Erosion Score Research Articles

Effect of cumulative exposure to corticosteroid and DMARD on radiographic progression in rheumatoid arthritis: results from the ESPOIR cohort.

Several authors have tried to predict the risk of radiographic progression in RA according to baseline characteristics, considering exposure to treatment only as a binary variable (Treated: Yes/No). This study aims to model the risk of 5-year radiographic progression taking into account both baseline characteristics and the cumulative time-varying exposure to corticosteroids or DMARDs. The study population consisted of 403 patients of the Etude et Suivi des Polyarthrites Indifférenciées Récentes cohort meeting the 1987 ACR or 2010 ACR/EULAR criteria for RA at inclusion and having complete radiographic data at baseline and 5 years. Radiographic progression was defined at 5 years as a significant increase of the Sharp/van der Heidje score (smallest detectable difference ⩾5). The best logistic regression model was selected from the following: model including only clinico-biological baseline characteristics; model considering baseline characteristics and treatments as binary variables; and model considering baseline characteristics and treatments as weighted cumulative exposure variables. Radiographic progression occurred in 143 (35.5%) patients. The best model combined anti-citrullinated peptide antibody positivity, ESR, swollen joint count >14 and erosion score at baseline, as well as corticosteroids, MTX/LEF (MTX or LEF) and biologic DMARDs (bDMARDs) as weighted cumulative exposure variables. Recent cumulative exposure to high doses of corticosteroids (⩽ 3months) was significantly associated with the risk of 5-year radiographic progression and a significant protective association was highlighted for a 36-month exposure to bDMARDs. Corticosteroids and bDMARDs play an important role in radiographic progression. Accounting for treatment class and intensity of exposure is a major concern in predictive models of radiographic progression in RA patients.

Standardized, musculoskeletal ultrasonographic reference values for healthy Korean adults.

Background/AimsTo define standard reference values for musculoskeletal ultrasonography (MSUS) in Korea.MethodsA total of 251 healthy adults were recruited for this study. Ultrasonography was performed by experienced rheumatologists who had undergone four appropriate training programs in Korea. A General Electric LOGIQ electronic ultrasound device fitted with a 12 MHz linear transducer was employed. Mean values ± standard deviations (SDs) were defined as standard reference values. Intraclass correlation coefficients was employed to evaluate the extent of inter- and intraobserver agreement when MSUS measurements were made.ResultsThe 251 study participants included 122 males. Mean subject age was 28.6 years. The average bone-to-capsule distance of the right-side second and third metacarpophalangeal (MCP) joints were 0.68 and 0.72 mm respectively, and those of the left-side joints 0.62 and 0.68 mm. The cartilage thicknesses of the right-side second and third MCP joints were 0.55 and 0.55 mm, and those of the left-side joints were 0.55 and 0.56 mm, respectively. The bone-to-capsule distances of the right and left wrists were 0.80 and 0.82 mm. In 12.4% of participants (31/251), the erosion score of the humeral head was 1.71. In the right-side knee joint, mean cartilage thicknesses of the medial and lateral condyles were 1.86 and 2.03 mm in longitudinal scans. High overall interobserver agreement was evident after appropriate training that included instruction on standard MSUS methodology.ConclusionsWe defined standard reference values for MSUS in healthy Korean adults. The reliabilities of interobserver agreements were high after appropriate training program.

Inflammation functions as a key mediator in the link between ACPA and erosion development: an association study in Clinically Suspect Arthralgia

