Osteopontin, Osteoprotegerin and Musculoskeletal Ultrasound findings in First-Degree Relatives of Rheumatoid Arthritis: Potential Markers of Preclinical Disease

Abstract Background: First-degree relatives (FDRs) of rheumatoid arthritis (RA) patients are known to have increased risk of developing the disease. The detection of altered bone metabolism in FDRs could be a predictor of the disease. Preclinical phase of RA is characterized by a state of autoimmunity and inflammation. Musculoskeletal ultrasound (MSUS) is known for its ability to detect subclinical joint inflammation in RA, but changes in FDRs are not yet described.Objectives: To study serum osteopontin (OPN) and osteoprotegerin (OPG) levels in first degree relatives (FDRs) of rheumatoid arthritis (RA) as markers of altered bone metabolism in relation to clinical, laboratory and musculoskeletal ultrasound (MSUS) findings. Methods: Fifty-five individuals were included, 20 had definite RA, 25 were FDRs of RA patients, and 10 healthy controls. Clinical evaluation for joint swelling/tenderness was performed for all. ESR, CRP, rheumatoid factor (RF), anti-citrullinated antibodies (ACPA), OPN, OPG, and MSUS by the US7 score were evaluated.Results: OPG was significantly higher in RA (143.89 pg/ml±365.47) than in FDRs (22.23 pg/ml±65.73; p=0.009) and controls (6.20 pg/ml±12.43; p=0.003). OPN was also higher in RA (3.66 ng/ml±4.20) than in FDRs (1.97 ng/ml±1.04) and controls (2.81 ng/ml±1.31), though not significant (p=0.102). Eight of 25 FDRs (32%) had arthralgia without clinical arthritis and 17/25 (68%) were asymptomatic. FDRs with arthralgia had significantly higher ESR and CRP levels than asymptomatic FDRs (9.82 mm/h±4.13; p=0.003, and 3.93 mg/l±3.58; p=0.003). OPG was higher in FDRs than in controls, and also in those with arthralgia (51.55 pg/ml±114.68) than in those without (8.44 pg/ml±9.67), though without significant difference. OPN was higher in FDRs with arthralgia (2.09 ng/ml±1.19) than in asymptomatics (1.70 ng/ml±0.55), also without significant difference. Pathologic findings by US7 were detected in 10/25 (40%) FDRs, of which three (12%) had arthralgia and seven (28%) were asymptomatic. Conclusions: The raised OPG and lower OPN in FDRs than in controls reflect an altered bone metabolism which could precede clinical disease phase. OPN and OPG could serve as markers of altered preclinical bone metabolism in FDRs of RA. US7 score might be a useful screening tool to identify ‘at-risk’ individuals.

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Characterising arthralgia in the preclinical phase of rheumatoid arthritis using MRI

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2014-205522 ◽

2014 ◽

Vol 74 (6) ◽

pp. 1225-1232 ◽

Cited By ~ 56

Author(s):

Hanna W van Steenbergen ◽

Jessica A B van Nies ◽

Tom W J Huizinga ◽

Johan L Bloem ◽

Monique Reijnierse ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Joint Inflammation ◽

