T2 Mapping as a New Method for Quantitative Assessment of Cartilage Damage in Rheumatoid Arthritis

Objective.Rheumatoid arthritis (RA) is associated with damage of the articular cartilage and the periarticular bone. While imaging of bone damage has substantially improved in recent years, direct imaging of the articular cartilage of the hand joints in patients with RA is still challenging. The study used T2 mapping of the finger joints to assess cartilage damage in RA.Methods.Magnetic resonance imaging (MRI) at 3 Tesla was done in 30 patients with RA, and T2 relaxation times visualizing alteration in the collagen network and hydration of articular cartilage were mapped in 6 cartilage regions of the metacarpophalangeal (MCP) joints 2 and 3. Values were related to autoantibody status [anticitrullinated protein antibodies (ACPA), rheumatoid factor (RF)], disease duration, and disease activity as well as sex and age of the patients.Results.T2 relaxation times could be reliably measured in the 6 regions of the MCP joints. Significantly higher relaxation times indicating more advanced cartilage alterations were observed in the metacarpal heads of ACPA-positive (p = 0.001–0.010) and RF-positive patients (p = 0.013–0.025) as well as those with longer disease duration (> 3 yrs; p = 0.028–0.043). Current disease activity, sex, and age did not influence T2 relaxation times.Conclusion.These data show that cartilage damage can be localized and quantified in the hand joints of patients with RA by T2 mapping. Further, ACPA and RF positivity as well as disease duration appear to be the crucial factors influencing cartilage damage.

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Assessment of T2 Relaxation Times for Normal Canine Knee Articular Cartilage by T2 Mapping Using 1.5-T Magnetic Resonance Imaging

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-17-01-0014 ◽

2017 ◽

Vol 30 (06) ◽

pp. 391-397 ◽

Cited By ~ 1

Author(s):

Asami Matsui ◽

Miki Shimizu ◽

Brian Beale ◽

Fumitaka Takahashi ◽

Sinya Yamaguchi

Keyword(s):

Magnetic Resonance Imaging ◽

Articular Cartilage ◽

Magnetic Resonance ◽

T2 Mapping ◽

Relaxation Times ◽

Cartilage Thickness ◽

Resonance Imaging ◽

T2 Relaxation ◽

Stifle Joint

Abstract Objectives This study aims to assess and compare the T2 relaxation times for articular cartilage of normal canine stifle joints in four regions by T2 mapping using a 1.5-T magnetic resonance imaging (MRI). Methods In vivo prospective study: 20 hindlimbs (left and right) from 10 normal healthy beagle dogs (n = 20). The region of interest (ROI) was subdivided into medial and lateral condyles of femoral cartilage (MF and LF, respectively) and medial and lateral condyles of tibial cartilage (MT and LT, respectively). The T2 relaxation times were assessed in regions where the cartilage thickness was greater than 0.5 mm. Results The median maximum cartilage thickness (mm) of the four ROI were 0.7 (range: 0.9–0.6), 0.6 (range: 0.7–0.5), 0.7 (range: 0.9–0.5) and 0.6 (range: 0.8–0.5) at MF, LF, MT and LT, respectively. The errors in the measurement (%) of the four ROI were 64.3 (range: 50.0–75.0), 75.0 (range: 64.3–90.0), 64.3 (range: 20.0–90.0) and 75.0 (range: 56.3–90.0) at MF, LF, MT and LT, respectively. The median T2 relaxation times (ms) for the articular cartilage of the four ROI were 70.2 (range: 57.9–87.9), 57.5 (range: 46.8–66.9), 65.0 (range: 52.0–92.0) and 57.0 (range: 49.0–66.2) at MF, LF, MT and LT, respectively. The inter-observer correlation coefficient (ICC, 2.1) for the T2 relaxation times of MF was 0.644. Clinical Significance This study offers useful information on T2 relaxation times for articular cartilage of the stifle joint using a 1.5-T MRI in normal dogs.

