SAT0031 CORRELATION BETWEEN IRREVERSIBLE PHYSICAL DISABILITY AND JOINT DAMAGE IN RHEUMATOID ARTHRITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 945-946
Author(s):  
E. Cipolletta ◽  
A. Incorvaia ◽  
R. Mashadi Mirza ◽  
A. DI Matteo ◽  
M. Tardella ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Remission ◽  
Physical Disability ◽  
Scoring System ◽  
Disease Duration ◽  
Cartilage Damage ◽  
Joint Damage ◽  
Erosion Score ◽  
Hands And Feet ◽  
And Cartilage

Background:In rheumatoid arthritis (RA), irreversible physical disability appears to be more clearly associated with cartilage damage rather than with bone erosions (BE) using conventional radiography (CR) imaging.Objectives:To investigate the correlation between the ultrasound (US) and CR findings indicative of joint damage and irreversible physical disability in patients with RA in sustained clinical remission.Methods:Patients in sustained clinical remission according to the Simplified Disease Activity Index (SDAI)≤3.3 for at least 6 months were enrolled. The following data were regireted: age, disease duration, anti-cyclic citrullinated peptide (ACPA) antibody and rheumatoid factor (RF) status, Health Assessment Questionnaire (HAQ), CR of hands and feet [evaluated using the Simple Erosion Narrowing Score (SENS) method]. A standardized US examination was carried out to investigate the presence of BE (lateral side of II metacarpophalangeal, V metacarpophalangeal and V metatarsophalangeal joints and ulnar styloid) and of cartilage damage (II to V metacarpal heads), bilaterally. BE and cartilage damage were assessed according to OMERACT definitions. A semiquantitative scoring system for both BE (1) and cartilage damage (2) was adopted.Results:Ninety patients were consecutively enrolled. Average time for US evaluation was 10±2 minutes. Both SENS-JSN and US score of cartilage damage (US-CD) were significantly associated with irreversible disability (R=0.39, p<0.01 and R=0.46, p<0.01). US and CR showed a moderate agreement in the evaluation of cartilage damage (kappa=0.52, 95% confidence interval: 0.44-0.61).Figure 1.shows the association between disability and structural damage (A: US-CD, B: US-BE, C: SENS-JSN and D: SENS-BE). After adjusting for confounding factors (age, disease duration, ACPA and RF status, SENS-BE and US-BE) cartilage damage was the only significant predictor of irreversible disability both using CR (R2=0.31, adjusted R2=0.26, standardized β=0.36, p<0.01) and US (R2=0.31, adjusted R2=0.26, standardized β=0.34, p<0.01).Conclusion:This study supports the hypothesis that cartilage damage is more relevant than BE in determining irreversible disability in RA. Our data provide further evidence in favor of the external validity of US in the assessment of cartilage damage.References:[1] Ohrndorf S, Messerschmidt J, Reiche BE, et al. Evaluation of a new erosion score by musculoskeletal ultrasound in patients with rheumatoid arthritis: is US ready for a new erosion score? Clin Rheumatol. 2014;33:1255-62.[2] Mandl P, Studenic P, Filippucci E, et al. Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis. Rheumatology (Oxford). 2019;58:1802-11.Disclosure of Interests:Edoardo Cipolletta: None declared, Antonella Incorvaia: None declared, Riccardo Mashadi Mirza: None declared, Andrea Di Matteo Grant/research support from: the publication was conducted while Dr. Di Matteo was an ARTICULUM fellow, Marika Tardella: None declared, Walter Grassi Speakers bureau: Prof. Grassi reports personal fees from AbbVie, personal fees from Celgene, personal fees from Grünenthal, personal fees from Pfizer, personal fees from Union Chimique Belge Pharma, outside the submitted work., Emilio Filippucci Speakers bureau: Dr. Filippucci reports personal fees from AbbVie, personal fees from Bristol-Myers Squibb, personal fees from Celgene, personal fees from Roche, personal fees from Union Chimique Belge Pharma, personal fees from Pfizer, outside the submitted work.

scholarly journals AC-CUTE: An Open-Label Study to Evaluate Progression of Structural Joint Damage and Inflammation in Subjects with Moderate to Severe Rheumatoid Arthritis