Partial Least Squares Analysis ◽

Independent Variables ◽

Preclinical Phase ◽

Clinical Arthritis ◽

Pls Analysis ◽

Symptoms And Signs ◽

Citrullinated Peptide ◽

Mtp Joints

BackgroundThe phase of arthralgia is the earliest moment to clinically recognize patients who may develop Rheumatoid Arthritis (RA). Previous imaging studies in the arthralgia phase have shown that inflammation precedes RA development. It is unknown which symptoms/characteristics relate to subclinical joint inflammation as measured by MRI. Among all patients with arthralgia, those with clinically suspect arthralgia (CSA) are suspected to progress to arthritis according to the clinical judgement of their rheumatologists. We determined the symptoms/characteristics of patients with CSA who had inflammation on MRI.Methods102 patients with CSA and without clinical arthritis were included. They completed questionnaires, underwent joint counts and unilateral 1.5 T MRI of MCP joints 2–4, wrist and MTP joints 1–5. Synovitis, bone marrow oedema (BME) and tenosynovitis were scored according to the OMERACT rheumatoid arthritis MRI scoring system. Symptoms and signs were related to MRI inflammation (based on MRI scores in symptom-free controls; a sum of synovitis, BME and tenosynovitis scores ≥3 was considered positive). Whether certain clinical characteristics frequently occurred together with MRI inflammation was studied by partial least squares analysis.ResultsMRI was performed in 93 patients with CSA, 44% of whom had subclinical MRI inflammation. Synovitis was the most prevalent inflammatory feature on MRI (20%). Patients with MRI inflammation were older and were more frequently positive for anti-citrullinated peptide antibodies than patients without MRI inflammation (p<0.001 and 0.049). In PLS analysis, including 16 clinical and serological characteristics as independent variables and MRI inflammation as dependent variable, no clear clusters of patients with and without MRI inflammation were identified.ConclusionsSubclinical inflammation as measured by MRI is present in 44% of patients with CSA. A combination of symptoms/characteristics incompletely differentiated patients with and without MRI inflammation.

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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

Applied Clinical Research Clinical Trials and Regulatory Affairs ◽

10.2174/2213476x07666200120111549 ◽

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.

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Effect of janus kinase inhibitors and methotrexate combination on malignancy in patients with rheumatoid arthritis: a systematic review and meta-analysis of randomized controlled trials

Autoimmunity Highlights ◽

10.1186/s13317-021-00153-5 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Vinod Solipuram ◽

Akhila Mohan ◽

Roshniben Patel ◽

Ruoning Ni

Keyword(s):

Rheumatoid Arthritis ◽

Combination Therapy ◽

Randomized Controlled Trials ◽

Random Effect ◽

Janus Kinase ◽

Controlled Trials ◽

Randomized Controlled ◽

Increased Risk ◽

Significant Difference ◽

Risk Of Malignancy

Abstract Background Rheumatoid arthritis (RA) is a systemic autoimmune disease. The combination therapy of methotrexate (MTX) and Janus kinase inhibitor (JAKi) is commonly used. Patients with RA are at increased risk of malignancy, however, it remains unclear whether the combination therapy is associated with a higher risk. Objective To assess the malignancy risk among patients with RA receiving combination therapy of JAKi and MTX compared to MTX alone. Methods PubMed, Cochrane and Embase were thoroughly searched for randomized controlled trials (RCTs) in patients with RA receiving JAKi and MTX, from inception to July 2020. Primary endpoints were malignancy events, Non melanomatous skin cancer (NMSC) and malignancy excluding NMSC and secondary endpoints were serious adverse events (SAE), deaths. Risk ratio (RR) and 95% CI were calculated using the Mantel–Haenszel random-effect method. Results 659 publications were screened and 13 RCTs with a total of 6911 patients were included in the analysis. There was no statistically significant difference in malignancy [RR = 1.42; 95% CI (0.59, 3.41)], neither NMSC [RR = 1.44 (0.36, 5.76)] nor malignancies excluding NMSC [RR = 1.12 (0.40, 3.13)]. No statistically significant difference between the two groups for SAE [RR = 1.15 (0.90, 1.47)] and deaths [RR = 1.99 (0.75, 5.27)] was found. Conclusion The adjunction of JAKi to MTX is not associated with an increased risk of malignancy when compared to MTX alone. There is no increased risk of SAE and deaths when compared to MTX alone in patients with RA.

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AB1119 U9: A NOVEL CLINICALLY ORIENTED ULTRASONOGRAPHIC SCALE AS A USEFUL MARKER FOR MONITORING THERAPEUTIC RESPONSE IN RHEUMATOID ARTHRITIS (MULTI CENTERS STUDY)

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2733 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1848.2-1849

Author(s):

