in UA with RA development. Ninety-one UA patients from the Nagasaki Early Arthritis Clinic who did not meet the 2010 European League Against Rheumatism/American College of Rheumatology classification criteria for RA were selected. Tenosynovitis at the MCP and wrist joints was scored according to the RA MRI scoring system. Results Of these 91 UA patients, 29 (31.9%) progressed to RA, with a median disease duration of 3 months, despite only 10.9% being positive for anti-cyclic citrullinated peptide antibody (ACPA). A univariate analysis showed higher MCP tenosynovitis scores, MCP flexor tenosynovitis, and symmetrical MCP tenosynovitis in the RA development group than in the non-development group (p<0.05). A multivariate analysis showed that symmetrical MCP tenosynovitis was independently associated with RA development after adjusting for age, gender, swollen joint count, C-reactive protein level, and ACPA positivity (odds ratio: 4.96). The presence of symmetrical MCP tenosynovitis had low sensitivity (35%) but high specificity (87%) for RA development. Conclusion MRI-detected tenosynovitis, especially symmetrical findings at the MCP joint, is predictive of RA development in a UA population with low ACPA positivity.
Collapse
Affiliation(s)
- Mami Tamai
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Vincent Grundeken
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - Kazuhiko Arima
- Department of Public Health, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Robin Ten Brinck
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | | | - Nozomi Ohki
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Masataka Uetani
- Department of Radiological Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| | - Atsushi Kawakami
- Department of Immunology and Rheumatology, Graduate School of Biomedical Sciences, Nagasaki University, Japan
| |
Collapse
|
15
|
van Dijk BT, Wisse LJ, van Steenbergen HW, Reijnierse M, Khidir SJH, DeRuiter MC, van der Helm-van Mil AHM. Interosseous tendon inflammation in the hands of patients with clinically suspect arthralgia: analysis of MRI data from a prospective cohort study. Lancet Rheumatol 2023; 5:e401-e412. [PMID: 38251551 PMCID: PMC7615884 DOI: 10.1016/s2665-9913(23)00129-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Inflammation around the tendons of interosseous muscles of the hand (interosseous tendon inflammation) was recently observed with MRI for the first time in patients with rheumatoid arthritis and in at-risk individuals with detectable anti-citrullinated protein antibodies, generating the hypothesis that interosseous tendon inflammation precedes clinical arthritis. To better understand the role of interosseous tendon inflammation during the development of rheumatoid arthritis, we studied the frequency of interosseous tendon inflammation in healthy individuals and in those with arthralgia that was suspected of progressing to rheumatoid arthritis (ie, clinically suspect arthralgia) and the association of interosseous tendon inflammation with other symptoms of inflamed joint tissues and with clinical arthritis development. METHODS Adult (age ≥18 years) patients who presented with clinically suspect arthralgia and symptom-free (control) individuals underwent contrast-enhanced hand MRI. MRIs were evaluated for interosseous tendon inflammation on the radial and ulnar sides of the second to fifth metacarpophalangeal joints, and for synovitis, tenosynovitis, and osteitis using the rheumatoid arthritis MRI scoring system. Patients with clinically suspect arthralgia were followed up for clinical arthritis development. The presence of local tenosynovium was examined using immunohistochemistry for anti-CD55 and anti-CD68 on tissue from the hands of three embalmed bodies donated for scientific research. The primary outcome for the cross-sectional part of the study was the presence of interosseous tendon inflammation on MRI. The primary outcome for the longitudinal part of the study was development of clinical arthritis. FINDINGS Between April 3, 2012, and May 20, 2020, 667 patients with clinically suspect arthralgia (mean age 44 years [SD 13], 504 [76%] were women and 163 [24%] were men) underwent contrast-enhanced hand MRI. Between Nov 1, 2013, and Nov 30, 2014, 193 symptom-free controls were recruited (mean age 50 years [SD 16], 136 [70%] were women and 57 [30%] were men). Two (1%) of 193 symptom-free controls had interosseous tendon inflammation. Immunohistochemistry of cadaveric hand tissues showed no tenosynovium surrounding interosseous tendons. At inclusion, 67 (10%) of 667 patients with clinically suspect arthralgia had interosseous tendon inflammation (p<0·0001 vs symptom-free controls). Interosseous tendon inflammation occurred more frequently if synovitis (odds ratio [OR] 2·2 [95% CI 1·2-4·2]), or tenosynovitis (OR 9·7 [5·5-17·0]), was present at metacarpophalangeal joints. A three-dimensional MRI reconstruction suggested confluency of interosseous tendon inflammation with metacarpophalangeal-flexor-tenosynovitis. 91 (16%) of 558 patients with clinically suspect arthralgia developed clinical arthritis during follow-up (median total follow-up 25·3 months [95% CI 25·1-25·5]). Patients with clinically suspect arthralgia with interosseous tendon inflammation had a higher risk of developing clinical arthritis (hazard ratio [HR] 4·5 [2·8-7·2]), which was attenuated but still significant after adjusting for concomitant synovitis, tenosynovitis, or osteitis (HR 1·7 [1·02-2·8]). INTERPRETATION Interosseous tendon inflammation is almost absent in symptom-free individuals but occurs in people with clinically suspect arthralgia, in whom it correlates with symptoms and is associated with the development of clinical arthritis. The absence of local tenosynovium suggests that interosseous tendon inflammation arises from expanding local subclinical inflammation in the pre-arthritis phase of rheumatoid arthritis. FUNDING European Research Council and the Dutch Arthritis Society.
Collapse
Affiliation(s)
- Bastiaan T van Dijk
- Department of Rheumatology, Leiden University Medical Centre, Leiden, Netherlands.
| | - Lambertus J Wisse
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Centre, Leiden, Netherlands
| | - Sarah J H Khidir
- Department of Rheumatology, Leiden University Medical Centre, Leiden, Netherlands
| | - Marco C DeRuiter
- Department of Anatomy and Embryology, Leiden University Medical Centre, Leiden, Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Centre, Leiden, Netherlands; Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands
| |
Collapse
|
16
|
Vega-Fernandez P, De Ranieri D, Oberle E, Clark M, Bukulmez H, Lin C, Shenoi S, Thatayatikom A, Woolnough L, Benham H, Brunner E, Henrickson M, Pratt LR, Proulx-Gauthier JP, Janow G, Cassedy A, Ting TV, Roth J. Comprehensive and reliable sonographic assessment and scoring system for inflammatory lesions of the paediatric ankle. Rheumatology (Oxford) 2023; 62:2239-2246. [PMID: 36308429 PMCID: PMC10234197 DOI: 10.1093/rheumatology/keac622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE The clinical decision-making process in paediatric arthritis lacks an objective, reliable bedside imaging tool. The aim of this study was to develop a US scanning protocol and assess the reliability of B-mode and Doppler scoring systems for inflammatory lesions of the paediatric ankle. METHODS As part of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) US group, 19 paediatric rheumatologists through a comprehensive literature review developed a set of standardized views and scoring systems to assess inflammatory lesions of the synovial recesses as well as tendons of the paediatric ankle. Three rounds of scoring of still images were followed by one practical exercise. Agreement among raters was assessed using two-way single score intraclass correlation coefficients (ICC). RESULTS Of the 37 initially identified views to assess the presence of ankle synovitis and tenosynovitis, nine views were chosen for each B-mode and Doppler mode semi-quantitative evaluation. Several scoring exercises and iterative modifications resulted in a final highly reliable scoring system: anterior tibiotalar joint ICC: 0.93 (95% CI 0.92, 0.94), talonavicular joint ICC: 0.86 (95% CI 0.81, 0.90), subtalar joint ICC: 0.91 (95% CI 0.88, 0.93) and tendons ICC: 0.96 (95% CI 0.95, 0.97). CONCLUSION A comprehensive and reliable paediatric ankle US scanning protocol and scoring system for the assessment of synovitis and tenosynovitis were successfully developed. Further validation of this scoring system may allow its use as an outcome measure for both clinical and research applications.
Collapse
Affiliation(s)
- Patricia Vega-Fernandez
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Deirdre De Ranieri
- Division of Rheumatology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Edward Oberle
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Matthew Clark
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hulya Bukulmez
- Division of Pediatric Rheumatology, Department of Pediatrics, Metro Health Medical System, Case Western Reserve University, Cleveland, OH, USA
| | - Clara Lin
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
| | - Susan Shenoi
- Seattle Children’s Hospital and Research Center University of Washington, Seattle, WA, USA
| | - Akaluck Thatayatikom
- AdventHealth Medical Group Pediatric Rheumatology and Immunology, Orlando, FL, USA
| | | | - Heather Benham
- Department of Pediatrics, Scottish Rite for Children, Frisco, TX, USA
| | - Emily Brunner
- Department of Pediatrics, Geisinger Medical Center, Danville, PA, USA
| | - Michael Henrickson
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Laura R Pratt
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Ginger Janow
- Joseph M. Sanzari Children’s Hospital, Hackensack, NJ, USA
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Tracy V Ting
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | |
Collapse
|
17
|
Naredo E, Largo R, Olivas-Vergara O, Herencia C, Mateos-Fernández M, García-de-Pereda-Notario CM, Mérida-Velasco JR, Herrero-Beaumont G, Murillo-González J. What happens under the flexor tendons of the fingers in dactylitis? Med Ultrason 2023; 25:42-47. [PMID: 36996392 DOI: 10.11152/mu-4026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/19/2023]
Abstract
AIM Tenosynovitis is one of the most frequently described inflammatory lesions in psoriatic dactylitis. The aim of the study was to assess by ultrasound the distribution of content within the synovial sheath of the finger flexor tendons in a cadaveric experimental model of tenosynovitis and to describe anatomically the elements of the space between the flexor tendons and the palmar aspect of the proximal phalanx of the fingers. MATERIAL AND METHOD Silicone was injected under ultrasound guidance into the digital flexor sheath of the index finger of a hand specimen. Ultrasound images of the distribution of the filling of the flexor synovial space with the injected material were obtained. These images were compared with images from patients with psoriatic dactylitis. The palmar regions of the hand and fingers were dissected to check the distribution of the injected silicone in the synovial cavity. Additionally, we dissected the 2nd to 5th fingers of five cadaveric hands, including the one used for the experiment. RESULTS During the injection of the substance, we observed an increasing homogeneous hypoechoic band around the flexor tendons that differed from the images of patients. Dissection of the specimen showed the injected silicone distributed throughout the digital flexor sheath to the distal interphalangeal joint. In addition, we provided an illustrated anatomical description of the elements located between the flexor tendons and the palmar aspect of the proximal phalanx, the inflammation of which could simulate flexor tenosynovitis. CONCLUSION The observations of this study may contribute to a better understanding of the anatomical structures involved in PsA dactylitis.