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T2 Versus T2* MRI Mapping in the Knee Articular Cartilage at 1.5 Tesla and 3 Tesla

Open Medicine Journal ◽

10.2174/1874220301805010119 ◽

2018 ◽

Vol 5 (1) ◽

pp. 119-129 ◽

Cited By ~ 1

Author(s):

Mokhtar Mars ◽

Zeineb Tbini ◽

Souha Gharbi ◽

Mouna Chelli Bouaziz ◽

Fethi Ladeb

Keyword(s):

Articular Cartilage ◽

Negative Correlation ◽

Significant Positive Correlation ◽

T2 Mapping ◽

Relaxation Times ◽

Significant Negative Correlation ◽

3 Tesla ◽

T2 Relaxation ◽

Positive Correlation ◽

T2 Mri

Background: Recently, several studies have shown that T2 and T2* MRI parametric mapping are sensitive to structural and biochemical changes in the extracellular cartilage matrix. The objective of this study was to assess, compare and correlate quantitative T2 and T2* relaxation time of the knee articular cartilage at 1.5 Tesla (T) and 3 Tesla. Methods: Thirty-eight symptomatic patients with knee articular cartilage disease and forty-one asymptomatic volunteers were prospectively included in the study. Knee MRI examination was performed by 3 T and 1.5 T scanner. Multi-Echo Spin-Echo (MESE) and Multi-Echo Gradient Echo (MEGE) sequences were used to determine T2* and T2 maps. T2 and T2* relaxation times values were measured in three Regions Of Itnterest (ROI) on knee articular cartilage using mono-exponential analysis fitting algorithm. Results: There was a significant difference between volunteers and patients for T2 and T2* relaxation times values at 1.5 T and 3 T (p<0.05). The comparison between magnetic fields has shown lower T2 and T2* relaxation times at 3 T compared to 1.5 T. Pearson’s correlation analysis between T2 and T2* at 1.5T revealed a significant positive correlation for volunteers (r=0.245, p = 0.01) and a significant negative correlation for patients (0.016, p = 0.018). At 3T, there was a significant positive correlation between T2 and T2* for volunteers (r=0.076) and patients (r=0.165). The correlation of T2 and T2* between 1.5 T and 3T showed a significant negative correlation (r=-0.087, p = 0.01). Conclusion: T2* mapping may be used for the diagnosis of knee articular cartilage osteoarthritis with the advantage of relatively short scanning time, higher SNR, shorter echo times and the non-effect of the stimulated echo compared to T2 mapping.

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AB1123 PROGRESSION OF FINGER JOINT CARTILAGE DAMAGE EVALUATED BY ULTRASOUND IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.5598 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1850.2-1851

Author(s):

T. Ogura ◽

A. Hirata ◽

S. Takenaka ◽

Y. Inoue ◽

T. Kagtagiri ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Disease Duration ◽

Cartilage Damage ◽

Joint Space ◽

Cartilage Thickness ◽

Finger Joint ◽

Joint Cartilage ◽

Direct Evaluation ◽

The Us

Background:Cartilage damage in rheumatoid arthritis (RA) has been evaluated by joint space narrowing (JSN) in X-ray, despite the fact that it is not a direct evaluation of cartilage. We have recently reported that direct evaluation of finger joint cartilage thickness evaluated by ultrasound (US) is valid and useful for patients with RA1).Objectives:In this study, we aimed to examine the progression of cartilage damage in RA patients.Methods:Forty-six patients with RA who had completed the US evaluation of finger joint cartilage thickness at baseline and after 1 year were included in this study. The cartilage thickness of metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of 2nd to 5th fingers were bilaterally visualized and measured at the middle portion of MCP and PIP joints from a longitudinal dorsal view, with approximately 90 degrees flexion. Cartilage thickness was measured from the base of the cartilage to the interface artefact at the cartilage surface by calculating the pixel counts on DICOM images.Results:In patients, 78% were female, the median age was 68 years and the median disease duration of the patients was 6 years. The median DAS28-CRP at baseline was 2.6. The sum of total cartilage thickness from 16 joints per patient ranged from 3.1 to 9.1 mm (median 6.4 mm) at baseline, and it was significantly correlated with disease duration (ρ=-0.423, p=0.003). A significant decrease from the baseline in the cartilage thickness (median -1.6%) was observed after 1 year (p=0.041). Furthermore, patients with persistently moderate/high disease activity for 1 year by DAS28-CRP (n=9) showed a greater decrease in the cartilage thickness than the remaining patients with controlled disease activity (n=37) (median -5.9% versus -1.5%, respectively, p=0.029).Conclusion:This study further supported the validity and usefulness of joint cartilage thickness evaluation by US in patients with RA.References:[1]Ogura T, et al. Arthritis Care Res 2019 Oct 25.Disclosure of Interests:Takehisa Ogura: None declared, Ayako Hirata: None declared, Sayaka Takenaka: None declared, Yuki Inoue: None declared, Takaharu Kagtagiri: None declared, Yuto Takakura: None declared, Hideki Ito: None declared, Hideto Kameda Grant/research support from: Abbvie, Asahi-Kasei, Chugai, Eisai, Mitsubishi-Tanabe and Novartis, Consultant of: Abbvie, Boehringer, Celgene, Eli Lilly, Janssen, Novartis, Sanofi, UCB, Speakers bureau: Abbvie, Asahi-Kasei, BMS, Chugai, Eisai, Eli Lilly, Janssen, Mitsubishi-Tanabe, Novartis and Pfizer