M. A. Mortada ◽

H. Eitta ◽

R. Elmallah ◽

A. Radwan ◽

A. Elsaman

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Clinical Laboratory ◽

Pearson Correlation ◽

Response To Treatment ◽

P Value ◽

Clinical Parameters ◽

Biologic Dmards ◽

Das 28 ◽

Significant Difference

Background:Musculoskeletal Ultrasonography (MSUS) is now a widely used tool for monitoring of rheumatoid arthritis (RA). Although there are many proposed sets of composite scores, a fixed set of joints may not be an ideal tool to assess a disease like RA, which affects many joints and tendons in different presentations. In previous study (1) U9 score was proven to be correlated with disease activity parameters.Objectives:To determine whether US assessment using U9 score is useful for monitoring response to treatment for RA or not?Methods:A prospective, multicenter study were conducted in period from July 2019 to December 2019. All recruited RA patients were subjected to: Disease activity assessment by clinical disease activity indices (CDAI and DAS28 ESR). Functional status assessment by (HAQ) and ultrasonographic assessment using U9 score which include 8 joints (bilateral wrists,2ndMCP,3RDMCP and knees) plus most clinically affected joint or tendon (one joint or one tendon). Most clinically affected joints from 48 joints. Any affected tendons could be choosing. All targeted joints were evaluated according to EULAR guidlines and by EULAR/ OMERACT combined score (0-3). Targeted tendons were scored (0-3).All patients received their treatment (biologic and non biologic DMARDs) according to the decision of the treating physicians. No specific therapy is needed. CDAI and DAS28 ESR, HAQ and U9 score were repeated after 3 months to detect the response to change after receiving the therapy.Results:One hundred and forty patients (23.6% were male) with mean age 39.26±11.30 were recruited from 4 tertiary referral university hospitals.There was a significant difference (<0.001) between the first and second visits as regards clinical, laboratory and ultrasonographic parameters. DAS 28 decreased form (5.29±1.21) to (3.95±0.99), ESR decreased from (42.12±15.24) to (26.84±12.32), HAQ2 improved from (0.652±0.350) to (0.510±0.237) and U9 total US score decreased from (13.56±5.18) to (8.02±4.28).There was significant correlation between U9 ultrasonographic score and clinical parameters at both visits (table 1).Table 1.correlation between U9 ultrasonographic score and clinical parameters.U9 at 1stvisitU9 at 2ndvisitDAS-28Pearson Correlation(P value)0.806<0.0010.790<0.001CDAIPearson Correlation(P value)0.787<0.0010.773<0.001HAQPearson Correlation(P value)0.431<0.0010.317<0.001We found that the most suitable cut-off value of U9 score to predict high disease activity was 11.5 (sensitivity 85.7% and specificity 80.6%), cut off value for moderate disease activity was 5.5(sensitivity 83.2% and specificity 88%) and cut off value for low disease activity was 3.5 (sensitivity of 83.3% and specificity 57.1%). These results are summarized in the following table:Conclusion:U9 ultrasonographic score is very useful method for evaluating the monitoring the response of treatment.References:[1]Mortada, et al. Annals of the Rheumatic Diseases 2019;78:1009.Disclosure of Interests:None declared

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Management of bone metabolism in epilepsy

Ideggyógyászati Szemle ◽

10.18071/isz.74.0257 ◽

2021 ◽

Vol 74 (7-8) ◽

pp. 257-265

Author(s):

Firdevs Ezgi Uçan Tokuç ◽

Fatma Genç ◽

Abidin Erdal ◽

Yasemin Biçer Gömceli

Keyword(s):