BackgroundAnti-citrullinated protein antibodies (ACPA) are associated with more severe joint erosions in rheumatoid arthritis (RA), but the underlying mechanism is unclear. Recent in vitro and murine studies indicate that ACPAs can directly activate osteoclasts leading to bone erosions and pain. This study sought evidence for this hypothesis in humans and evaluated whether in patients with arthralgia who are at risk of RA, ACPA is associated with erosions (detected by magnetic resonance imaging (MRI)) independent of inflammation, and also independent of the presence of rheumatoid factor (RF).MethodsPatients with Clinically Suspect Arthralgia (n = 507) underwent determination of ACPA and RF and 1.5 T contrast-enhanced MRI of the metacarpophalangeal, wrist and metatarsophalangeal joints at baseline. MRIs were scored for presence of local inflammation and erosions. Comparisons of erosion scores were performed using the Kruskal-Wallis test. To evaluate if inflammation is, in statistical terms, intermediary in the causal path of ACPA and erosions, three-step mediation analysis was performed using linear regression.ResultsACPA-positive patients had higher erosion scores than ACPA-negative patients (p = 0.006). ACPA-positive patients without subclinical inflammation did not have higher erosion scores than ACPA-negative patients (p = 0.68), in contrast to ACPA-positive patients with local inflammation (p < 0.001). Mediation analyses suggested that local inflammation is in the causal path of ACPA leading to higher erosion scores. Compared to ACPA-negative/RF-negative patients, ACPA-positive/RF-negative patients did not differ (p = 0.30), but ACPA-positive/RF-positive patients had higher erosion scores (p = 0.006).ConclusionsThe effect of ACPA on erosions is mediated by inflammation and is not independent of RF.

Prevalence of Sacroiliitis in Inflammatory Bowel Disease Using a Standardized Computed Tomography Scoring System.

There is an increasing emphasis on the early identification and treatment of ankylosing spondylitis (AS) of which the hallmark is sacroiliitis. Patients with inflammatory bowel disease (IBD) are at increased risk of AS and often receive computed tomography (CT) scans of their abdomen, affording clinicians the opportunity to determine the presence of sacroiliitis. Previous studies using CT have relied only on the radiologist's gestalt or a nonvalidated adaptation of the modified New York criteria. Our aim is to assess the prevalence of sacroiliitis in IBD using a validated screening tool and to determine how frequently these patients are referred for rheumatologic evaluation. Patients with IBD were recruited from an IBD clinic. Control patients were recruited from a urology clinic and were confirmed to be without back pain, spondylitis, psoriasis, colitis, or uveitis by chart review. CT scans were read by 2 blinded readers and sacroiliitis was defined by the presence of ankylosis or a total erosion score of ≥3. CT scans were available in 233 Crohn's disease (CD) patients, 83 ulcerative colitis (UC) patients, and 108 control patients, and sacroiliitis was seen in 15%, 16.9%, and 5.6% of patients, respectively. The prevalence was higher in patients with IBD than in controls (P = 0.007), with no significant difference between CD and UC patients. Of the 49 IBD patients found to have sacroiliitis by CT scan, only 5 had been referred to a rheumatologist. There is a 3-fold higher prevalence of sacroiliitis in IBD compared with controls. Despite a growing awareness of this increased prevalence, many patients are not referred to a rheumatologist.

What is the added value of ultrasound joint examination for monitoring synovitis in rheumatoid arthritis and can it be used to guide treatment decisions? A systematic review and cost-effectiveness analysis.