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AB0115 COMPARISON OF ULTRASOUND FINDINGS BETWEEN TNF INHIBITORS AND NON-TNF INHIBITORS AT FIRST BIOLOGICS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.1377 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1086.2-1087

Author(s):

T. Okano ◽

T. Koike ◽

K. Inui ◽

K. Mamoto ◽

Y. Yamada ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Disease Duration ◽

Power Doppler ◽

Tnf Inhibitors ◽

Tnf Inhibitor ◽

Significant Difference ◽

The Us ◽

Us Findings ◽

Improvement Ratio

Background:In rheumatoid arthritis (RA), biologics treatment is one of the effective treatment options. Usually, there is no difference in therapeutic effect regardless of which biologics is used, but the effect for joint synovitis is unknown. Recently, ultrasound (US) has played a role of sensitive imaging modality in the diagnosis and follow-up of patients with RA.Objectives:The aim of this study was to compare the improvement of US findings between TNF inhibitors and non-TNF inhibitors at first biologics in patients with RA.Methods:Fifty-four RA patients who started the first biologics from September 2016 to December 2018 were included in this longitudinal study (SPEEDY study, UMIN000028260). All the patients were performed clinical examination, blood test and US examination at baseline, 4, 12, 24, 36 and 52 weeks. A US examination was performed at the bilateral first to fifth metacarpophalangeal (MCP) joints, first interphalangeal (IP) and second to fifth proximal interphalangeal (PIP) joints, wrist joints (three part of radial, medial and ulnar) and first to fifth metatarsophalangeal (MTP) joints, by using HI VISION Ascendus (Hitachi Medical Corporation, Japan) with a multifrequency linear transducer (18-6 MHz). The gray scale (GS) and power Doppler (PD) findings were assessed by the semi-quantitative method (0-3). GS score and PD score (both 0-108 points) were defined as the sum of each score. The change of disease activity and US findings were compared between TNF group and non-TNF group.Results:Among 54 cases, 32 patients were used TNF inhibitor and 22 were non-TNF inhibitor. Age and duration of RA were significantly higher in the non-TNF group, and MTX dose was significantly lower in the non-TNF group. The baseline inflammatory markers tended to be higher in the non-TNF group and the disease activity was also higher in the non-TNF group. However, the US findings showed no significant difference in both GS and PD between two groups at baseline. US improvement ratio was no difference between TNF group and non-TNF group at 4, 12, 24, 36 and 52 weeks in both GS and PD score. Regardless of the type of biologics, patients with long-term disease duration tended to have poor improvement in US synovial fingings.Table 1.Baseline patient and disease characteristicsTNF (n=32)non-TNF (n=22)P valueFemale patients, n (%)21 (65.6)16 (72.7)0.767Age (years)63.5±15.471.0±9.00.030Disease duration (years)6.5±8.213.0±11.70.032CRP (mg/dl)1.8±2.53.0±3.20.170DAS28-ESR5.0±1.45.8±1.20.022GS score26.1±18.831.8±21.10.313PD score17.6±11.423.1±14.60.150Figure 1.GS and PD improvement ratio at 4, 12, 24, 36 and 52 weeksConclusion:There was no difference in the US findings improvement between patients with TNF inhibitor and non-TNF inhibitor at first biologics in patients with RA.References:[1]Grassi W, Okano T, Di Geso L, Filippucci E. Imaging in rheumatoid arthritis: options, uses and optimization. Expert Rev Clin Immunol. 2015;11:1131-46.[2]Nishino A, Kawashiri SY, Koga T, et al. Ultrasonographic Efficacy of Biologic andTargeted Synthetic Disease-ModifyingAntirheumatic Drug Therapy in RheumatoidArthritis From a Multicenter RheumatoidArthritis Ultrasound Prospective Cohort in Japan. Arthritis Care Res (Hoboken). 2018;70:1719-26.Acknowledgements:We wish to thank Atsuko Kamiyama, Tomoko Nakatsuka for clinical assistant, Setsuko Takeda, Emi Yamashita, Yuko Yoshida, Rika Morinaka, Hatsue Ueda and Tomomi Iwahashi for their special efforts as a sonographer and collecting data.Disclosure of Interests:None declared