Bone Mineral Density ◽

Vitamin D ◽

Bone Metabolism ◽

Bone Mineral ◽

Outpatient Clinic ◽

Bone Mineralization ◽

Mineral Density ◽

Low Bone Mineral Density ◽

Increased Risk ◽

Significant Difference

Many systemic problems arise due to the side effects of antiepileptic drugs (AEDs) used in epilepsy patients. Among these adverse effects are low bone mineral density and increased fracture risk due to long-term AED use. Although various studies have supported this association with increased risk in recent years, the length of this process has not been precisely defined and there is no clear consensus on bone density scanning, intervals of screening, and the subject of calcium and vitamin D supplementation. In this study, in accordance with the most current recommendations, our applications and data, including the detection of possible bone mineralization disorders, treatment methods, and recommendations to prevent bone mineralization disorders, were evaluated in epilepsy patients who were followed up at our outpatient clinic. It was aimed to draw attention to the significance of management of bone metabolism carried out with appropriate protocols. Epilepsy patients were followed up at the Antalya Training and Research Hospital Department of Neurology, Epilepsy Outpatient Clinic who were at high risk for osteoporosis (use of valproic acid [VPA] and enzyme-inducing drugs, using any AED for over 5 years, and postmenopausal women) and were evaluated using a screening protocol. According to this protocol, a total of 190 patients suspected of osteoporosis risk were retrospectively evaluated. Four patients were excluded from the study due to secondary osteoporosis. Of the 186 patients who were included in the study, 97 (52.2%) were women and 89 (47.8%) were men. Prevalence of low bone mineral density (BMD) was 42%, in which osteoporosis was detected in 11.8% and osteopenia in 30.6% of the patients. Osteoporosis rate was higher at the young age group (18-45) and this difference was statistically significant (p=0.018). There was no significant difference between male and female sexes according to osteoporosis and osteopenia rates. Patients receiving polytherapy had higher osteoporosis rate and lower BMD compared to patients receiving monotherapy. Comparison of separate drug groups according to osteoporosis rate revealed that osteoporosis rate was highest in patient groups using VPA+ carbamazepine (CBZ) (29.4%) and VPA polytherapy (19.4%). Total of osteopenia and osteoporosis, or low BMD, was highest in VPA polytherapy (VPA+ non-enzyme-inducing AED [NEID]) and CBZ polytherapy (CBZ+NEID) groups, with rates of 58.3% and 55.1%, respectively. In addition, there was no significant difference between drug groups according to bone metabolism markers, vitamin D levels, and osteopenia-osteoporosis rates. Assuming bone health will be affected at an early age in epilepsy patients, providing lifestyle and diet recommendations, avoiding polytherapy including VPA and CBZ when possible, and evaluating bone metabolism at regular intervals are actions that should be applied in routine practice.

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The Latent Tuberculin Test after 1-year Therapy with Anti-TNF in Babylon, Iraq

Journal of University of Babylon for Pure and Applied Sciences ◽

10.29196/jubpas.v26i8.1680 ◽

2018 ◽

Vol 26 (8) ◽

pp. 144-150

Author(s):

Ali Alkazzaz ◽

Murtadha Najah Jawad ◽

Zeyad Tareq Kareem

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Medical History ◽

Demographic Data ◽

Latent Tuberculosis ◽

Tuberculin Test ◽

P Value ◽

Cross Sectional ◽

Increased Risk ◽

Significant Difference

Background: Rheumatoid arthritis (RA) patients receiving receive anti-TNF agents are at increased risk of reactivation of latent tuberculosis infection (LTBI). The tuberculin skin test (TST) is widely used to screen LTBI and providing preventive treatment, in an effort to meet the WHO target of a 90% reduction in TB by 2035. Objectives: To determine the proportion of TST conversion among RA patients after 1 year of anti-TNF treatment and association of positive TST result with patients’ socio-demographic characteristics and medical history. Methods: This community-based cross-sectional study was conducted at the Department of Rheumatology of Marjan Teaching Hospital in Iraq, for a period of 1 year. Patients with RA/and spondyloarthropathy, and who received anti-TNF therapy for >1 year, underwent TST. Their demographic data and medical history were also obtained. All statistical analysis was performed using SPSS (Version 20) and, p < 0.05 was considered as a sign. Data from the baseline and 1 year follow-up was subjected to the Kolmogorov-Smirnov test to determine whether they were normally distributed. Chi-Square test used to test significance of TST among etanrecept and infliximab at the end of the study. Results: A total of 96 patients were enrolled, including 55 (57.3%) males and 41 (42.3%) females with an average age of 41.1, and mostly 68 (70.8%) from Babylon Governorate of Iraq. A total of 40 (41.7%) patients had rheumatoid arthritis alone, and the remaining 56 (58.3%) had a comorbidity of spondyloarthropathy. Majority of the patients 65 (67.7%) received the biological agent infliximab, while 31 (32.3%) patients received Etanercept for RA for a period of 1 year. There was a statistically significant decreasing in the median ESR and disease activity from the baseline to the end of the study (p-value <0.01). There was no significant difference in TST results based on gender or age. Both infliximab and etanercept were significantly associated with a decreasing in ESR and disease activity Conclusion: This study has shown that there was very low TST conversion among RA patients after 1 year of anti-TNF treatment and, age and gender were not associated with TST.

