Abstract
BackgroundEven though cartilage loss is a known feature of psoriatic arthritis (PsA), little is known about its role in the pathogenesis of PsA. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) as a non-invasive marker of the tissue’s proteoglycan content, such early (i.e., pre-morphological) changes have been associated with inflammation in rheumatoid arthritis (RA). Yet, this association has not been studied before in PsA.MethodsThe metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of 17 patients with active PsA were evaluated by high-resolution clinical standard morphological and dGEMRIC sequences using a 3T MRI scanner (Magnetom Skyra, Siemens) and a dedicated 16-channel hand coil. Images were analyzed by two independent raters for dGEMRIC indices, PsA MRI scores (PsAMRIS), and total cartilage thickness (TCT). Kendall tau correlation coefficients (τ) were calculated.ResultsWe found significant negative correlations between dGEMRIC indices and total PsAMRIS (τ = − 0.5, p = 0.012), synovitis (τ = − 0.56, p = 0.006), flexor tenosynovitis (τ = − 0.4, p = 0.049), and periarticular inflammation (τ = − 0.72, p < 0.001). Significant positive correlations were found between TCT and dGEMRIC indices at all joint levels (τ = 0.43, p < 0.001). No significant correlations were determined between dGEMRIC indices and bone erosion, bone edema, or bone proliferation.ConclusionIn PsA, proteoglycan loss as assessed by dGEMRIC is associated with periarticular inflammation, synovitis, and flexor tenosynovitis, but not with bone erosion or proliferation. Thereby, these findings contribute to in vivo concepts of the disease’s pathophysiology. Beyond morphology, advanced MRI techniques may be used to assess cartilage composition in PsA and to identify early changes in the cartilage as an imaging biomarker with potential application in detection, monitoring, and prediction of outcomes of PsA.Trial registration2014123117, December 2014.
Highlights
Psoriatic arthritis (PsA) is a chronic autoimmune disease that potentially leads to joint mutilation and high functional disability [1]
In psoriatic arthritis (PsA), proteoglycan loss as assessed by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is associated with periarticular inflammation, synovitis, and flexor tenosynovitis, but not with bone erosion or proliferation
While for rheumatoid arthritis (RA), a strong body of scientific evidence has linked dGEMRIC to the detection of cartilage damage and associated intra- and periarticular changes, these associations have not yet been studied for PsA. Against this background and on the basis of high-resolution morphological and compositional magnetic resonance imaging (MRI) techniques, the present study aimed to study the relationship of early cartilage damage and associated osteodestructive, osteoproliferative, and acute inflammatory changes at the MCP, proximal interphalangeal (PIP), and distal interphalangeal (DIP) joint levels in patients with long-standing PsA
Summary
Psoriatic arthritis (PsA) is a chronic autoimmune disease that potentially leads to joint mutilation and high functional disability [1]. As a well-established imaging modality of contemporary medicine, magnetic resonance imaging (MRI) has become increasingly important in the clinical and scientific evaluation of rheumatic diseases This is due to its high sensitivity for joint inflammation, even at subclinical stages, and joint damage as well as the close association of erosive progression of bone damage and MRI findings [6,7,8]. Using delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) as a non-invasive marker of the tissue’s proteoglycan content, such early (i.e., pre-morphological) changes have been associated with inflammation in rheumatoid arthritis (RA). This association has not been studied before in PsA
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