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SAT0039 ADAPTIVE DEEP LEARNING FOR THE PREDICTION OF INDIVIDUAL DISEASE ACTIVITY IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2712 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 950.1-950

Author(s):

M. Hügle ◽

G. Kalweit ◽

U. Walker ◽

A. Finckh ◽

R. Muller ◽

...

Keyword(s):

Neural Network ◽

Rheumatoid Arthritis ◽

Disease Activity ◽

Deep Neural Networks ◽

Disease Duration ◽

Research Support ◽

Disease Characteristics ◽

Individual Disease ◽

Active Disease ◽

Research Grant

Background:Rheumatoid arthritis (RA) lacks reliable biomarkers that predict disease evolution on an individual basis, potentially leading to over- and undertreatment. Deep neural networks learn from former experiences on a large scale and can be used to predict future events as a potential tool for personalized clinical assistance.Objectives:To investigate deep learning for the prediction of individual disease activity in RA.Methods:Demographic and disease characteristics from over 9500 patients with 65.000 visits from the Swiss Quality Management (SCQM) database were used to train and evaluate an adaptive recurrent neural network (AdaptiveNet). Patient and disease characteristics along with clinical and patient reported outcomes, laboratory values and medication were used as input features. DAS28-BSR was used to predict active disease and future numeric individual disease activity by classification and regression, respectively.Results:AdaptiveNet predicted active disease defined as DAS28-BSR>2.6 at the next visit, with an overall accuracy of 75.6% and a sensitivity and specificity of 84.2% and 61.5%, respectively. Apart from DAS28-BSR, the most influential characteristics to predict disease activity were joint pain, disease duration, age and medication. Longer disease duration, age >50 or antibody positivity marginally improved prediction performance. Regression allowed forecasting individual DAS28-BSR values with a mean squared error of 0.9.Conclusion:Deep neural networks have the capacity to predict individual disease outcome in RA. Low specificity remains challenging and might benefit from alternative input data or outcome targets.References:[1] Hügle M, Kalweit G, Hügle T, Boedecker J. A Dynamic Deep Neural Network For Multimodal Clinical Data Analysis. Be Publ Stud Comput Intell Springer Verl. 2020.Figure 1.Examples of true disease activity and corresponding predictions of AdaptiveNet by regression analysis. Predictions are made step to step from the current to next visit.Disclosure of Interests:Maria Hügle Paid instructor for: Lilly, Gabriel Kalweit: None declared, Ulrich Walker Grant/research support from: Ulrich Walker has received an unrestricted research grant from Abbvie, Consultant of: Ulrich Walker has act as a consultant for Abbvie, Actelion, Boehringer Ingelheim, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, Phadia, Roche, Sandoz, Sanofi, and ThermoFisher, Paid instructor for: Abbvie, Novartis, and Roche, Speakers bureau: Abbvie, Actelion, Bristol-Myers Squibb, Celgene, MSD, Novartis, Pfizer, Phadia, Roche, Sandoz, and ThermoFisher, Axel Finckh Grant/research support from: Pfizer: Unrestricted research grant, Eli-Lilly: Unrestricted research grant, Consultant of: Sanofi, AB2BIO, Abbvie, Pfizer, MSD, Speakers bureau: Sanofi, Pfizer, Roche, Thermo Fisher Scientific, Rudiger Muller Consultant of: AbbVie, Nordic, Sandoz, Almut Scherer: None declared, Joschka Boedecker: None declared, Thomas Hügle Grant/research support from: Abbvie, Novartis, Consultant of: Abbvie, Pfizer, Novartis, Roche, Lilly, BMS