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Paul Bird ◽  
Charles Peterfy ◽  
Peter Countryman ◽  
Hedley Griffiths ◽  
Rina Barrett ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Joint Damage ◽  
Cartilage Loss ◽  
Dominant Hand ◽  
Severe Rheumatoid Arthritis ◽  
Open Label ◽  
Das28 Remission ◽  
Registration Number ◽  
Hands And Feet ◽  
And Cartilage

Aim. Examine the efficacy of once-weekly subcutaneous tocilizumab (SC-TCZ) on joint damage at 24 weeks based on radiography of the hands and feet and magnetic resonance imaging (MRI) of the hand in subjects with moderate to severe rheumatoid arthritis (RA). Methods. In this Australian open-label, multicentre, prospective, single-arm study, subjects received 162 mg SC-TCZ weekly. Primary endpoint was change in radiographic Genant-modified Total Sharp Score (TSS) between baseline and Week 24. Secondary endpoints included change from baseline to Week 24 in RA MRI scoring (RAMRIS) of erosions, synovitis, and osteitis and Cartilage Loss Score (CARLOS) in the dominant hand and disease activity score 28 (DAS28). Results. 52 subjects were enrolled (80% female, mean (SD) age 57  (12) years). Radiography showed mild but not significant progression of joint damage (mean (SD) change in TSS 0.46 (1.29)). Synovitis reduced significantly on MRI; however, osteitis, erosion, and cartilage loss did not change significantly. DAS28 improved significantly by Week 24; 78% of subjects achieved DAS28 remission. SC-TCZ was generally well tolerated. Conclusion. Synovitis and DAS28 decreased significantly; however, no significant change in osteitis or joint damage was observed at Week 24. Trial registration. This trial is registered with Clinicaltrials.gov registration number NCT01951170 (ML28703).

Repair of Radiographic Joint Damage Following Treatment with Etanercept in Psoriatic Arthritis Is Demonstrable by 3 Radiographic Methods

2011 ◽  
Vol 38 (6) ◽  
pp. 1066-1070 ◽  
Author(s):  
LIHI EDER ◽  
VINOD CHANDRAN ◽  
DAFNA D. GLADMAN
Keyword(s):  
Psoriatic Arthritis ◽  
Scoring System ◽  
Joint Space Narrowing ◽  
Joint Damage ◽  
Joint Space ◽  
Radiographic Assessment ◽  
Radiographic Damage ◽  
Erosion Score ◽  
Sharp Score ◽  
Hands And Feet

Objective.Psoriatic arthritis (PsA) is characterized by varied radiographic features. We describe a patient with PsA with severe radiographic damage that improved significantly following treatment with etanercept. The improvement was documented by several methods of radiographic assessment.Methods.Etanercept was introduced in September 2005. Radiographs of the hands and feet were read using 3 methods: the modified Steinbrocker method, the van der Heijde (vdH) modification of the Sharp method, and the Ratingen scoring system.Results.In July 2009, radiographs of the hands and feet showed improvement in erosion score and joint space narrowing, while bony proliferation remained the same [43 by modified Steinbrocker, 26 by the vdH Sharp score (12 for erosions and 14 for joint space narrowing), and 56 by the Ratingen (18 for erosion and 38 for proliferation].Conclusion.The 3 radiographic methods were useful in demonstrating improvement in joint scores. The modified Steinbrocker method, which is the simplest, was able to reveal improvement in our patient.

scholarly journals AB0124 STRUCTURAL DAMAGE IN THE FOOT IN RHEUMATOID ARTHRITIS: DON’T MISS THE OTHER METATARSOPHALANGEAL JOINTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1091.1-1091
Author(s):  
M. Yasmine ◽  
H. Ferjani ◽  
D. Kaffel ◽  
K. Maatallah ◽  
S. Rahmouni ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Structural Damage ◽  
Disease Duration ◽  
Plain Radiograph ◽  
Joint Damage ◽  
The Other ◽  
American College Of Rheumatology ◽  
The Mean ◽  
Hands And Feet ◽  
Mtp Joints