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Cardiomyopathy, oxidative stress and impaired contractility in a rheumatoid arthritis mouse model

Heart ◽

10.1136/heartjnl-2018-312979 ◽

2018 ◽

Vol 104 (24) ◽

pp. 2026-2034 ◽

Cited By ~ 10

Author(s):

Gianluigi Pironti ◽

Alex Bersellini-Farinotti ◽

Nilesh M Agalave ◽

Katalin Sandor ◽

Teresa Fernandez-Zafra ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Oxidative Stress ◽

Heart Failure ◽

Mouse Model ◽

Posttranslational Modifications ◽

Contractile Function ◽

Joint Inflammation ◽

Left Ventricular ◽

Increased Risk ◽

Fractional Shortening

ObjectivesPatients with rheumatoid arthritis (RA) display an increased risk of heart failure independent of traditional cardiovascular risk factors. To elucidate myocardial disease in RA, we have investigated molecular and cellular remodelling of the heart in an established mouse model of RA.MethodsThe collagen antibody-induced arthritis (CAIA) RA mouse model is characterised by joint inflammation and increased inflammatory markers in the serum. We used CAIA mice in the postinflammatory phase that resembles medically controlled RA or RA in remission. Hearts were collected for cardiomyocyte isolation, biochemistry and histology analysis.ResultsHearts from mice subjected to CAIA displayed hypertrophy (heart/body weight, mean±SD: 5.9±0.8vs 5.1±0.7 mg/g, p<0.05), fibrosis and reduced left ventricular fractional shortening compared with control. Cardiomyocytes from CAIA mice showed reduced cytosolic [Ca2+]i transient amplitudes (F/F0, mean±SD: 3.0±1.2vs 3.6±1.5, p<0.05) that was linked to reductions in sarcoplasmic reticulum (SR) Ca2+ store (F/F0, mean±SD: 3.5±1.3vs 4.4±1.3, p<0.01) measured with Ca2+ imaging. This was associated to lower fractional shortening in the cardiomyocytes from the CAIA mice (%FS, mean±SD: 3.4±2.2 vs 4.6%±2.3%, p<0.05). Ca2+ handling proteins displayed oxidation-dependent posttranslational modifications that together with an increase in superoxide dismutase expression indicate a cell environment with oxidative stress.ConclusionsThis study shows that inflammation during active RA has long-term consequences on molecular remodelling and contractile function of the heart, which further supports that rheumatology patients should be followed for development of heart failure.

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Assessment of the Ovarian Reserve by Serum Anti-Müllerian Hormone in Rheumatoid Arthritis Patients: A Systematic Review and Meta-Analysis

International Archives of Allergy and Immunology ◽

10.1159/000520133 ◽

2021 ◽

pp. 1-8

Author(s):

Xian-hui Zhang ◽

Ying-an Zhang ◽

Xin Chen ◽

Peng-yan Qiao ◽

Li-yun Zhang

Keyword(s):

Rheumatoid Arthritis ◽

Ovarian Reserve ◽

Meta Analysis ◽

Cochrane Library ◽

Dmard Treatment ◽

Standard Mean Difference ◽

Increased Risk ◽

Significant Difference ◽

Newcastle Ottawa Scale ◽

The Cochrane Library

Background: The ovarian reserve has been reported to be diminished in patients with rheumatoid arthritis. However, these results are still controversial. Anti-Müllerian hormone (AMH) is considered a reliable biomarker for the ovarian reserve. We thus performed a meta-analysis to evaluate the AMH levels and the effect of DMARDs on the ovarian reserve in rheumatoid arthritis patients. Methods: PubMed, EMBASE, the Cochrane Library, and 2 Chinese databases (CNKI and Wanfang database), up to September 2021, were searched for relevant studies. The Newcastle-Ottawa scale (NOS) was used to assess the quality of the included studies. Pooled standard mean difference (SMD) with 95% confidence intervals (CIs) were determined with the random-effects model. The heterogeneity was described by I2 statistic and p value from the Cochrane Q test. Results: Eight eligible studies (679 patients and 1,460 controls) were included in the meta-analysis. Compared with healthy control, the AMH levels in RA patients were significantly lower with the pooled SMD of −0.40 (95% CI: −0.66 to −0.14). However, in comparison of AMH with and without DMARD treatment, there was no significant difference with the pooled SMD of −0.1 (95% CI: −0.39 to 0.19). Conclusion: The results indicated that there was an increased risk of ovarian failure in RA patients and which is not related to DMARD treatment.