Collapse
Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology. Hospital Universitario Fundación Jiménez Díaz, Madrid. Spain. Bone and Joint Research Unit. IIS-Fundación Jiménez Díaz- Universidad Autónoma of Madrid. Madrid, Spain..
| | - Raquel Largo
- Bone and Joint Research Unit. IIS-Fundación Jiménez Díaz- Universidad Autónoma of Madrid. Madrid, Spain..
| | - Otto Olivas-Vergara
- Department of Rheumatology. Hospital Universitario Fundación Jiménez Díaz, Madrid. Spain. Bone and Joint Research Unit. IIS-Fundación Jiménez Díaz- Universidad Autónoma of Madrid. Madrid, Spain..
| | - Carmen Herencia
- Bone and Joint Research Unit. IIS-Fundación Jiménez Díaz- Universidad Autónoma of Madrid. Madrid, Spain..
| | - Myriam Mateos-Fernández
- Bone and Joint Research Unit. IIS-Fundación Jiménez Díaz- Universidad Autónoma of Madrid. Madrid, Spain..
| | | | - José Ramón Mérida-Velasco
- Department of Anatomy and Embryology, Faculty of Medicine, Universidad Complutense of Madrid. Madrid, Spain..
| | - Gabriel Herrero-Beaumont
- Department of Rheumatology. Hospital Universitario Fundación Jiménez Díaz, Madrid. Spain. Bone and Joint Research Unit. IIS-Fundación Jiménez Díaz- Universidad Autónoma of Madrid. Madrid, Spain..
| | - Jorge Murillo-González
- Department of Anatomy and Embryology, Faculty of Medicine, Universidad Complutense of Madrid. Madrid, Spain..
| |
Collapse
|
18
|
Bhat AK, Vyas R, Acharya AM, Rajagopal KV. De Quervain's tenosynovitis: a non-randomized two-armed study comparing ultrasound-guided steroid injection with surgical release. Musculoskelet Surg 2023; 107:105-114. [PMID: 35195844 PMCID: PMC10020267 DOI: 10.1007/s12306-022-00735-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/29/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE Ultrasonography is currently used for both diagnostic and therapeutic purposes in de Quervain's tenosynovitis. There is a dearth of information on how effective an ultrasound-guided (USG) steroid injection is when compared to surgical release of the first extensor compartment. Hence, we performed a non-randomized two-armed comparison study to test our hypothesis that USG guided steroid injection is equally effective as surgery. METHOD 62 consecutive patients participated in the study with 32 of them selecting the option of USG guided injection (Set A), and the rest undergoing surgical release (Set B). We reviewed them after 3 and 6 weeks and 6 months for functional outcome using DASH, PRWE and VAS scores, recurrence, or any complications. They were further followed if they were symptomatic. RESULTS The DASH/PRWE/VAS scores improved at the end of 6 months from 81.7/79.3/6.8 to 1.0/1.7/1.0, respectively for patients undergoing USG guided steroid injection. Similarly, for the patient undergoing surgery, the scores improved from 82.2/81.5/6.7 to 1.7/3.4/1.0, respectively. This was statistically significant in both the groups (p < 0.05) and was comparable to each other. Two patients in Set A came back with recurrence at eight and 10 months and two reported occasional pain on heavy work. Three patients had tenderness and two had numbness in Set B at the scar site. CONCLUSION We observed that USG guided steroid injections are comparable to surgical release in terms of pain relief, functional outcome, complications.
Collapse
Affiliation(s)
| | | | - A M Acharya
- Division of Hand and Microsurgery, Department of Orthopaedics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India.
| | - K V Rajagopal
- Department of Radiodiagnosis, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, 576104, India
| |
Collapse
|
19
|
Beidleman MB, Colberg RE, Beason DP, Fleisig GS. A Retrospective Case Series Study on a Minimally Invasive Ultrasound-Guided First Dorsal Compartment Release Technique for Refractory De Quervain Tenosynovitis. Am J Phys Med Rehabil 2023; 102:235-240. [PMID: 35944081 DOI: 10.1097/phm.0000000000002082] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcomes of patients treated with a novel minimally invasive complete release of the first dorsal compartment percutaneously under ultrasound guidance using an 18-gauge needle with an 18 blade at the tip. DESIGN This was a retrospective case series. Nine adults (ten wrists) were included in the study of this technique. All patients had failed conservative care and had tenderness to palpation over the first dorsal compartment, a positive Finklestein test, and confirmed tenosynovitis with ultrasound imaging before the procedure. The main outcome measures were reduction in pain as determined by the numeric rating scale and improvement of function determined by the Nirschl Phase scale at both short- and long-term follow-up. RESULTS There was 100% follow-up, with mean (SD) follow-up occurring at 23.1 (9.8) mos (range, 9-42 mos). From preprocedure to follow-up, numeric rating scale pain decreased from 4.1 (SD, 2.5) to 0.0 (SD, 0.0) ( P < 0.001), and Nirschl phase improved from 2.5 (SD, 1.9) to 0.2 (SD, 0.4) ( P = 0.03). No patients required revision open-release surgery or suffered neurovascular complications. CONCLUSION This technique resulted in significant improvement of pain and function for all patients and no short- or long-term neurovascular complications were seen.
Collapse
|
20
|
Krishnamurthy A, Circiumaru A, Sun J, Kisten Y, Damberg P, Sakuraba K, Sandor K, Jarvoll P, Zhou T, Malmström V, Svensson CI, Hensvold A, Catrina AI, Klareskog L, Réthi B. Combination of Two Monoclonal Anti-Citrullinated Protein Antibodies Induced Tenosynovitis, Pain, and Bone Loss in Mice in a Peptidyl Arginine Deiminase-4-Dependent Manner. Arthritis Rheumatol 2023; 75:164-170. [PMID: 35930718 PMCID: PMC10108252 DOI: 10.1002/art.42320] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/04/2022] [Accepted: 07/26/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The appearance of anti-citrullinated protein antibodies (ACPAs) in the circulation represents a major risk factor for developing rheumatoid arthritis (RA). Patient-derived ACPAs have been shown to induce pain and bone erosion in mice, suggesting an active role in the pathogenicity of RA. We undertook this study to investigate whether ACPAs can induce tenosynovitis, an early sign of RA, in addition to pain and bone loss and whether these symptoms are dependent on peptidyl arginine deiminase 4 (PAD4). METHODS Monoclonal ACPAs generated from plasma cells of RA patients were transferred to wild-type and PAD4-deficient mice. Pain-like behavior and macroscopic inflammation were monitored for a period of 4 weeks, followed by the analyses of tenosynovitis in the ankle joints using magnetic resonance imaging (MRI) and bone microarchitecture in the tibia using an X-ray microscope. Microscopic changes in the tendon sheath were analyzed in decalcified ankle joint sections. RESULTS The combination of 2 monoclonal ACPAs (1325:04C03 and 1325:01B09) induced long-lasting pain-like behavior and trabecular bone loss in mice. Although no synovitis was observed macroscopically, we detected tenosynovitis in the ACPA-injected mice by MRI. Microscopic analyses of the joints revealed a cellular hyperplasia and a consequent enlargement of the tendon sheath in the ACPA-treated group. In PAD4-/- mice, the effects of ACPAs on pain-like behavior, tenosynovitis, and bone loss were significantly reduced. CONCLUSION Monoclonal ACPAs can induce tenosynovitis in addition to pain and bone loss via mechanisms dependent on PAD4-mediated citrullination.