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SAT0047 RISK FACTORS FOR THE POSTOPERATIVE DELAYED WOUND HEALING IN PATIENTS WITH RHEUMATOID ARTHRITIS TREATED WITH A BIOLOGICAL AGENT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.3424 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 954.3-954

Author(s):

S. Okita ◽

H. Ishikawa ◽

A. Abe ◽

S. Ito ◽

A. Murasawa ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Wound Healing ◽

Retrospective Study ◽

Nutritional Status ◽

Disease Activity ◽

Disease Duration ◽

Foot And Ankle ◽

Delayed Wound Healing ◽

Chugai Pharmaceutical

Background:It has been suggested that perioperative use of biological disease-modifying anti-rheumatic drugs (bDMARDs) in rheumatoid arthritis (RA) patients carries risks for the surgical-site infection and the delayed wound healing (DWH); however, the risk of DWH with perioperative use of bDMARDs has not reached a general consensus.Objectives:This retrospective study aimed to investigate the risk factors associated with DWH after orthopedic surgery in RA patients treated with bDMARDs.Methods:We reviewed medical records of 277 orthopedic procedures for 188 RA patients treated with bDMARDs between from 2014 to 2017 in Niigata Rheumatic Center. As preoperative nutritional status assessment, we evaluated body mass index (BMI), prognostic nutritional index (PNI), and CONtrolling NUTritional status (CONUT). In addition, we evaluated DAS28-CRP, DAS28-ESR, face scale for pain, global health (GH), and Health Assessment Questionnaire-Disability Index (HAQ-DI) to assess the disease activity. Univariate and multivariate logistic regression analyses were performed to evaluate the risk factor for DWH.Results:The major characteristics of the patients in 277 procedures were mean age of 63.2 years old and mean disease duration of 18.2 years. Surgical site were hand and wrist (145 procedures), foot and ankle (76), hip and knee (31), elbow and shoulder (24), and spine (1). Seventy-four patients were treated with tocilizumab, 62 with etanercept, 55 with golimumab, 49 with abatacept, 16 with infliximab, 15 with adalimumab, and 6 with certolizumab. According to nutritional assessment in PNI and CONUT, 63% (n=175) and 47% (n=130) were normal nourished patients, respectively.In 277 procedures, DWH were identified in 24 patients (8.6%). The following variables were significant in the univariate analyses: disease duration (OR 1.053; 95% CI 1.010–1.099; p=0.016), foot and ankle surgery (OR 7.091; 95% CI 2.130–23.603; p=0.001), tocilizumab (OR 0.286; 95% CI 0.093–0.881; p=0.029) (Table 1). These variables were entered into a multivariate model, and it was revealed that pre-operative use of tocilizumab (OR 0.265; 95% CI 0.074–0.953; p=0.042) and procedures in the foot and ankle (OR 6.915; 95% CI 1.914–24.976; p=0.003) were associated with an increased risk of DWH (Table 1).Conclusion:As previous study on tocilizumab described, the current retrospective study suggested that pre-operative use of tocilizumab and procedures in the foot and ankle were risk factors for DWH. Pre-operative disease activity and nutritional status were not independent risk factors for an increase in the prevalence of DWH.References:[1] Momohara S, Hashimoto J, Tsuboi H et al. Analysis of perioperative clinical features and complications after orthopaedic surgery in rheumatoid arthritis patients treated with tocilizumab in a real-world setting: Results from the multicentre tocilizumab in perioperative period (TOPP) study. Modern rheumatology. 2013, 23: 440-9.Disclosure of Interests:Shunji Okita: None declared, Hajime Ishikawa: None declared, Asami Abe: None declared, Satoshi Ito Speakers bureau: Abbvie,Eisai, Akira Murasawa: None declared, Keiichiro Nishida Grant/research support from: K. Nishida has received scholarship donation from CHUGAI PHARMACEUTICAL Co., Eisai Co., Mitsubishi Tanabe Pharma and AbbVie GK., Speakers bureau: K. Nishida has received speaking fees from CHUGAI PHARMACEUTICAL Co., Eli Lilly, Janssen Pharmaceutical K.K., Eisai Co. and AYUMI Pharmaceutical Corporation., Toshifumi Ozaki: None declared