Synovitis (inflamed joint synovial lining) in rheumatoid arthritis (RA) can be assessed by clinical examination (CE) or ultrasound (US). To investigate the added value of US, compared with CE alone, in RA synovitis in terms of clinical effectiveness and cost-effectiveness. Electronic databases including MEDLINE, EMBASE and the Cochrane databases were searched from inception to October 2015. A systematic review sought RA studies that compared additional US with CE. Heterogeneity of the studies with regard to interventions, comparators and outcomes precluded meta-analyses. Systematic searches for studies of cost-effectiveness and US and treatment-tapering studies (not necessarily including US) were undertaken. A model was constructed that estimated, for patients in whom drug tapering was considered, the reduction in costs of disease-modifying anti-rheumatic drugs (DMARDs) and serious infections at which the addition of US had a cost per quality-adjusted life-year (QALY) gained of £20,000 and £30,000. Furthermore, the reduction in the costs of DMARDs at which US becomes cost neutral was also estimated. For patients in whom dose escalation was being considered, the reduction in number of patients escalating treatment and in serious infections at which the addition of US had a cost per QALY gained of £20,000 and £30,000 was estimated. The reduction in number of patients escalating treatment for US to become cost neutral was also estimated. Fifty-eight studies were included. Two randomised controlled trials compared adding US to a Disease Activity Score (DAS)-based treat-to-target strategy for early RA patients. The addition of power Doppler ultrasound (PDUS) to a Disease Activity Score 28 joints-based treat-to-target strategy in the Targeting Synovitis in Early Rheumatoid Arthritis (TaSER) trial resulted in no significant between-group difference for change in Disease Activity Score 44 joints (DAS44). This study found that significantly more patients in the PDUS group attained DAS44 remission (p = 0.03). The Aiming for Remission in Rheumatoid Arthritis (ARCTIC) trial found that the addition of PDUS and grey-scale ultrasound (GSUS) to a DAS-based strategy did not produce a significant between-group difference in the primary end point: composite DAS of < 1.6, no swollen joints and no progression in van der Heijde-modified total Sharp score (vdHSS). The ARCTIC trial did find that the erosion score of the vdHS had a significant advantage for the US group (p = 0.04). In the TaSER trial there was no significant group difference for erosion. Other studies suggested that PDUS was significantly associated with radiographic progression and that US had added value for wrist and hand joints rather than foot and ankle joints. Heterogeneity between trials made conclusions uncertain. No studies were identified that reported the cost-effectiveness of US in monitoring synovitis. The model estimated that an average reduction of 2.5% in the costs of biological DMARDs would be sufficient to offset the costs of 3-monthly US. The money could not be recouped if oral methotrexate was the only drug used. Heterogeneity of the trials precluded meta-analysis. Therefore, no summary estimates of effect were available. Additional costs and health-related quality of life decrements, relating to a flare following tapering or disease progression, have not been included. The feasibility of increased US monitoring has not been assessed. Limited evidence suggests that US monitoring of synovitis could provide a cost-effective approach to selecting RA patients for treatment tapering or escalation avoidance. Considerable uncertainty exists for all conclusions. Future research priorities include evaluating US monitoring of RA synovitis in longitudinal clinical studies. This study is registered as PROSPERO CRD42015017216. The National Institute for Health Research Health Technology Assessment programme.

Impact of switching oral bisphosphonates to denosumab or daily teriparatide on the progression of radiographic joint destruction in patients with biologic-naïve rheumatoid arthritis.

The aim of this study was to clarify the effects of switching oral bisphosphonates (BPs) to denosumab (DMAb) or daily teriparatide (TPTD) on the progression of radiographic joint destruction in patients with biologic-naïve rheumatoid arthritis (RA). A retrospective, case-controlled study involving 90 female RA patients (mean age 68.2years, 96.7% postmenopausal, disease activity score assessing 28 joints with CRP (DAS28-CRP) 2.4, methotrexate treatment 81.1%, prednisolone treatment 68.9%, and prior BP treatment 44.8months), who were allocated depending on each patient's and physician's wishes, to (1) the BP-continue group (n = 30), (2) the switch-to-DMAb group (n = 30), or (3) the switch-to-TPTD group (n = 30), was conducted. Patients were retrospectively selected to minimize the difference of possible clinical backgrounds that may affect the joint destruction of RA. The primary endpoint was to clarify the change of the modified total Sharp score (mTSS) from baseline to 12months. After 12months, the mean changes of the modified Sharp erosion score were significantly lower in the switch-to-DMAb group (0.2 ± 0.1; mean ± standard error) than in the switch-to-TPTD group (1.3 ± 0.5; P < 0.05), and mTSS was significantly lower in the switch-to-DMAb group (0.3 ± 0.2) than in the BP-continue group (1.0 ± 0.3; P <0.05) and the switch-to-TPTD group (1.7 ± 0.6; P < 0.05). The logistic regression analysis showed that mTSS changes were significantly associated with the percent changes of TRACP-5b at 6months (β = 0.30, 95% CI = 0.002-0.016; P <0.01). Changes of systemic bone turnover induced by switching BPs to DMAb or TPTD may affect not only systemic bone mass, but also local joint destruction, and its clinical relevance should be considered comprehensively.