Collapse
Affiliation(s)
- Akilan Krishnamurthy
- Department of Medicine, Rheumatology UnitCenter of Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Alexandra Circiumaru
- Department of Medicine, Rheumatology UnitCenter of Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Jitong Sun
- Department of Medicine, Rheumatology UnitCenter of Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Yogan Kisten
- Department of Medicine, Rheumatology UnitCenter of Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Peter Damberg
- Karolinska Experimental Research and Imaging Centre (KERIC)StockholmSweden
| | - Koji Sakuraba
- Department of Medicine, Rheumatology UnitCenter of Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Katalin Sandor
- Department of Physiology and PharmacologyCenter for Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Patrik Jarvoll
- Karolinska Experimental Research and Imaging Centre (KERIC)StockholmSweden
| | - Tunhe Zhou
- Stockholm University Brain Imaging Centre (SUBIC), Stockholm UniversityStockholmSweden
| | - Vivianne Malmström
- Department of Medicine, Rheumatology UnitCenter of Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Camilla I. Svensson
- Department of Physiology and PharmacologyCenter for Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Aase Hensvold
- Department of Medicine, Rheumatology UnitCenter of Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Anca I. Catrina
- Department of Medicine, Rheumatology UnitCenter of Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Lars Klareskog
- Department of Medicine, Rheumatology UnitCenter of Molecular Medicine, Karolinska InstitutetStockholmSweden
| | - Bence Réthi
- Department of Medicine, Rheumatology UnitCenter of Molecular Medicine, Karolinska InstitutetStockholmSweden
| |
Collapse
|
21
|
Floris A, Rozza D, Zanetti A, Carrara G, Bellis E, Cauli A, Iagnocco A, Scirè CA, Piga M. Musculoskeletal ultrasound may narrow the gap between patients and physicians in the assessment of rheumatoid arthritis disease activity. Rheumatology (Oxford) 2022; 62:116-123. [PMID: 35482548 DOI: 10.1093/rheumatology/keac255] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/10/2022] [Accepted: 04/10/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES To investigate the association between patient-physician discordance in the assessment of disease activity and residual US synovitis/tenosynovitis in a cohort of patients with RA in clinical remission. METHODS A post hoc analysis of the STARTER study, promoted by the Musculoskeletal-US (MSUS) Study Group of the Italian Society for Rheumatology, was performed using data from 361 consecutive patients with RA in clinical remission. The global assessment of disease activity by each patient (PGA) and evaluator/physician (EGA) was recorded on a 100-mm visual analogue scale. The PGA-EGA discordance was classified as positive (PGA>EGA) or negative (PGA<EGA) using a cut-off of ±10 mm. The association of discordance with greyscale (GS) and power Doppler (PD) synovitis (S) and tenosynovitis (T) scores was evaluated through logistic regression analysis. The odds ratio for each point of the scores, adjusted for prespecified confounders (adjOR), was calculated. RESULTS The mean (s.d.) PGA and EGA scores were 6.1 (7.1) and 8.8 (12) mm, respectively, with a median (IQR) absolute difference of 4 (0-10) mm. Positive and negative discordances were recorded in 39 (10.8%) and 65(18.0%) patients, respectively. The GS-S (adjOR 1.099) and PD-S (adjOR 1.167) scores were associated with positive discordance (P < 0.01), while the GS-T (adjOR 1.083), GS-S (adjOR 1.063) and PD-S (adjOR 1.089) scores were associated with negative discordance (P < 0.05). The PGA-EGA discordance did not predict flares at 6 and 12 months. CONCLUSIONS Patient-physician discordance is associated with the lack of US remission in patients with RA and may represent a further indication for MSUS.
Collapse
Affiliation(s)
- Alberto Floris
- Rheumatology Unit, Department of Medicine and Public Health, Azienda Ospedaliero-Universitaria and University of Cagliari, Monserrato, Italy
| | - Davide Rozza
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- Department of Statistics and Quantitative Methods, Division of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Emanuela Bellis
- Day Hospital Multidisciplinare Ospedale di Borgomanero e Ambulatori di Reumatologia, ASL Novara, Novara, Italy
| | - Alberto Cauli
- Rheumatology Unit, Department of Medicine and Public Health, Azienda Ospedaliero-Universitaria and University of Cagliari, Monserrato, Italy
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Carlo Alberto Scirè
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Matteo Piga
- Rheumatology Unit, Department of Medicine and Public Health, Azienda Ospedaliero-Universitaria and University of Cagliari, Monserrato, Italy
| |
Collapse
|
22
|
Wang J, Wu Z, Wang M, Qi Q, Song Q, Sun B, Li C, Dong Y. Evaluation of tenosynovitis in patients with seronegative rheumatoid arthritis using microvascular flow imaging. Med Eng Phys 2022; 110:103839. [PMID: 35773135 DOI: 10.1016/j.medengphy.2022.103839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/06/2022] [Accepted: 06/23/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES The purpose of this research was investigate the potential use of MVFI (microvascular flow imaging) in the assessment of tenosynovitis in cases with SNRA (seronegative rheumatoid arthritis). METHODS Fifty-six SNRA cases and 20 HCs (healthy controls) were enrolled, and all of them were subjected to ultrasonographic examination of the compartments I-VI of the extensor tendons of the wrist, flexor carpi radialis and flexor tendons of the five digits. Each tendon synovial sheath was semi-quantitatively scored by GS (gray-scale) ultrasound, PD (power Doppler) ultrasound, and MVFI. The PD and MVFI scores for each tendon synovial sheath were added up for each patient to get the total scores. GS scores, PD scores, and MVFI scores of tendon synovial sheaths were compared between the two groups. The correlations of total PD scores and total MVFI scores with DAS28 (disease activity scores in 28 joints), ESR (erythrocyte sedimentation rate), and CRP (C-reactive protein) were analyzed. RESULTS (1) In the HC group (480 tendons), GS revealed abnormalities in 29 (6.04%) tendon synovial sheaths. The GS score was 1.03 ± 0.18 with the predominance of GS grade 1 (96.55%). In the SNRA group (1,344 tendons), GS detected abnormalities in 418 tendon synovial sheaths (31.10%). The GS score was 1.97 ± 0.53 with the predominance of GS grade 2 (71.77%). There were significant differences in the GS examination rate and grade for tenosynovitis between the two groups (P < 0.05). (2) In the SNRA group, involvement of the extensor carpi ulnaris in the 6th dorsal compartment was the most common among all extensor tendons; the flexor tendon of the third digit was the most commonly affected among all flexor tendons. (3) In the HC group, the MVFI and PD scores were 0 for tendon synovial sheaths upon GS examination. In the SNRA group, the blood flow display rate of abnormal tendon synovial sheaths indicated by GS was 83.49% and 64.59% upon MVFI and PD, respectively. The results of the two imaging techniques were significantly different (P < 0.05). The blood flow grade of abnormal tendon synovial sheaths indicated by GS was significantly different between MVFI and PD (P < 0.05), which was higher upon MVFI than PD. (4) The total MVFI score and the total PD score in the SNRA group were correlated positively with CRP, ESR and DAS28 (P < 0.05). CONCLUSION MVFI is a more sensitive way in detection of blood flow in the tendon synovial sheaths of SNRA cases, which may be used in clinic to evaluate disease activity and tenosynovitis in SNRA cases.
Collapse
Affiliation(s)
- Junkui Wang
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Zhibin Wu
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Miao Wang
- Department of Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Qinghua Qi
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China.
| | - Qingshan Song
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Bingfang Sun
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Caiyun Li
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| | - Yu Dong
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, 450052 China
| |
Collapse
|
23
|
Caillault L, Coiffier G, Robin F, Droitcourt C, Lescoat A. Sclerosing tenosynovitis in a patient with pan-sclerotic morphea. Joint Bone Spine 2022; 89:105421. [PMID: 35671975 DOI: 10.1016/j.jbspin.2022.105421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/30/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Leïla Caillault
- Department of internal medicine and clinical immunology, university of Rennes 1, CHU Rennes, Rennes, France.
| | - Guillaume Coiffier
- Department of internal medicine and clinical immunology, university of Rennes 1, CHU Rennes, Rennes, France; Department of rheumatology, CH Dinan, Dinan, France
| | - François Robin
- Inserm, Inra, department of rheumatology, Institut NUMECAN (Nutrition Metabolism and Cancer), CHU Rennes, 35000 Rennes, France
| | - Catherine Droitcourt
- Inserm CIC1414, UPRES EA 7449 REPERES (Pharmacoepidemiology and access to health care), University Rennes 1 and French School of Public Health, department of dermatology, university of Rennes 1, CHU Rennes, Rennes, France
| | - Alain Lescoat
- Department of internal medicine and clinical immunology, university of Rennes 1, CHU Rennes, Rennes, France; Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail) - UMR_S 1085, university of Rennes, CHU Rennes, 35000 Rennes, France
| |
Collapse
|
24
|
Kahn M, Fleece M. Rice Bodies in Tenosynovitis Due to Psoriatic Arthritis. N Engl J Med 2022; 387:e14. [PMID: 35960208 DOI: 10.1056/nejmicm2118312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Molly Fleece
- University of Alabama at Birmingham, Birmingham, AL
| |
Collapse
|
25
|
Draghi F, Ferrozzi G, Ballerini D, Bortolotto C. Psoriatic arthritis: Ultrasound peculiarities with particular emphasis on enthesitis. J Clin Ultrasound 2022; 50:556-560. [PMID: 35238049 DOI: 10.1002/jcu.23170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/09/2022] [Accepted: 02/08/2022] [Indexed: 06/14/2023]
Abstract
The prevalence of psoriatic arthritis among patients with psoriasis has a marked variability with ethnic and geographic variations. Inflammatory changes associated with psoriatic arthritis include bone erosion, tenosynovitis, and synovial hypertrophy, but enthesitis is considered the hallmark. Both X-ray and magnetic resonance imaging (MRI) are usefull in the diagnosis of psoriatic arthritis, but ultrasonography is the best imaging modality to assess entheses. Ultrasound findings of enthesitis include a loss of the regular fibrillar architecture, hypoechoic thickening, hypervascularization of tendons, ligaments, and joint capsules at their bony attachment, bony changes (including irregularities and erosions). Ultrasound has also proved the ability to detect inflammatory subclinical findings and to be useful in the follow-up of therapies.