Background:The foot involvement in rheumatoid arthritis (RA) affects the functionality and the quality of life in patients. Despite this, the clinicians do not give enough care to the foot in RA patients, especially if asymptomatic, resulting in joint damage, deformity, and disability. The distribution of erosions of the other MTP joints (excluding the 5th) has not previously been studied.Objectives:This study aimed to investigate the distribution of erosions in MTP joints and their clinical implications.Methods:We conducted a retrospective study including patients with RA according to the American college of rheumatology/ the European league against rheumatism classification criteria. Sociodemographic data, as well as disease activity related characteristics, were recorded.Posterior–anterior radiographs of the hands and feet of each patient were assessed for erosions.All patients were assessed by Ultrasonography (US) of the hands. US erosions were scored 0-3 according to Szkudlarek [1]. We divided patients into two groups (G1 without MTPs erosions and G2 with MTPs erosions).Results:We enrolled forty-two females and eleven males in our studies. The mean age was 58.6 years ±12.7 [23-77], and the mean disease duration was 8.4 years [1-47]. Rheumatoid factor or cyclic citrullinated peptide antibodies (Anti-CCP) were positive in 62.3% of cases. The mean DAS28ESR score was 5.1±1.16 [2.5-7.7]. Half of the patients had the active disease (52.8%). Hand erosions evaluated with plain radiographs and the US were found in 43.1% and 50.9% of cases, respectively. The distribution of foot erosions (15.1%) was at follows: 5th right MTP (7.5%), the 5th right IPP (2%), the 1st left MTP (2%), 3th left MTP (3.8%), 4th left MTP (5.7%) and the 5th left MTP (9.4%). Erosions on MTPs with the exclusion of the 5th MTP were present in 9.4% of cases. The presence of MTPs erosion was more frequent in males (p=0.01) but was not associated with age (p=0.6) or disease duration (p=0.2). Seropositivity was similar between the two groups (p=0.06). Similarly, the inflammatory markers (ESR and CRP), as well as DAS28 ESR, did not differ between the two groups (p>0.05). MTPs erosion was not associated with the presence of hand erosions on a plain radiograph (p=0.445). However, MTPs erosion was significantly more frequent in patients with less erosive hands-on US (p=0.034).Conclusion:Our study showed that screening of other MTPs (excluding the 5th) is mandatory in RA diagnosis. Interestingly, in our result, MTPs erosion is more frequent in males with less erosive hands.Disclosure of Interests:None declared

Anti-carbamylated Protein Antibodies and Serum Level of 14-3-3 Protein for Early Detection of Rheumatoid Arthritis Patient in Correlation with Rheumatoid Factor, Anti-CCP Antibodies, Disease Activity and Joint Damage using High Frequency Musculoskeletal Ultrasound

2020 ◽  
Vol 7 (2) ◽  
pp. 141-153
Author(s):  
Sahar A. Ahmed ◽  
Enas M. Darwish ◽  
Walaa A. Attya ◽  
Mai Samir ◽  
Mennatallah Elsayed ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Rheumatoid Factor ◽  
Disease Activity Score ◽  
Joint Damage ◽  
Musculoskeletal Ultrasound ◽  
Activity Score ◽  
Das 28 ◽  
Significant Difference ◽  
Hands And Feet

Background: Rheumatoid arthritis (RA) is a common progressive chronic inflammatory autoimmune disease which affects mostly small joints, causing pain, swelling, deformity, and disability. Although progress has been made in exploring RA nature, still there is a lot to know about the disease pathogenesis, diagnosis, and treatment. Aim of the Work: To investigate the role of serum anti-carbamylated protein antibodies and 14-3-3η in the diagnosis of RA compared to rheumatoid factor (RF), anti-CCP antibodies, and highfrequency musculoskeletal ultrasound used to assess the disease activity and joint damage. Methods: Serum anti-carbamylated protein antibodies and 14-3-3η were measured using ELISA in 61 RA patients and 26 normal controls. RA Disease Activity Score (DAS 28), X-ray and musculoskeletal ultrasound (hands and feet), carotid ultrasound (Intima-Media Thickness IMT) were used in assessing the RA disease. Results: Anti-carbamylated protein antibodies were significantly elevated in RA patients 4.5 (4.1- 8.9 U⁄ml) compared to the control 3.2(1.9- 4.3 U⁄ml) (p< 0.001) but 14-3-3η showed no significant difference. There was a significant positive correlation between anti-carbamylated protein antibodies, 14-3-3η levels and disease activity score assessed by DAS 28, increased IMT measured by carotid duplex, total synovitis and total erosion score were assessed by musculoskeletal ultrasound. There was no correlation between RF and anti-CCP antibodies. Anti-carbamylated protein antibodies were found to have 66.7% sensitivity and 85.2% specificity in RA diagnosis, while 14- 3-3η had 51.9% sensitivity and 72.1% specificity. Conclusion: Anti-carbamylated protein antibodies and 14-3-3η have a high sensitivity and specificity in RA diagnosis and had a correlation with the disease activity and joint damage.