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Rheumatoid arthritis—clinical features

10.1093/med/9780199642489.003.0111 ◽

2013 ◽

Author(s):

Eugen Feist ◽

Gerd-R. Burmester

Keyword(s):

Rheumatoid Arthritis ◽

Clinical Features ◽

Clinical Laboratory ◽

Systemic Disease ◽

Systemic Autoimmune Disease ◽

Joint Involvement ◽

Loss Of Function ◽

Increased Risk ◽

Autoantibody Status ◽

Disease Entities

Rheumatoid arthritis (RA) presents with variable clinical features, making this most frequent chronic systemic autoimmune disease with characteristic joint involvement a diagnostic and therapeutic challenge. This chapter describes in detail the different clinical, laboratory and imaging findings in patients with RA. In addition to the characteristic arthritic involvement, which can lead to severe joint changes with progressive destruction and loss of function, other systemic disease manifestations as well as an increased risk for cardiovascular events and non-Hodgkin's lymphoma with relevance for patients' prognosis are described. Recent approaches to early diagnosis and stratification of patients by predictive factors for a severe course of disease are discussed. These patient profiles include increased inflammatory markers, the presence of autoantibodies, and erosive changes at the time of diagnosis. The novel classification criteria for RA and the significance of autoantibody status, namely seropositivity for antibodies against citrullinated antigens as highly specific diagnostic markers, are highlighted to further promote early differentiation of RA from other arthritic disease entities.

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Analysis of distribution and severity of inflammation in patients with osteoarthitis compared to rheumatoid arthritis by ICG-enhanced fluorescence optical imaging and musculoskeletal ultrasound: a pilot study

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2015-207345 ◽

2015 ◽

Vol 75 (3) ◽

pp. 566-570 ◽

Cited By ~ 26

Author(s):

A-M Glimm ◽

S G Werner ◽

G R Burmester ◽

M Backhaus ◽

S Ohrndorf

Keyword(s):

Rheumatoid Arthritis ◽

Optical Imaging ◽

Joint Inflammation ◽

Musculoskeletal Ultrasound ◽

Imaging Method ◽

Hand Osteoarthritis ◽

Dominant Hand ◽

Fluorescence Optical Imaging ◽

Inflammatory Status ◽

Inflammatory Changes

BackgroundIn rheumatoid arthritis (RA), hand synovitis appears especially in wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. In hand osteoarthritis (OA), potential inflammatory changes are mainly present in PIP and distal interphalangeal (DIP) joints. Joint inflammation can be visualised by fluorescence optical imaging (FOI) and musculoskeletal ultrasound (US).ObjectiveComparison of the amount and distribution of inflammatory signs in wrist and finger joints of the clinically dominant hand in patients with OA and RA by FOI and gray-scale (GSUS) and power Doppler US (PDUS).MethodsFOI and GSUS/PDUS were performed in 1.170 joints (wrists, MCP, PIP, DIP) in 90 patients (67 RA, 23 OA). Joint inflammation was graded by a semiquantitative score (0–3) for each imaging method.ResultsGSUS/PDUS showed wrist and MCP joints mostly affected in RA. DIP joints were graded higher in OA. In FOI, RA and OA featured inflammatory changes in the respective joint groups depending on the phase of fluorescence dye flooding.ConclusionsUS and FOI detected inflammation in both RA and OA highlighting the inflammatory component in the course of OA. The different inflammatory patterns and various shapes of fluorescence enhancement in FOI may offer opportunities to distinguish and determine the inflammatory status in both diseases.

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