Collapse
Affiliation(s)
- Ferdinando Draghi
- Diagnostic Imaging Department, IRCCS Maugeri Montescano, Montescano (PV), Italy
- Diagnostic Imaging Department, Centro Medico Clastmed, Codevilla, Italy
| | - Guia Ferrozzi
- Diagnostic Imaging Department, Centro Medico Inacqua, Piacenza, Italy
- Diagnostic Imaging Department, Centro Medico Riabilitativo Rocca, Piacenza, Italy
| | - Daniela Ballerini
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chandra Bortolotto
- Radiology Institute, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| |
Collapse
|
26
|
Leidersnaider CL, Sztajnbok FR, Coutinho ESF, Vaz JLP, Porangaba M, Hamdan PC, Martins PH, Constantino CPL, Ancillotti RV, Messeder AM, Monteiro DG, Folly MM, Mogami R. Chikungunya Fever: Comparison Study of Synovitis and Tenosynovitis of the Hands and Wrists Using Physical Examination, Ultrasound, and MRI Findings. J Ultrasound Med 2022; 41:865-873. [PMID: 34170018 DOI: 10.1002/jum.15766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/10/2021] [Accepted: 05/31/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES To compare musculoskeletal changes on a physical examination (PE), ultrasound (US) and magnetic resonance imaging (MRI) of the hands and wrists of patients with Chikungunya fever (CF). METHODS The sample consisted of 30 patients in the chronic phase of CF. The sites analyzed were the interphalangeal (IP), metacarpophalangeal (MCP) and wrist/mediocarpal (WMC) joints and periarticular soft tissue. The interval between the PE and imaging tests was 7 days, and the interval between US and MRI was 2 days. The kappa coefficient was calculated to estimate the agreement between the PE and US and MRI findings and between the US and MRI findings. RESULTS Significant agreement was observed between PE and US in the diagnosis of synovitis. The only statistically significant agreement between US and MRI was the finding of flexor tenosynovitis; the agreement was moderate. CONCLUSIONS US has great potential for use in diagnosing synovitis suspected based on a PE. The limited agreement observed between US and MRI, in turn, may suggest a complementary role of these methods.
Collapse
Affiliation(s)
| | | | | | - João Luiz Pereira Vaz
- Department of Rheumatology, Federal University of the State of Rio de Janeiro, Brazil
| | - Marina Porangaba
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Paulo Cesar Hamdan
- Department of Rheumatology, Rio de Janeiro Federal University, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Mayara Malta Folly
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | - Roberto Mogami
- Department of Radiology, Rio de Janeiro State University, Rio de Janeiro, Brazil
| |
Collapse
|
27
|
Guillén-Astete CA, García-López H, Zurita-Prada PA, Urrego-Laurín C, Kanaffo S, Terán-Tinedo MA, García-Montes N. Ultrasound changes following controlled mechanical stress in synovial tissue in the hands of healthy individuals. ARP Rheumatol 2022; 1:117-121. [PMID: 35810369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The physiological response of the synovium to acute mechanical stress has not been extensively studied. This response is interesting in terms of the morphological changes it can cause as any such changes should be taken into account during ultrasound examinations. The purpose of this study was to assess the extent of changes in ultrasound images of the synovial joint in the hands of healthy individuals after controlled mechanical stress. METHOD We included 110 healthy volunteers on whom we carried out two ultrasound examinations of the non-dominant hand: one at baseline and the other after controlled handgrip exercise at 70% of the maximum voluntary contraction. RESULTS The synovitis scores at baseline and after exercise were 0.472±0.798 and 0.772±1.162 t(109)=-3.791, respectively; p < 0.001. We observed no tenosynovitis in 88.2% of the participants at baseline, while after exercise the percentage fell to 70.9%; x2 (1, N=110) =10.0851, p = 0.0014. CONCLUSION We conclude that synovitis and tenosynovitis are inducible by physical exercise and are detectable on ultrasound. This should be taken into account during ultrasound examinations for suspicion or follow-up of inflammatory rheumatism.
Collapse
|
28
|
Carità E, Donadelli A, Laterza M, Perazzini P, Tamburin S, Zanette G. High-resolution ultrasound in the diagnosis of failed carpal tunnel decompression: a study of 35 cases. J Hand Surg Eur Vol 2022; 47:364-368. [PMID: 35000473 DOI: 10.1177/17531934211068636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We used high-resolution ultrasound to examine 35 median nerves (35 patients) with failed carpal tunnel decompression to identify the cause of failure. The carpal tunnel was examined before revision surgery, and the results were correlated with surgical findings. The cross-sectional area was measured, and nerve morphology was analysed at the sites of compression. We found persistent median nerve compression in 30 out of 35 patients. In 20 patients, the compression was caused by a residual transverse carpal ligament, in four by perineural fibrosis, in five by both of these causes and in one by tenosynovitis. In four patients, evidence of median nerve injury with an epineural/fascicular lesion was detected; and in one, no abnormalities were found. Surgical findings were consistent with the ultrasound findings except in one patient where tenosynovitis was associated with a giant cell tumour, which was missed by ultrasound. High-resolution ultrasound can provide helpful information in preoperative diagnosis of failed carpal tunnel decompression with good correlation between the ultrasound and surgical findings.Level of evidence: IV.
Collapse
Affiliation(s)
| | | | - M Laterza
- Clinica San Francesco, Verona, Italy
| | | | - S Tamburin
- Department of Neurosciences, University of Verona, Verona, Italy
| | - G Zanette
- Ospedale P. Pederzoli, Peschiera del Garda (Verona), Verona, Italy
| |
Collapse
|
29
|
Ge L, Zhang L, Lu L. Stenosing tenosynovitis with rice bodies formation diagnosed by ultrasound: A case report. Medicine (Baltimore) 2022; 101:e28871. [PMID: 35363196 PMCID: PMC9282108 DOI: 10.1097/md.0000000000028871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 02/01/2022] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Rice bodies are usually found in several nonspecific chronic inflammatory diseases that are symptomatically dominated by primary disease and local compression symptoms. Rice bodies are usually detected by magnetic resonance imaging; however, some remote areas and areas with poor economic conditions do not have access to magnetic resonance imaging examination, which leads to delayed diagnosis of the disease. PATIENT CONCERNS We report the case of a 62-year-old man with pain in the metacarpophalangeal joint of his right middle finger and limited flexion activity of his middle finger. DIAGNOSES The mass was 1 cm, well-circumscribed, soft, and painless. Ultrasound showed stenosing tenosynovitis with rice body formation. INTERVENTIONS The patient underwent tenosynovectomy with synovectomy of the right middle finger tendon sheath under plexus block anesthesia. OUTCOMES No postoperative complications were noted. A 6-month follow-up showed no recurrence. The activity of the patient's middle finger improved significantly. LESSONS Stenosing tenosynovitis with rice body formation is a very rare condition, and we use ultrasound for diagnosis. Ultrasound is convenient, rapid, inexpensive, and can obtain blood flow information, facilitate disease follow-up, and even allow ultrasound localization in advance for guided needle biopsy.
Collapse
Affiliation(s)
- Lei Ge
- Department of Emergency, People's Hospital of Rizhao, Jining Medical University, Shandong, China
| | - Lei Zhang
- Department of Emergency, People's Hospital of Rizhao, Jining Medical University, Shandong, China
| | - Libin Lu
- Department of Emergency, People's Hospital of Rizhao, Jining Medical University, Shandong, China
| |
Collapse
|
30
|
Massignan Â, Mendonça da Silva Chakr R, Pamplona Bueno de Andrade N, Brenol CV. Synovitis and Tenosynovitis on Ultrasound as Predictors of DMARD Tapering Failure in Patients with Long-Standing Rheumatoid Arthritis in Clinical Remission or Low Disease Activity. J Ultrasound Med 2021; 40:2549-2559. [PMID: 33492685 DOI: 10.1002/jum.15640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/02/2021] [Accepted: 01/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This study aimed to investigate the predictive value of synovitis and tenosynovitis detected by grayscale (GS) and by power Doppler (PD) ultrasound (US) in relation to failure of tapering disease-modifying antirheumatic drugs (DMARD) in rheumatoid arthritis (RA) patients. METHODS Long-standing RA patients who de-escalated treatment were included in this prospective cohort study. All patients underwent 3 ultrasonographic and clinical assessments, at baseline and every 3 or 4 months, over a period of 6-8 months. US investigation of 32 joints was performed. Synovitis was assessed by GS and PD semiquantitative scoring (0-3) and a global score was calculated for each individual by summing single joint scores. The presence of tenosynovitis was recorded whenever detected during ultrasound assessment. RESULTS Thirty-three patients completed the follow-up period (29 women; 4 men). Eight patients (25%) relapsed. Using the optimal cutoff values determined by receiver operating characteristic curve, patients with a PD synovitis ≥1 at baseline had significantly greater chances to relapse than those without PD activity. During follow-up, GS tenosynovitis was detected in 6 patients (5 with PD) who failed and in 3 patients (1 with PD) who succeeded in tapering therapy. Having at least 1 joint with PD synovitis resulted in a relative risk of 3.14 and having GS tenosynovitis resulted in a relative risk of 11.4 (95% CI: 1.03-9.60 and 2.82-45.9, respectively) for relapse in the multivariate Poisson model. CONCLUSIONS PD synovitis and GS tenosynovitis may be useful to identify RA patients in risk of relapse after DMARD tapering.