scholarly journals Managing Osteoporosis and Joint Damage in Patients with Rheumatoid Arthritis: An Overview

2021 ◽  
Vol 10 (6) ◽  
pp. 1241
Author(s):  
Yoshiya Tanaka
Keyword(s):  
Rheumatoid Arthritis ◽  
Structural Damage ◽  
Kinase Inhibitors ◽  
Joint Destruction ◽  
Joint Damage ◽  
Nuclear Factor Κb ◽  
Cartilage Destruction ◽  
Janus Kinase ◽  
Systemic Autoimmune Disease ◽  
And Cartilage

In rheumatoid arthritis, a representative systemic autoimmune disease, immune abnormality and accompanying persistent synovitis cause bone and cartilage destruction and systemic osteoporosis. Biologics targeting tumor necrosis factor, which plays a central role in the inflammatory process, and Janus kinase inhibitors have been introduced in the treatment of rheumatoid arthritis, making clinical remission a realistic treatment goal. These drugs can prevent structural damage to bone and cartilage. In addition, osteoporosis, caused by factors such as menopause, aging, immobility, and glucocorticoid use, can be treated with bisphosphonates and the anti-receptor activator of the nuclear factor-κB ligand antibody. An imbalance in the immune system in rheumatoid arthritis induces an imbalance in bone metabolism. However, osteoporosis and bone and cartilage destruction occur through totally different mechanisms. Understanding the mechanisms underlying osteoporosis and joint destruction in rheumatoid arthritis leads to improved care and the development of new treatments.

Association of Mucoid Degeneration of the ACL with Medial Tibiofemoral Osteoarthritis Progression at MR Imaging

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Samer Mohamed Moustafa ◽  
Amany Moh. Rashad Abdel-Aziz ◽  
Mennatallah Hatem Shalaby
Keyword(s):  
Cartilage Damage ◽  
Strong Association ◽  
Pulse Sequences ◽  
Joint Damage ◽  
Radiology Department ◽  
Proton Density ◽  
Mucoid Degeneration ◽  
University Hospitals ◽  
Osteoarthritis Progression ◽  
And Cartilage

Abstract Background Using MRI, ACL mucoid degeneration is defined as a thickened ACL with increased signal intensity on all MR pulse sequences, with discrete fibers easily distinguished on fatsaturated T2-weighted or fat-saturated proton-density (PD)-weighted images but poorly differentiated on T1-weighted or non-fat-saturated PD-weighted images. Objective To assess the prevalence of ACL mucoid degeneration in a population of patients referred for routine knee MRI, and its association with age and structural joint damage. Patients and Methods Our study is a retrospective study conducted at the radiology department of Ain Shams University hospitals and Ain Shams University Specialized Hospital including 81 cases of knees with ACL mucoid degeneration by MRI and no sex predilection. Cases and controls were scored with respect to independent articular features: cartilage signal and morphology, subarticular bone marrow abnormality, subarticular cysts, subarticular bone attrition, marginal osteophytes and medial meniscal integrity. Results Patients with ACL mucoid degeneration were older than patients with a normal ACL, without statistically significant sex difference. Knees with ACL mucoid degeneration had statistically significant medial meniscal injuries and cartilage damage involving the central and posterior MTFC compared to control knees with a normal ACL frequency matched for age, sex and MR field strength. Conclusion Our study proved that there is a strong association between ACL mucoid degeneration and cartilage damage in MTFC.

scholarly journals Hexokinase 2 as a novel selective metabolic target for rheumatoid arthritis