Assessment of long-term articular damage and function in rheumatoid arthritis patients

Aim of the workThis study aimed to assess long-term articular damage and function in rheumatoid arthritis (RA) patients in relation to the type of treatment. Early disease modifying anti-rheumatic drug (DMARD) therapy has not been evaluated in this study. Patients and methodsOne hundred and fifty RA patients (141 females and 9 males) with disease duration more than five years and disease activity score-28 (DAS-28) <3.2 were included in this study. Sixty patients received disease modifying anti-rheumatic drugs (DMARDs) (group A), 60 received DMARDs and corticosteroids (CS) (group B), and 30 patients received CS only (group C). The functional outcome was assessed using the Modified Health Assessment Questionnaire (MHAQ). The articular damage was measured by using Rheumatoid Arthritis Articular Damage (RAAD) Score. The van der Heijde modification of the Sharp erosion score was used to define the plain X-ray of both hands and feet. ResultsThe mean age of the patients was 49.3 ± 11.5 years, and disease duration was 12 ± 7.9 years. There was a significant difference between the RAAD, visual analogue scale and MHAQ scores among the three groups (p = 0.001), with higher score in group C followed by B. By using Multiple regression analysis to examine the relationship between RAAD score and other independent variables there was a significant association of the RAAD score with higher X-ray score (p < 0.001) and with patients taking steroids only (p = 0.001). ConclusionAlthough, use of corticosteroids may help to control the disease activity, but it increases the risk of overall joint damage.

Inflammatory and structural changes in vertebral bodies and posterior elements of the spine in axial spondyloarthritis: construct validity, responsiveness and discriminatory ability of the anatomy-based CANDEN scoring system in a randomised placebo-controlled trial

BackgroundThe Canada-Denmark (CANDEN) definitions of spinal MRI lesions allow a detailed anatomy-based evaluation of inflammatory and structural lesions in vertebral bodies and posterior elements of the spine in patients with...

Are MRI-detected erosions specific for RA? A large explorative cross-sectional study

ObjectivesMRI is recommended in the diagnostic process of rheumatoid arthritis (RA) to detect joint damage early. MRI-detected erosions are also present in symptom-free controls, especially at older age. It is...

Relationship Between Smoking and Structural Damage, Autoimmune Antibodies, and Disability in Rheumatoid Arthritis Patients.

This study aims to investigate the relationship between smoking and structural damage, autoimmune antibodies, and disability in rheumatoid arthritis (RA) patients. This cross-sectional study included 165 RA patients (36 males, 129 females; mean age 52.4±12.8 years; range 21 to 82 years). Disease duration, age at disease onset, smoking habits, rheumatoid factor (RF), and anti-cyclic citrullinated peptide levels were recorded. Morning stiffness, pain with visual analog scale, Health Assessment Questionnaire Scores And Disease Activity Score 28 were calculated. Patients' standard hand radiographs were evaluated. Patients were divided into three groups according to their smoking habits. Ninety-nine patients (60%) were never smokers, 45 patients (27.3%) were long-term smokers and 21 patients (12.7%) were new smokers. Three groups were compared for disease activity. Disease activity score 28 scores were 3.2±1.2, 3.2±1.3, and 3.2±1.4, respectively (p>0.05). The erosion score (2.6±5.8, 7.1±10.9, and 11.1±19.2, respectively) and joint space narrowing score (9.9±7.3, 18.6±14.9, and 17.3±12.3, respectively) according to modified Sharp method were significantly lower in never smokers group than other groups (p<0.05). RF titrations were 55.2±58.9, 60.5±63.1, and 84.9±71.5, respectively, and levels of long-term smokers group were significantly higher than the other groups (p<0.05). Joint space narrowing score was 16.2±11.9 and 6.4±10.4 in RF (+) and RF (-) patients, respectively (p<0.05). There was no significant relationship between anti-cyclic citrullinated peptide levels and others parameters. Although smoking is known as a poor prognostic factor in RA, there was no correlation between disease activity and smoking in our study. However, less radiographic damage was found in never smokers. Smoking does not appear to correlate with RA disease activity but it may be effective in the long-term joint damage.