Collapse
Affiliation(s)
- Ângela Massignan
- Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Rafael Mendonça da Silva Chakr
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Nicole Pamplona Bueno de Andrade
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Claiton Viegas Brenol
- Serviço de Reumatologia, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| |
Collapse
|
31
|
Kim JN, Kwon ST, Shin HD. Subluxation of the extensor carpi ulnaris on magnetic resonance imaging on neutral wrist position: correlation with tenosynovitis of the extensor carpi ulnaris and translation of the distal radioulnar joint. Skeletal Radiol 2021; 50:1593-1603. [PMID: 33432435 DOI: 10.1007/s00256-020-03705-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/23/2020] [Accepted: 12/27/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To identify the subluxation degrees of extensor carpi ulnaris (ECU) tendon on neutral wrist MRI in patients with ulnar-sided wrist pain and to evaluate the relationships of ECU subluxation with accompanying imaging findings such as ECU tenosynovitis, distal radioulnar joint (DRUJ) stability, and triangular fibrocartilage complex (TFCC) pathology. MATERIALS AND METHODS A total of 297 MRIs of 292 patients having ulnar side pain were reviewed retrospectively. Degrees of ECU subluxation was classified into four grades: grade 0, no subluxation; grade 1, tendon displacement < 50% of the tendon width; grade 2, tendon displacement 51 to 99% of the tendon width; and grade 3, tendon displacement of 100% of the tendon width. ECU tenosynovitis, ECU tendinosis, injuries of triangular fibrocartilage and distal radioulnar ligaments (DRUL), translation ratio of the DRUJ, rotation angle of the DRUJ, and the width, depth, and length of the ulnar groove were assessed on wrist MRI. The relationships between degree of ECU subluxation and these imaging findings were investigated. RESULTS Women had higher subluxation degrees of the ECU tendon (p = 0.001). Tenosynovitis of the ECU, sprain of the dorsal DRUL, dorsovolar translation ratio and rotation angle of the DRUJ, and depth and length of the ulnar groove were statistically significantly related to the subluxation degree of the ECU tendon (p = 0.000). CONCLUSION High-grade subluxation of the ECU tendon was strongly correlated with ECU tenosynovitis and DRUJ translation. Clinicians and radiologists should scrutinize imaging findings, particularly when patients with ulnar-sided wrist pain have high-grade subluxation of the ECU tendon.
Collapse
Affiliation(s)
- Ji Na Kim
- Department of Radiology, Kangbuk Samsung Hospital, 29 Saemunan-ro, Jongno-gu, 03181, Seoul, Republic of Korea
| | - Soon Tae Kwon
- Department of Radiology, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munwha-ro Jung-gu, 35015, Daejeon, Republic of Korea.
| | - Hyun Dae Shin
- Department of Orthopaedic Surgery, Chungnam National University Hospital, Chungnam National University School of Medicine, 282 Munwha-ro Jung-gu, 35015, Daejeon, Republic of Korea
| |
Collapse
|
32
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
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
| |
Collapse
|
33
|
Kandemirli SG, Cicek F, Erdemli Gursel B, Bilgin C, Kilic SS, Yazici Z. Superb Microvascular Imaging in Assessment of Synovitis and Tenosynovitis in Juvenile Idiopathic Arthritis. Ultrasound Q 2021; 37:56-62. [PMID: 33661799 DOI: 10.1097/ruq.0000000000000516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
ABSTRACT The aim of this study is to evaluate the diagnostic utility of superb microvascular imaging (SMI) in assessment of synovitis/tenosynovitis in juvenile idiopathic arthritis in comparison to power Doppler ultrasound. Thirty juvenile idiopathic arthritis cases with active clinical findings and ultrasound features of effusion and/or tenosynovitis were further imaged with power Doppler and SMI. For classification of synovial inflammation, a semiquantitative scale (4 points) adopted by Outcome Measures in Rheumatology was used.A total of 35 knee, 2 hip, 2 ankle, 2 wrist, 2 elbow joints, and 6 flexor hallucis longus/tibialis posterior tenosynovitis were assessed. In knee joint, power Doppler and SMI scales were the same for 23 (65.7%) joints, SMI upgraded scale from 0 to 2 in single joint (2.9%); 1 to 2 (14.3%) in 5 joints; and 2 to 3 (17.1%) in 6 joints. For other joints, power Doppler and SMI scales were the same for 5 (62.5%) joints. Superb microvascular imaging upgraded scale from 1 to 2 (25%) in 2 joints and 1 to 3 (12.5%) in a single joint. For flexor hallucis longus/tibialis posterior tenosynovitis, power Doppler and SMI scales were the same for two cases (33.3%). Superb microvascular imaging upgraded scale from 0 to 2 in two cases (33.3%); and 2 to 3 (33.3%) in 2 cases. There was no case of SMI scale downgraded compared with power Doppler scale.Superb microvascular imaging is a feasible technique in the assessment of synovial inflammation and tenosynovitis in juvenile idiopathic arthritis. Superb microvascular imaging has higher sensitivity compared with power Doppler ultrasound in depiction of increased vascularity.
Collapse
Affiliation(s)
| | - Fatih Cicek
- Department of Pediatrics, Uludag University Faculty of Medicine, Bursa, Turkey
| | | | | | - Sara Sebnem Kilic
- Department of Pediatrics, Uludag University Faculty of Medicine, Bursa, Turkey
| | | |
Collapse
|
34
|
Kwon KB, Lee SY, Chung CY, Park MS, Choi JH, Koo S, Lee KM. Posterior Tibial Tendon Integrity Can Be Screened With Plain Anteroposterior Foot Radiography. Orthopedics 2020; 43:e503-e507. [PMID: 32882051 DOI: 10.3928/01477447-20200827-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 10/18/2019] [Indexed: 02/03/2023]
Abstract
Posterior tibial tendon integrity is an important consideration when treating adult-acquired flatfoot caused by posterior tibial tendon dysfunction. The condition of this tendon traditionally has been evaluated with ultrasonography or magnetic resonance imaging, but recent advances in radiography have increased the resolution of radiographic soft tissue images. The authors examined whether the posterior tibial tendon could be screened with anteroposterior foot radiographs, based on interobserver agreement and accuracy. The authors retrospectively evaluated consecutive patients who underwent weight-bearing foot radiography and ultrasonography based on suspicion of posterior tibial tendinopathy. The integrity of the posterior tibial tendon was evaluated by 2 orthopedic surgeons with foot radiographs and scored as normal or abnormal. The authors evaluated interobserver agreement and compared the findings of ultrasonography and radiography to evaluate diagnostic accuracy. The study included 21 patients with a mean age of 51.5±15.7 years. Ultrasonography showed that 4 patients had normal tendon integrity, 6 patients had tenosynovitis and no tendinopathy, 8 patients had tendinopathy and tendon continuity, and 3 patients had loss of tendon continuity. The surgeons provided consistent radiographic findings for 81.0% of patients (17 of 21). On the basis of the ultrasonographic findings, the surgeons' accuracy was 76.2% (16 of 21) and 61.9% (13 of 21). The results indicate that weight-bearing anteroposterior foot radiography can be used to evaluate posterior tibial tendon integrity, which may allow orthopedic surgeons to predict the prognosis of patients with posterior tibial tendon dysfunction, determine the extent of surgical treatment, and evaluate tendon integrity postoperatively. [Orthopedics. 2020;43(6):e503-e507.].
Collapse
|
35
|
Kim SJ, Lee CH, Khil EK, Choi JA, Im WY, Lee KH. Can Ultrasonography Be Useful in Planning Surgery for De Quervain Tenosynovitis?: A Prospective Study With Emphasis on Detection of the Superficial Radial Nerve and Dominant Pathologic Tendon. J Ultrasound Med 2020; 39:1553-1560. [PMID: 32045018 DOI: 10.1002/jum.15244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 01/18/2020] [Accepted: 01/28/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We performed preoperative ultrasonography (US) to detect the anatomic course of the superficial radial nerve (SRN) and dominant pathologic tendon of the first extensor compartment in de Quervain tenosynovitis. METHODS We prospectively studied 27 patients (29 wrists) with de Quervain tenosynovitis who underwent surgical release of the first extensor compartment. Preoperatively, US was performed to evaluate the presence of the dominant pathologic tendon and the septum in the subcompartment, number of SRNs in the area of the surgical incision, and anatomic running course of the SRN. These variables were also checked intraoperatively. Cohen κ statistics were calculated to investigate agreement between US and surgical field findings. RESULTS There were 7 men and 20 women (mean age, 47.8 years; range, 26-67 years). For the dominant pathologic tendon, there were 2 cases (6.9%) of an abductor pollicis longus, 11 cases (37.9%) of an extensor pollicis brevis, and 16 cases (55.2 %) of a nondominant tendon (κ = 0.94). For the subcompartment, there were 10 cases (34.5%) without a septum, 8 (27.6%) with an incomplete septum, and 11 (37.9%) with a complete septum (κ = 0.95). Most SRNs crossed over the first extensor compartment (κ = 0.78). CONCLUSIONS Preoperative US can be useful in detecting the anatomic running course of the SRN and dominant pathologic tendon before surgery for de Quervain tenosynovitis. Classifying the anatomic course of the SRN could be essential to planning surgery, and it could be helpful to prevent injury of the SRN during surgery.