2018 ◽  
Vol 77 (11) ◽  
pp. 1636-1643 ◽  
Author(s):  
Marta F Bustamante ◽  
Patricia G Oliveira ◽  
Ricard Garcia-Carbonell ◽  
Adam P Croft ◽  
Jeff M Smith ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Glucose Metabolism ◽  
Cartilage Damage ◽  
Critical Role ◽  
Lactate Production ◽  
Migration And Invasion ◽  
Synovial Lining ◽  
Serum Transfer ◽  
And Cartilage

ObjectivesRecent studies indicate that glucose metabolism is altered in rheumatoid arthritis (RA) fibroblast-like synoviocytes (FLS). Hexokinases (HKs) catalyse the first step in glucose metabolism, and HK2 constitutes the principal HK inducible isoform. We hypothesise that HK2 contributes to the synovial lining hypertrophy and plays a critical role in bone and cartilage damage.MethodsHK1 and HK2 expression were determined in RA and osteoarthritis (OA) synovial tissue by immunohistochemistry. RA FLS were transfected with either HK1 or HK2 siRNA, or infected with either adenovirus (ad)-GFP, ad-HK1 or ad-HK2. FLS migration and invasion were assessed. To study the role of HK2 in vivo, 108 particles of ad-HK2 or ad-GFP were injected into the knee of wild-type mice. K/BxN serum transfer arthritis was induced in HK2F/F mice harbouring Col1a1-Cre (HK2Col1), to delete HK2 in non-haematopoietic cells.ResultsHK2 is particular of RA histopathology (9/9 RA; 1/8 OA) and colocalises with FLS markers. Silencing HK2 in RA FLS resulted in a less invasive and migratory phenotype. Consistently, overexpression of HK2 resulted in an increased ability to migrate and invade. It also increased extracellular lactate production. Intra-articular injection of ad-HK2 in normal knees dramatically increased synovial lining thickness, FLS activation and proliferation. HK2 was highly expressed in the synovial lining after K/BxN serum transfer arthritis. HK2Col1 mice significantly showed decreased arthritis severity, bone and cartilage damage.ConclusionHK2 is specifically expressed in RA synovial lining and regulates FLS aggressive functions. HK2 might be an attractive selective metabolic target safer than global glycolysis for RA treatment.

scholarly journals Antibodies to Infliximab and Adalimumab in Patients with Rheumatoid Arthritis in Clinical Remission: A Cross-Sectional Study

Arthritis ◽  
2015 ◽  
Vol 2015 ◽  
pp. 1-7 ◽  
Author(s):  
Grith P. Eng ◽  
Klaus Bendtzen ◽  
Henning Bliddal ◽  
Michael Stoltenberg ◽  
Marcin Szkudlarek ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Clinical Remission ◽  
Disease Duration ◽  
Cross Sectional Study ◽  
Infliximab Treatment ◽  
Sectional Study ◽  
Cross Sectional ◽  
Gene Assay ◽  
A Cell ◽  
Low Levels

Objective. To investigate if antibodies towards biological TNF-α inhibitors (anti-TNFi Abs) are present in patients with rheumatoid arthritis (RA) in clinical remission and to relate any anti-TNFi Abs to circulating level of TNF-α inhibitor (TNFi). Methods. Patients with RA, treated with infliximab or adalimumab, and in clinical remission (DAS28(CRP) < 2.6) were included from 6 out-patient clinics. In blood samples, presence of anti-TNFi Abs was determined by radioimmunoassay, and concentration of bioactive TNFi was measured by a cell-based reporter gene assay. Results. Anti-TNFi Abs were present in 8/44 patients (18%) treated with infliximab and 1/49 patients (2%) treated with adalimumab (p=0.012). In the former group, anti-TNFi Abs corresponded with low levels of TNFi (p=0.048). Anti-TNFi Ab-positive patients had shorter disease duration at initiation of TNFi therapy (p=0.023) but were similar for the rest of the compared parameters. Conclusions. In RA patients in clinical remission, anti-TNFi Abs occur frequently in patients treated with infliximab, while they occur rarely in patients treated with adalimumab. Presence of anti-infliximab Abs is accompanied by low or undetectable levels of infliximab. These data suggest that continued infliximab treatment may be redundant in a proportion of RA patients treated with infliximab and in clinical remission.

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