Dental Erosion in 10 – 12 Year Old Children in Mosul City

The aim of this study was to determine the prevalence of dental erosion among 10-12 year old children in Mosul city, mean erosion in teeth and surfaces, amount ofcarbonated beverages and fruit juice consumed in the sample, and the correlationbetween dental erosion and some variables. Total sample consisted of 400 childrenderived from different primary schools in the city center. Examination was performedaccording to tooth wear index by Smith and Knight 1984 modified by Millword et al1994.Results showed that dental erosion was highly prevalent 74.2% in the sample,increasing with increasing age, with boys showing a higher prevalence in dentalerosion compared to girls with significant difference. Mean erosion scores for primaryteeth were slightly less then permanent teeth, with a significant difference between 10and 12 years of age for both dentitions.Buccal/labial surfaces exhibited more erosion, followed by lingual/palatal andfinally occlusal /incisal surfaces, with boys showing more erosion in all surfaces thangirls. A large proportion of the sample consumed carbonated beverages 3-5 /weekwith boys consuming more than girls as seen in the erosion group, fruit juice was alsolargely consumed by the sample, especially the group that showed erosion. A positivecorrelation was found between erosion, level of father’s education, time of drinking,method, amount of carbonated beverages and fruit juice consumed.Preventive measures are considered to be the only effective course of managementof dental erosion, by reducing intake of carbonated beverages and fruit juice, alsomodification of erosive drinks, medicines and foods may prove to be an acceptablefuture strategy world wide.

Cone-beam computed tomography, a new low-dose three-dimensional imaging technique for assessment of bone erosions in rheumatoid arthritis: reliability assessment and comparison with conventional radiography – a BARFOT study

Objectives: To determine the intra- and inter-observer agreement of erosions detected and scored with cone-beam computed tomography (CBCT) of bones in the hands and feet, and to compare CBCT with conventional radiography (CR) for assessment of bone erosions in patients with long-standing rheumatoid arthritis (RA).Method: Thirty patients with long-standing RA from the Better Anti-Rheumatic PharmacOTherapy (BARFOT) cohort were examined with CBCT and CR of hands and feet at their 15 year follow-up. Intra- and inter-class correlation coefficients (ICCs) were calculated. Erosions were analysed with the total rheumatoid arthritis magnetic resonance imaging erosion score (RAMRIS erosion score) for ICCs with CBCT, and with the modified RAMRIS erosion score (RAMRIS-mod.) for the same locations as used in the Sharp van der Heijde score and Sharp van der Heijde erosion score for CR.Results: All 30 patients showed erosions on CBCT and 26 on CR. The ICCs for both intra- and inter-observer reliability were 0.92–0.99. CBCT showed numerically more erosions than CR for all regions compared, although a statistically significant difference was found only for the metacarpophalangeal joints [median number of eroded joints 1.0 (range 0–14) with CBCT and 0.5 (0–13) with CR, p = 0.044].Conclusion: CBCT has high reproducibility and is more sensitive than CR in detecting erosions in this cohort of patients with long-standing RA. CBCT has the potential to become an important tool in the detection and follow-up of erosions in patients with RA.

MRI assessment of erosion repair in patients with long-standing rheumatoid arthritis receiving double-filtration plasmapheresis in addition to leflunomide and methotrexate: a randomized controlled trial.

The objective of this study is to investigate whether the addition of double-filtration plasmapheresis (DFPP) to leflunomide and methotrexate repairs MRI bone erosion in patients with long-standing rheumatoid arthritis (RA). Seventy-two patients with highly active RA of > 3years' duration were randomized to receive DFPP in addition to DMARDs (leflunomide and methotrexate) or DMARDs. Contrast-enhanced MRI of the right wrist was performed at months 0, 6, and 12. MRI bone erosion, synovitis, and bone edema were scored with validated methods. The primary endpoint was the change in MRI bone erosion over 12months. Patients treated with DFPP in addition to DMARDs demonstrated significantly greater decrease in MRI erosion score compared with those treated with DMARDs, being 11.3 ± 9.6 at month 12, compared with 16.9 ± 8.3 in patients with DMARDs (P < 0.001), and compared with 14.4 ± 9.6 at baseline (P < 0.001). 84.2% of patients treated with DFPP in addition to DMARDs demonstrated a decrease in MRI erosion score. Synovitis and bone edema improved significantly with DFPP in addition to DMARDs compared with DMARDs at months 6 and 12. (1.05 ± 1.7 and 2.0 ± 3.9 compared with 8.0 ± 1.4 and 12.6 ± 7.9 at month 12). Patients without synovitis and bone edema reached in 55.3% among patients with DFPP in addition to DMARDs. This study demonstrated that DFPP combination therapy significantly decreased bone erosion and received the primary goal of repair of erosions through abrogating MRI inflammation (synovitis and bone edema) in long-standing RA patients with high disease activity. The findings suggest that addition of DFPP is associated with repair of erosions and further suppression of inflammation.