Collapse
Affiliation(s)
- Sung-Jae Kim
- Departments of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Chang-Hun Lee
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea
| | - Eun Kyung Khil
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Jung-Ah Choi
- Department of Radiology, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Woo-Young Im
- Departments of Orthopedic Surgery, Hallym University Dongtan Sacred Heart Hospital, Hwaseong-si, Korea
| | - Kwang-Hyun Lee
- Department of Orthopedic Surgery, Hanyang University Hospital, Seoul, Korea
| |
Collapse
|
36
|
Rogier C, Hayer S, van der Helm-van Mil A. Not only synovitis but also tenosynovitis needs to be considered: why it is time to update textbook images of rheumatoid arthritis. Ann Rheum Dis 2020; 79:546-547. [PMID: 31857342 PMCID: PMC7147173 DOI: 10.1136/annrheumdis-2019-216350] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 11/29/2019] [Accepted: 12/12/2019] [Indexed: 11/07/2022]
Affiliation(s)
- Cleo Rogier
- Rheumatology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Silvia Hayer
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Annette van der Helm-van Mil
- Rheumatology, Erasmus Medical Center, Rotterdam, Zuid-Holland, The Netherlands
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
37
|
Dakkak YJ, Jansen FP, DeRuiter MC, Reijnierse M, van der Helm-van Mil AHM. Rheumatoid Arthritis and Tenosynovitis at the Metatarsophalangeal Joints: An Anatomic and MRI Study of the Forefoot Tendon Sheaths. Radiology 2020; 295:146-154. [PMID: 32043949 PMCID: PMC7212020 DOI: 10.1148/radiol.2020191725] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Although tenosynovitis in the hands is associated with rheumatoid arthritis (RA), it is unknown whether tenosynovitis of the forefoot is associated with RA. Purpose To determine the anatomy of tendon sheaths of the forefoot and the relationship between MRI-detected tenosynovitis at metatarsophalangeal (MTP) joints and RA. Materials and Methods Fourteen forefeet of donated bodies were examined at flexor tendons and extensor tendons for the presence and course of tendon sheaths. In the prospective study between June 2013 and March 2016, newly presenting patients with RA, patients with other early arthritides, and healthy control participants all underwent MRI of unilateral MTP joints 1-5. MRI studies were scored by two independent readers for tenosynovitis, synovitis, and bone marrow edema. The association between the presence of these features and RA was examined by using logistic regression. Results Macroscopically, all extensor and flexor tendons crossing MTP joints demonstrated sheaths surrounding tendons. Microscopically, a synovial sheath was present. MRI evaluation was performed in 634 participants: 157 newly presenting patients with RA (109 women; mean age, 59 years ± 11 [standard deviation]), 284 patients with other early arthritides (158 women; mean age, 56 years ± 17), and 193 healthy control participants (136 women; mean age, 50 years ± 16). MRI-detected tenosynovitis was associated with RA, both when compared with patients with other arthritides (odds ratio [OR], 2.5; 95% confidence interval [CI]: 1.7, 3.9; P < .001) and healthy control participants (OR, 46; 95% CI: 14, 151; P < .001). The association was OR of 2.4 (95% CI: 1.5, 3.8; P < .001) for flexor tendons and OR of 3.1 (95% CI: 1.9, 5.2; P < .001) for extensor tendons. The sensitivity of tenosynovitis in RA was 65 of 157 (41%; 95% CI: 35%, 50%). The specificity for RA was 63 of 284 (78%; 95% CI: 72%, 82%) compared with other arthritides, and three of 193 (98%; 95% CI: 96%, 99%) compared with healthy control participants. Conclusion Tendons at metatarsophalangeal joints are surrounded by tenosynovium. MRI-detected tenosynovitis at metatarsophalangeal joints was specific for rheumatoid arthritis when compared with findings in patients with other arthritides and findings in healthy control participants. © RSNA, 2020 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Yousra J Dakkak
- From the Departments of Rheumatology (Y.J.D., A.H.M.v.d.H.v.M.), Anatomy & Embryology (F.P.J., M.C.D.), and Radiology (M.R.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Friso P Jansen
- From the Departments of Rheumatology (Y.J.D., A.H.M.v.d.H.v.M.), Anatomy & Embryology (F.P.J., M.C.D.), and Radiology (M.R.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Marco C DeRuiter
- From the Departments of Rheumatology (Y.J.D., A.H.M.v.d.H.v.M.), Anatomy & Embryology (F.P.J., M.C.D.), and Radiology (M.R.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Monique Reijnierse
- From the Departments of Rheumatology (Y.J.D., A.H.M.v.d.H.v.M.), Anatomy & Embryology (F.P.J., M.C.D.), and Radiology (M.R.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - Annette H M van der Helm-van Mil
- From the Departments of Rheumatology (Y.J.D., A.H.M.v.d.H.v.M.), Anatomy & Embryology (F.P.J., M.C.D.), and Radiology (M.R.), Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands
| |
Collapse
|
38
|
Bao Z, Zhao Y, Chen S, Chen X, Xu X, Wei L, Xiong M. Ultrasound Versus Contrast-Enhanced Magnetic Resonance Imaging for Subclinical Synovitis and Tenosynovitis: A Diagnostic Performance Study. Clinics (Sao Paulo) 2020; 75:e1500. [PMID: 31967284 PMCID: PMC6963161 DOI: 10.6061/clinics/2020/e1500] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 11/04/2019] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES Radiographic manifestations of synovitis (e.g., erosions) can be observed only in the late stage of rheumatoid arthritis. Ultrasound is a noninvasive, cheap, and widely available technique that enables the evaluation of inflammatory changes in the peripheral joint. In the same way, dynamic contrast-enhanced magnetic resonance imaging (MRI) enables qualitative and quantitative measurements. The objectives of the study were to compare the sensitivity and accuracy of ultrasound in detecting subclinical synovitis and tenosynovitis with those of contrast-enhanced MRI. METHODS The ultrasonography and contrast-enhanced MRI findings of the wrist, metacarpophalangeal, and proximal interphalangeal joints (n=450) of 75 patients with a history of joint pain and morning stiffness between 6 weeks and 2 years were reviewed. The benefits score was evaluated for each modality. RESULTS The ultrasonic findings showed inflammation in 346 (77%) joints, while contrast-enhanced MRI found signs of early rheumatoid arthritis in 372 (83%) joints. The sensitivities of ultrasound and contrast-enhanced MRI were 0.795 and 0.855, respectively, and the accuracies were 0.769 and 0.823, respectively. Contrast-enhanced MRI had a likelihood of 0-0.83 and ultrasound had a likelihood of 0-0.77 for detecting synovitis and tenosynovitis at one time. The two imaging modalities were equally competitive for detecting synovitis and tenosynovitis (p=0.055). CONCLUSION Ultrasound could be as sensitive and specific as contrast-enhanced MRI for the diagnosis of subclinical synovitis and tenosynovitis.
Collapse
Affiliation(s)
- Zhongtao Bao
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
- *Corresponding author. E-mail:
| | - Yanchun Zhao
- Department of Ultrasound, Fujian Provincial Hospital, Fuzhou, Fujian, 350000, China
| | - Shuqiang Chen
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Xiaoyu Chen
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Xiang Xu
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Linglin Wei
- Department of Ultrasound, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| | - Meilian Xiong
- Department of Imaging, First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, 350000, China
| |
Collapse
|
39
|
|
40
|
Wong PC, Lee G, Delle Sedie A, Hanova P, Inanc N, Jousse-Joulin S, Ohrndorf S, Stoenoiu MS, Keen HI, Terslev L, D'Agostino MA, Bruyn GA. Musculoskeletal Ultrasound in Systemic Lupus Erythematosus: Systematic Literature Review by the Lupus Task Force of the OMERACT Ultrasound Working Group. J Rheumatol 2019; 46:1379-1387. [PMID: 31203213 DOI: 10.3899/jrheum.181087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify and synthesize the best available evidence on the application of musculoskeletal (MSK) ultrasound (US) in patients with systemic lupus erythematosus (SLE) and to present the measurement properties of US in different elementary lesions and pathologies. METHODS A systematic literature search of PubMed, Embase, and the Cochrane Library was performed. Original articles were included that were published in English between August 1, 2014, and December 31, 2018, reporting US, Doppler, synovitis, joint effusion, bone erosion, tenosynovitis, and enthesitis in patients with SLE. Data extraction focused on the definition and quantification of US-detected synovitis, joint effusion, bone erosion, tenosynovitis, enthesitis, and the measurement properties of US according to the OMERACT Filter 2.1 instruments selection. RESULTS Of the 143 identified articles, 15 were included. Most articles were cross-sectional studies (14/15, 93%). The majority of the studies used the OMERACT definitions for ultrasonographic pathology. Regarding the measurement properties of US in different elementary lesions and pathologies, all studies dealt with face validity, content validity, and feasibility. Most studies achieved construct validity. Concerning the reliability of image reading, 1 study (1/15, 7%) assessed both intraobserver and interobserver reliability. For image acquisition, 4 studies (4/15, 27%) evaluated interobserver reliability and none had evaluated intraobserver reliability. Criterion validity was assessed in 1 study (1/15, 7%). Responsiveness was not considered in any of the studies. CONCLUSION This literature review demonstrates the need for further research and validation work to define the involvement of US as an outcome measurement instrument for the MSK manifestations in patients with SLE.
Collapse
Affiliation(s)
- Priscilla C Wong
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands.