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AB0101 THE IMPACT OF TIME SPAN TO ACHIEVE BOOLEAN REMISSION FOR MAINTAINING DISEASE ACTIVITY AFTER ACQUISITION IN RHEUMATOID ARTHRITIS PATIENT

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.297 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1079.1-1079

Author(s):

I. Yoshii

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Disease Duration ◽

Remission Rate ◽

Mean Value ◽

Time Span ◽

Mean Values ◽

The Mean ◽

The Relationship

Background:Boolean remission criteria is one most popular and stringent criteria in treating patient with rheumatoid arthritis (RA), because it may guarantees a stable clinical course after attaining remission.Objectives:Impact of time span from initiation to achieving Boolean remission on maintaining disease activity, daily activities, and quality of life after attaining Boolean remission was investigated from daily clinical practice data.Methods:685 patients with RA since August 2010 under the T2T strategy were treated. They were monitored for their TJC, SJC, PGA, EGA, CRP, and disease activity indices such as CDAI, SDAI, DAS28, and Boolean criteria at every visit. HAQ-DI score, pain score using visual analog scale (PS-VAS), and EQ-5D were also monitored, and the quality of life score (QOLS) calculated from EQ-5D was determined at every visit from the time of diagnosis (baseline).Of 685 patients, 465 patients had achieved Boolean remission >1 times, and were consecutively followed up for >3 years. These patients were enrolled in the study. Time span from the first visit to first Boolean remission was calculated. The relationship between the time span and each of background parameters, and the relationship between the time span and each of the mean values of the SDAI score, HAQ score, PS-VAS, SHS, and QOLS at the first Boolean remission and thereafter was evaluated statistically.Patients were subsequently divided into the G ≤ 6 and G > 6 groups based on the achievement of first Boolean remission within two groups: time span G ≤ 6 months and G > 6 months. The two groups were compared with regard to the SDAI score, HAQ score, PS-VAS, SHS, and QOLS at first visit and at the time of first Boolean remission, and the mean values of these parameters after remission were evaluated statistically. Moreover, changes of these parameters and the mean Boolean remission rate after the first remission, and SDAI remission rate at the first Boolean remission to thereafter were compared between the two groups statistically.Results:Out of 465 patients, females comprised 343 (73.7%), and the mean age was 67.8 years (range, from 21–95 years). The mean disease duration at first visit was 6.1 years (range, from 1 months–45 years). The mean follow up length was 88.1 months (range: 36–122 months; median: 85 months) and mean time span from the first visit to the first Boolean remission was 8.1 months. The mean SDAI score, HAQ score, PS-VAS, and the QOLS at first visit were 13.3, 0.467, 33.2, and 0.834, respectively. Among the study parameters, PS-VAS and QOLS were significantly correlated with the time span. For parameters at the first Boolean remission, HAQ-DI score, PS-VAS, and QOLS demonstrated significant correlation with the time span, whereas SDAI, HAQ-DI score, PS-VAS, SHS, and QOLS after the Boolean remission demonstrated significant correlation with the time span.The comparison between the G ≤ 6 and the G > 6 groups revealed that the disease duration, HAQ score, and PS-VAS at baseline in the G > 6 were significantly higher than that in the G ≤ 6 group, and QOLS in the G ≤ 6 group was significantly higher than that in the G > 6 group at baseline. Similarly, the HAQ score and PS-VAS at the first Boolean remission in the G > 6 group were significantly higher than that in the G ≤ 6 group, whereas QOLS in the G ≤ 6 group demonstrated no significant difference compared with that in the G > 6 group.The mean value of the SDAI score after the first Boolean remission in the G > 6 group was significantly higher than that in the G ≤ 6 group. Similarly, the SDAI score, HAQ score, and PS-VAS after the first Boolean remission in the G > 6 group were also significantly higher than those in the G ≤ 6 group, and the mean value of the QOLS in the G ≤ 6 group were significantly higher than that in the G > 6 group. The Boolean remission rate and SDAI remission rate after the first Boolean remission were significantly higher in the G ≤ 6 group than those in the G > 6 group.Conclusion:Attaining Boolean remission ≤ 6 months for RA has significant benefit for more stable disease control, that leads good maintenance of ADL.Disclosure of Interests:None declared