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep.
| | - Gavin Lee
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Andrea Delle Sedie
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Petra Hanova
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Nevsun Inanc
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Sandrine Jousse-Joulin
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Sarah Ohrndorf
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Maria S Stoenoiu
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Helen I Keen
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Lene Terslev
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Maria-Antonietta D'Agostino
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - George A Bruyn
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| |
Collapse
|
41
|
Zuliani F, Zabotti A, Errichetti E, Tinazzi I, Zanetti A, Carrara G, Quartuccio L, Sacco S, Giovannini I, Stinco G, De Vita S. Ultrasonographic detection of subclinical enthesitis and synovitis: a possible stratification of psoriatic patients without clinical musculoskeletal involvement. Clin Exp Rheumatol 2019; 37:593-599. [PMID: 30620282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 09/03/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVES To evaluate the prevalence of articular/extra-articular inflammatory lesions and structural damage on ultrasonography in patients suffering from psoriasis as well as to assess possible correlations between ultrasonographic elementary lesions and clinical features. METHODS Psoriatic patients without musculoskeletal symptoms and healthy controls (HCs) were recruited. All patients received a blinded extended ultrasonographic examination of 42 joints, 12 entheses and 32 tendons. Active synovitis was defined by the presence of a grade ≥2 for grey scale (GS) and ≥1 for power Doppler (PD), while active enthesitis corresponded to entheseal hypoecogenicity in GS and entheseal PD signal (<2 mm from bone insertion). RESULTS Forty psoriatic patients and 20 HCs were included. A total of 2516 joints and 712 entheses were scanned. Active synovitis was found in 11/40 (27.5%) psoriatic patients and 0/20 HCs (p=0.01). Articular synovitis (GS≥2) was more frequent in psoriasis than in HCs [34/40 (85.0%) and 11/20 (55.0%) respectively; p=0.024). Active enthesitis was found only in psoriatic patients, with a prevalence of 20.0% (8/40) (p=0.04). No significant difference in the prevalence of tenosynovitis or paratenonitis was observed between psoriatic patients and HCs. In psoriasis cohort, age was correlated with the presence of active synovitis (p=0.03), while male sex and a higher PASI score were independently correlated with the presence of active enthesitis (p=0.05 and p=0.034, respectively). CONCLUSIONS Active enthesitis and synovitis could be useful to identify subclinical psoriatic arthritis. This might represent a relevant clinical step to better stratify patients with psoriasis.
Collapse
Affiliation(s)
- Francesca Zuliani
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Italy
| | - Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Italy
| | - Enzo Errichetti
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Italy
| | - Ilaria Tinazzi
- Unit of Rheumatology, Ospedale Sacro Cuore, Negrar, Verona, Italy
| | - Anna Zanetti
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Greta Carrara
- Epidemiology Unit, Italian Society for Rheumatology, Milan, Italy
| | - Luca Quartuccio
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Italy
| | - Stefania Sacco
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Italy
| | - Ivan Giovannini
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Italy
| | - Giuseppe Stinco
- Department of Experimental and Clinical Medicine, Institute of Dermatology, University of Udine, Italy
| | - Salvatore De Vita
- Department of Medical and Biological Sciences, Rheumatology Clinic, University of Udine, Italy.
| |
Collapse
|
42
|
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] [What about the content of this article? (0)] [Affiliation(s)] [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.
Collapse
Affiliation(s)
- David A Rubin
- Department of Radiology, Washington University School of Medicine, 510 South Kingshighway Blvd., St. Louis, MO, 63110, USA.
| |
Collapse
|
43
|
Lee KA, Min SH, Kim TH, Lee SH, Kim HR. Magnetic resonance imaging-assessed synovial and bone changes in hand and wrist joints of rheumatoid arthritis patients. Korean J Intern Med 2019; 34:651-659. [PMID: 29166759 PMCID: PMC6506727 DOI: 10.3904/kjim.2016.271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 02/22/2017] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Magnetic resonance imaging (MRI) is a sensitive and useful method for the detection of synovitis and joint destruction in rheumatoid arthritis (RA) patients. However, the patterns of MRI-detected bone erosion, bone marrow edema (BME), synovitis, and tenosynovitis have received insufficient attention. Therefore, this study evaluated the patterns of bone erosion, BME, synovitis, and tenosynovitis, and calculated the RA-MRI score (RAMRIS) of patients with RA at the carpal and metacarpophalangeal (MCP) joints using MRI. METHODS MRI datasets from 43 RA patients were analyzed. All patients had undergone MRI of one wrist. In addition, 36 patients had MCP joint images taken, and three had also received MRI of the contralateral wrist and MCP joints. The MR images were evaluated for bone erosion, BME, and synovitis in consensus by two blinded readers according to the Outcome Measures in Rheumatology Clinical Trials (OMERACT) RAMRIS. The MRI-detected tenosynovitis was evaluated based on Haavardsholm's tenosynovitis score. RESULTS The capitate, lunate, triquetrum, and hamate bones were the most common sites of erosion and BME and showed the highest RAMRIS erosion and BME scores. Moreover, MRI-detected tenosynovitis was present in 78.3% of all patients with RA, and the extensor compartment 4 and flexor digitorum profundus and superficialis were frequently affected. CONCLUSION This study identified the distribution and prevalence of MRI-detected bone erosion, BME, synovitis, and tenosynovitis of the wrist and MCP joints in RA patients. The patterns of the MRI-detected abnormalities may help to select sites for the application of MRI protocols in clinical trials and practice.
Collapse
Affiliation(s)
- Kyung-Ann Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Sang-Ho Min
- Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Tae-Hyung Kim
- Department of Radiology, Konkuk University Medical Center, Seoul, Korea
| | - Sang-Heon Lee
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
| | - Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, Seoul, Korea
- Correspondence to Hae-Rim Kim, M.D. Division of Rheumatology, Department of Internal Medicine, Konkuk University Medical Center, 120-1 Neungdong-ro, Gwangjin-gu, Seoul 05030, Korea Tel: + 82-2-2030-7542 Fax: + 82-2-2030-7748 E-mail:
| |
Collapse
|
44
|
Aizenberg E, Ten Brinck RM, Reijnierse M, van der Helm-van Mil AHM, Stoel BC. Identifying MRI-detected inflammatory features specific for rheumatoid arthritis: two-fold feature reduction maintains predictive accuracy in clinically suspect arthralgia patients. Semin Arthritis Rheum 2019; 48:579-586. [PMID: 29853189 PMCID: PMC7615878 DOI: 10.1016/j.semarthrit.2018.04.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/17/2018] [Accepted: 04/29/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE MRI-detected inflammation is considered of diagnostic value for rheumatoid arthritis (RA), but its evaluation involves a time-consuming scoring of 61 joint-level features. It is not clear, however, which of these features are specific for RA and whether evaluating a subset of specific features is sufficient to differentiate RA patients. This study aimed to identify a subset of RA-specific features in a case-control setting and validate them in a longitudinal cohort of arthralgia patients. METHODS The difference in frequency of MRI-detected inflammation (bone marrow edema, synovitis, and tenosynovitis) between 199 RA patients and 193 controls was studied in 61 features across the wrist, metacarpophalangeal, and metatarsophalangeal joints. A subset of RA-specific features was obtained by applying a cutoff on the frequency difference while maximizing discriminative performance. For validation, this subset was used to predict arthritis development in 225 clinically suspect arthralgia (CSA) patients. Diagnostic performance was compared to a reference method that uses the complete set of 61 features normalized for inflammation levels in age-matched controls. RESULTS Subset of 30 features, mainly (teno)synovitis, was obtained from the case-control setting. Validation in CSA patients yielded an area of 0.69 (95% CI: 0.59-0.78) under the ROC curve and a positive predictive value (PPV) of 31%, compared to 0.68 (95% CI: 0.60-0.77) and 29% PPV of the reference method with 61 features. CONCLUSION Subset of 30 MRI-detected inflammatory features, dominated by (teno)synovitis, offers a considerable reduction of scoring efforts without compromising accuracy for prediction of arthritis development in CSA patients.
Collapse
Affiliation(s)
- Evgeni Aizenberg
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
| | - Robin M Ten Brinck
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands; Department of Rheumatology, Erasmus Medical Center, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Berend C Stoel
- Department of Radiology, Division of Image Processing, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| |
Collapse
|
45
|
Colberg RE, Henderson RG. Ultrasound-Guided First Dorsal Compartment Release for Refractory de Quervain Tenosynovitis: A Case Report. PM R 2019; 11:665-668. [PMID: 30609241 DOI: 10.1002/pmrj.12063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2018] [Accepted: 12/02/2018] [Indexed: 11/07/2022]
Abstract
De Quervain tenosynovitis is an overuse syndrome associated with inflammation of the tendons in the first dorsal compartment of the wrist. Management includes activity modification, splinting, and corticosteroid injections. In refractory cases, surgical release may be performed, which may be complicated by incomplete release, tendon subluxation, or radial nerve injury. Alternatively, ultrasound-guided release may improve patient satisfaction and outcomes through faster recovery time as well as improved visualization of subcompartments and neurovascular structures. To the best of the authors' knowledge, this is the first case in the literature describing a novel technique for ultrasound-guided first dorsal compartment release for refractory de Quervain tenosynovitis.