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Patients with Rheumatoid Arthritis in Clinical Remission Manifest Persistent Joint Inflammation on Histology and Imaging Studies

The Journal of Rheumatology ◽

10.3899/jrheum.140411 ◽

2014 ◽

Vol 41 (11) ◽

pp. 2153-2160 ◽

Cited By ~ 26

Author(s):

Allen Anandarajah ◽

Ralf Thiele ◽

Ellen Giampoli ◽

Johnny Monu ◽

Gwy-Suk Seo ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Clinical Remission ◽

Severe Disease ◽

Joint Inflammation ◽

Imaging Studies ◽

American College Of Rheumatology ◽

Remission Criteria ◽

Magnetic Resonance Imaging Mri ◽

Active Inflammation

Objective.The purpose of our study was to test the hypothesis that synovitis on magnetic resonance imaging (MRI) and ultrasound (US) observed in patients with rheumatoid arthritis (RA) who meet remission criteria reflects active inflammation on histopathology.Methods.We analyzed 15 synovial specimens obtained during surgical procedures from 14 patients with RA in clinical remission as defined by the American College of Rheumatology criteria. Histological specimens were scored for hyperplasia of synovial lining and synovial stroma, inflammation, lymphoid follicles, and vascularity. The histology scores were classified as minimal, mild, moderate, or severe disease activity. US and MRI performed within a 4-month period of surgery were scored for disease activity. The correlation between histology and imaging scores was examined.Results.Four of 14 patients were receiving anti-tumor necrosis factor (TNF) therapy, 4 were receiving methotrexate (MTX) alone, 4 were taking MTX and hydroxychloroquine (HCQ), and 1 was taking HCQ and sulfasalazine. Four specimens had severe, 6 moderate, 3 mild, and 2 minimal disease activity on histology. Three of 4 specimens with minimal and mild histology were observed in subjects receiving anti-TNF therapy. Synovitis was noted on greyscale in 80% of joints and Doppler signal in 60%. MRI demonstrated synovitis and bone marrow edema in 86% of images. Positive but not significant correlations were noted between histology and synovitis scores on US.Conclusion.Despite clinical remission, histology and imaging studies documented a persistently active disease state that may explain the mechanism for radiographic progression.

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Myocardial Tissue Characterization By T2 Mapping in Thalassemia Major

Blood ◽

10.1182/blood-2020-134591 ◽

2020 ◽

Vol 136 (Supplement 1) ◽

pp. 27-28

Author(s):

Alessia Pepe ◽

Nicola Martini ◽

Rita Borrello ◽

Vincenzo Positano ◽

Laura Pistoia ◽

...

Keyword(s):