Collapse
Affiliation(s)
- Ricardo E Colberg
- Non-surgical Sports Medicine Division, Andrews Sports Medicine and Orthopedic Center, Andrews Sports Medicine Institute, Birmingham, AL
| | - Rachel G Henderson
- Non-surgical Sports Medicine Division, Andrews Sports Medicine and Orthopedic Center, Andrews Sports Medicine Institute, Birmingham, AL
| |
Collapse
|
46
|
Bing JH, Choi SJ, Jung SM, Ryu DS, Ahn JH, Kang CH, Shin DR. Ultrasound-guided steroid injection for the treatment of de Quervain's disease: an anatomy-based approach. Skeletal Radiol 2018; 47:1483-1490. [PMID: 29730702 DOI: 10.1007/s00256-018-2958-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Revised: 03/04/2018] [Accepted: 04/23/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To suggest different ultrasound-guided steroid injection (USI) techniques based on anatomical variations of the first extensor compartment (FEC), and to evaluate the usefulness of it, in patients with de Quervain's disease. MATERIALS AND METHODS Twenty-eight patients who underwent USI for de Quervain's disease were included. Anatomical variations were classified into complete sub-compartmentalization (n = 11), distal incomplete sub-compartmentalization (n = 5), and no sub-compartmentalization (n = 12) on ultrasound. Involved sub-compartments were recorded in patients with complete sub-compartmentalization. USIs were performed based on the anatomical variations: in both sub-compartments (n = 2) or only in the affected sub-compartment (n = 9) depending on the location of tenosynovitis involvement, in patients with complete sub-compartmentalization; in proximal FEC in patients with distal incomplete sub-compartmentalization (n = 5); in the common compartment in patients with no sub-compartmentalization (n = 12). Medical charts were retrospectively reviewed for evaluation of clinical outcome at follow-up visits. RESULTS Twenty-three out of 28 patients were followed up with a mean period of 31.2 days after injection (6~87 days). Mean VAS was 7.96 before injection (range: 4 to 10), which was significantly reduced to 0.65 at rest and 1.57 during activity at follow-up visits (p < 0.05). Twenty-two out of 23 patients were satisfied with the results. The mean proportion of subjective pain reduction was 82.0% (median 95%). CONCLUSION Ultrasound-guided steroid injections using different injection techniques based on the anatomical variations of the FEC have shown to be beneficial in the management of de Quervain's disease.
Collapse
Affiliation(s)
- Jong-Hyun Bing
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Soo-Jung Choi
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea.
| | - Seung-Moon Jung
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Dae-Shick Ryu
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Jae-Hong Ahn
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Chae-Hoon Kang
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| | - Dong-Rock Shin
- Department of Radiology, Asan Foundation, Gangneung Asan Hospital, University of Ulsan, College of Medicine, 38, Bangdong-gil, Sacheon-myeon, Gangneung-si, Gangwon-do, 25440, Republic of Korea
| |
Collapse
|
47
|
Niemantsverdriet E, van der Helm-van Mil AHM. Imaging detected tenosynovitis of metacarpophalangeal and wrist joints: an increasingly recognised characteristic of rheumatoid arthritis. Clin Exp Rheumatol 2018; 36 Suppl 114:131-138. [PMID: 30296973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 06/08/2023]
Abstract
Tenosynovitis is traditionally recognised at physical examination in patients with inflammatory rheumatic diseases, such as, e.g. psoriatic arthritis and (longstanding) rheumatoid arthritis (RA). The increasing use of sensitive imaging techniques (ultrasound, magnetic resonance imaging (MRI)) has recently revealed that subclinical tenosynovitis is prevalent in early RA and in patients in different phases of RA development (asymptomatic state, arthralgia, early arthritis). In this review, the recent findings on MRI-detected tenosynovitis and associations with RA development are highlighted, and an overview of the most reported inflamed tendon locations within the hand and wrist of patients in different disease phases is provided. The data presented show that tenosynovitis is one of the earliest inflammatory features in patients with imminent RA and associated with impairment of activities in daily life. The value of tenosynovitis as an outcome measure in RA is also discussed.
Collapse
Affiliation(s)
| | - Annette H M van der Helm-van Mil
- Department of Rheumatology, Leiden University Medical Center; and Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
48
|
Gupta L, Gupta V, Kumar T. Rice Bodies in Tuberculous Tenosynovitis of Wrist. Reumatol Clin (Engl Ed) 2018; 14:314-316. [PMID: 29102590 DOI: 10.1016/j.reuma.2017.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 08/20/2017] [Accepted: 08/25/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Latika Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India
| | - Vikas Gupta
- Department of Clinical Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow 226014, Uttar Pradesh, India.
| | - Tushant Kumar
- Department of Radiodiagnosis, Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow 226010, Uttar Pradesh, India
| |
Collapse
|
49
|
Vlad V, Berghea F, Iorgoveanu V, Popescu M, Predeteanu D, Ionescu R. Does patients' opinion of remission in rheumatoid arthritis overlap ultrasound "true" remission? - a pilot study. Med Ultrason 2018; 20:328-334. [PMID: 30167586 DOI: 10.11152/mu-1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
AIM Patients describe rheumatoid arthritis (RA) remission as the absence of any symptoms or return to normality. Residual ultrasound (US) synovitis was frequently described in remission cohorts in previous studies. US tenosynovitis evaluation and scoring seems to better follow clinical remission scores compared with synovitis in RA. Our objective was to verify the presence of US findings suggestive of persistent inflammation in a cohort of patients in remission according to their own opinion. MATERIALS AND METHODS Forty-three RA patients were prospectively enrolled in this pilot study between 2015-2017 according to their positive answer to the question "Are you feeling free of symptoms, just like before your RA symptomsstarted?". Clinical evaluation of tender and swollen joints was performed in the same day with US evaluation of 24 joints and 26 tendon sites and lab C-reactive protein (CRP) evaluation. DAS28-CRP and SDAI were calculated. RESULTS A total of 72.9% (35 of 43) of patients were in remission per DAS28 criteria. Except for CRP value, no other variables were significantly different in the 35 of 43. PD scoring in tenosynovitis of the ankle and feet was 100% overlapping remission felt by patients. PD tenosynovitis in both upper and lower limbs was found in less than 10% of patients, and only grade 1 (minimal). CONCLUSION A combination of patients' opinion and PDUS evaluation could be a starting point for RA treatment tapering.
Collapse
Affiliation(s)
- Violeta Vlad
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, Bucharest, Romania.
| | | | - Vasilia Iorgoveanu
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, Bucharest, Romania.
| | - Mihaela Popescu
- Department of Internal Medicine and Rheumatology "Sf. Maria" Hospital, Bucharest, Romania.
| | | | | |
Collapse
|
50
|
Danielsen MA. Ultrasonography for diagnosis, monitoring and treatment of tenosynovitis in patients with rheumatoid arthritis. Dan Med J 2018; 65:B5474. [PMID: 29510818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Rheumatod arthritis is a chronic systemic autoimmune disease, characterized by inflammation in joints and tendon sheaths, which frequently leads to permanent and serious disability due to joint destruction, but also tendon and ligament ruptures. Clinical management of rheumatoid arthritis has traditionally been supported by biochemical and radiographic findings. However, imaging modalities like ultrasound and magnetic resonance imaging (MRI) have improved the possibility for better management of rheumatoid arthritis patients, due to higher sensitivity and specificity for detecting ongoing inflammation, this thesis is focusing on tenosynovitis as recent studies have shown that inflammation in tendon sheaths, i.e. tenosynovitis, is a very common manifestation of rheumatoid arthritis and may often be mistaken for synovitis. Furthermore, presence of ultrasonographic tenosynovitis may predict clinical flare and erosive progression.
The main aim of this PhD thesis was to further develop and validate ultrasound as a tool for diagnosis, monitoring and treatment of tenosynovitis. This was investigated in four studies:
Study I: 3D Doppler Ultrasound findings in healthy wrist and finger tendon sheaths - Can feeding vessels lead to misinterpretation in Doppler-detected tenosynovitis?
Study II: Image fusion of Ultrasound and MRI and B-flow evaluation of tenosynovitis - A pilot study on new imaging techniques in rheumatoid arthritis patients.
Study III: Validity and sensitivity to change of the semi-quantitative Outcome Measures in Rheumatology Clinical Trials (OMERACT) ultrasound scoring system for tenosynovitis in patients with rheumatoid arthritis and for the quantitative scoring system, pixel index.
Study IV: Intramuscular versus ultrasound guided intratenosynovial glucocorticoid injection for tenosynovitis in patients with rheumatoid arthritis - A randomised, double-blind, controlled study with ultrasound and clinical follow up at 4 and 12 weeks.
From the studies presented in the PhD thesis the following was concluded:
Doppler findings in or in close proximity to the tendon sheaths were common in wrists and fingers in healthy participants. These feeding vessels may be a source of misinterpretation, i.e .wrong diagnosis of a low degree of tenosynovitis, not only due to their presence but also because they may be interpreted as being inside the tendon sheath due to blooming and reverberations artefacts.
Ultrasound and MRI had high agreement using image fusion for assessment of tenosynovitis when MRI partial volume artefacts were taken into account. In contrast, the agreement between B-flow and ultrasound was poor, since the quality of the b-flow images and the flow sensitivity were low.
The OMERACT ultrasound scoring system for tenosynovitis had an excellent intra- and interreader agreement between trained investigators and a high ability to detect change over time, similarly, the quantitative tenosynovitis assessment by pixel index had a very good intrareader agreement and moderate to good interreader agreement, but only a moderate ability to detect change over time. The ultrasound scores had a high responsiveness, indicating that the OMERACT ultrasound scoring system was useful for diagnosing and monitoring tenosynovitis in rheumatoid arthritis patients in clinical trials and practice. For treatment of tenosynovitis in rheumatoid arthritis patients, remission (ultrasound tenosynovitis grey scale score ≤1 and Doppler score = 0) was achieved significantly more frequently in the ultrasound guided intratenosynovial glucocorticoid injection group than in the intramuscular glucocorticoid injection group, both at 4 and 12 week follow-ups. Furthermore, tenosynovitis responded significantly better clinically and by ultrasound assessment when treated with ultrasound guided intratenosynovial glucocorticoid injection com-pared to intramuscular glucocorticoid injection, both at 4 and 12 week follow-ups.
Collapse
|