Tissue Characterization ◽

Spin Echo ◽

T2 Mapping ◽

Relaxation Times ◽

Thalassemia Major ◽

Fast Spin Echo ◽

Myocardial Inflammation ◽

Healthy Population ◽

Myocardial Iron ◽

Magnetic Resonance Imaging Mri

Introduction.The presence of iron deposits results in a significant reduction in all magnetic resonance imaging (MRI) relaxation times (T1, T2 and T2*). In the clinical setting the T2* technique is the method of choice for cardiac iron quantification and it has revolutionized the management of patients with hemoglopinopathies. Purpose.To compare myocardial T2 against T2* in patients with thalassemia major (TM) for myocardial iron characterization. Methods.133 TM patients (79 females, 38.4±11.3 years) enrolled in the Extension Myocardial Iron Overload in Thalassemia (eMIOT) Network were considered. T2 and T2* images were acquired, respectively, with multi-echo fast-spin-echo and gradient-echo sequences. Global heart T2 and T2* values were obtained by averaging the values in all 16 myocardial segments. The normal T2 range was established as mean±2 standard deviations on data acquired on 80 healthy volunteers (males: 48-56 ms and females: 50-57 ms). The lower limit of normal for global heart T2*, established on the same healthy population, was 32 ms. Results.A significant correlation was detected between global heart T2 and T2* values (R=0.577; P<0.0001) (Figure). Out of the 113 (84.9%) patients with a normal global heart T2* value, none had a decreased global heart T2 value, while 58 (51.3%) had an increased T2 value. Out of the 20 patents with a decreased global heart T2* value, only 10 (50%) had also a reduced T2 value. Conversely, 9 (45.0%) had a normal global heart T2 value and one (4.5) showed an increased T2 value. The 59 patients with increased global heart T2 value were significantly older than the remaining patients (40.8±10.5 vs 36.4±11.6 years; P=0.019) Conclusion.All patients with decreased T2 value had also a decreased T2* value and in half of the patients iron load was undetected by T2, suggesting that T2 mapping does not offer any advantage in terms of sensitivity for MIO assessment. However, more than half of TM patients had an increased T2 value, thus may be caused by the presence of myocardial inflammation and/or edema. So, T2 mapping could reveal subclinical myocardial involvement in TM patients. Figure Disclosures Pistoia: Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.Meloni:Chiesi Farmaceutici S.p.A.:Other: speakers' honoraria.

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Reasons for discordances between ultrasonography and magnetic resonance imaging in the evaluation of the ankle, hindfoot and heel of the patients with rheumatoid arthritis

Medical Ultrasonography ◽

10.11152/mu-2304 ◽

2019 ◽

Vol 21 (4) ◽

pp. 405 ◽

Cited By ~ 2

Author(s):

Oana Șerban ◽

Daniela Fodor ◽

Iulia Papp ◽

Mihaela Cosmina Micu ◽

Dan Gabriel Duma ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Disease Activity ◽

Activity Index ◽

Imaging Techniques ◽

Disease Activity Index ◽

Resonance Imaging ◽

Magnetic Resonance Imaging Mri ◽

Definition Of

Aim: To compare the ultrasonography (US) performance with magnetic resonance imaging (MRI) in identifying pathology in ankles, hindfeet and heels of rheumatoid arthritis (RA) patients and to evaluate the reasons for discordances between the two imaging methods.Material and methods: RA patients were enrolled and evaluated using the Clinical Disease Activity Index (CDAI) and the Disease Activity Score 28 with C-reactive Protein (DAS28-CRP). The ankle (tibiotalar joint, tendons), hindfoot (talonavicular, subtalar joints) and heel of the most symptomatic or dominant foot (for the asymptomatic patient)were evaluated by two pairs of examiners using US and contrast-enhanced MRI.Results: Totally, 105 joints, 245 tendons and 35 heels in 35 patients [mean age 59.2±11.25 years old, median disease duration 36 (16.5-114), mean CDAI 19.87±12.7] were evaluated. The interobserver agreements between the two sonographers, and the two radiologists were good and very good (k=0.624-0.940). The overall agreement between US and MRI was very good for subcalcaneal panniculitis (k=0.928, p<0.001), moderate for synovitis (k=0.463, p<0.001) and tenosynovitis (k=0.514, p<0.001), fair for osteophytes (k=0.260, p=0.004), and poor for erosions (k=0.063, p=0.308) and heel’s structures. MRI found more erosions, synovitis, osteophytes,tenosynovitis and retrocalcaneal bursitis, but US found more enthesophytes and plantar fasciitis. Many of the discordancesbetween the two imaging techniques have explanations related to the technique itself or definition of the pathologic findings.Conclusions: US is comparable to MRI for the evaluation of ankle, hindfoot and heel in RA patients and discordances in theinterpretation of the pathological findings/normal structures must be carefully analyzed.

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