A cross sectional study of bone and cartilage biomarkers: correlation with structural damage in rheumatoid arthritis

ABSTRACTThe aim of our study was to assess the relationship between bone and cartilage remodeling biomarkers and joint damage in Rheumatoid Arthritis (RA), and to detect whether they have the capacity to predict the progression of joint disease assessment by computed tomography (CT) erosion score. We analyzed 65 female patients with established RA in our Rheumatology Department. Serum levels of bone and cartilage markers were measured: osteocalcin (OC), N-propeptide of type I collagen (PINP), collagen type I and II, C-telopeptide (CTX I, CTX-II) and cartilage oligomeric matrix protein (COMP). Radiography of both wrist and MCP joints were available. Two expert-readers independently scored articular damage and progression using the High-resolution low dose CT scan in a blinded fashion. 65 female patients with established RA with a median age of 44 years were included. The median disease-duration was two years and the median (Disease activity score) DAS 28 score at 4.46 [2.65–7.36]. The percentage of patient with low disease activity was 13.8%, while 55.4 and 30.8% for those with moderate and high disease activity respectively. The resorption bone markers were high in active versus non-active RA. Wrist and MCP erosion scores were also associated with RA activity. Our study shows that biomarkers of bone and cartilage collagen breakdown were related to specific joint erosion in RA and could predict subsequent radiographic damage in RA. Further larger scale longitudinal studies maybe needed to confirm our data.

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

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).

Long-term impact of zinc supplementation in sows: Impact on claw quality

Objectives: To evaluate the long-term impact of zinc (Zn) supplementation on claw lesions, claw conformation, and histological and mechanical claw characteristics of sows housed in groups on rubber top layer or concrete floors during gestation. Materials and methods: Six groups of 21 ± 4 sows were allotted to group housing on different floor types for 80 days during gestation. Within each group, sows were randomly allocated to one of three diets supplementing a basal diet (46.6 and 128.9 mg Zn per kg during gestation and lactation, respectively) with 0, 50, or 100 mg Zn per kg. Claw lesion scoring, claw conformation, and horn growth and wear measurements were performed at days 50 and 140 of every cycle. Histological and mechanical characteristics were evaluated on claw samples of 36 sows after slaughter. Results: Dietary Zn supplementation affected heel horn erosion score (P = .01): sows supplemented with100 mg Zn per kg diet had better scores. Distances between dermal papillae of the sagittal heel horn were larger (P = .004). Heel height was lower for sows supplemented with 0 and 100 mg Zn per kg than for 50 mg per kg (P = .01). Horn growth and wear were lower for sows housed on rubber at day 50 (P &lt; .001, both variables), but not at day 140. Dermal papillae distance was shorter for sows on rubber (P = .04). Implications: Unlike floor type and phase within the reproductive cycle, and under the conditions of this study, dietary zinc supplementation minimally influences claw quality.

Comparison between Several Ultrasound Hand Joint Scores and Conventional Radiography in Diagnosing Hand Osteoarthritis

This is the first study to investigate the usefulness of a standardized ultrasound (US) examination protocol in diagnosing hand osteoarthritis (OA). We conducted a cross-sectional study including 62 patients, ultimately diagnosed with hand OA based on imaging evidence of osteoarthritic changes with the particular distribution required for fulfilment of American College of Radiology diagnosis criteria. We compared a 32-joint US score (wrists, metacarpophalangeal [MCP], proximal interphalangeal [PIP] or distal interphalangeal [DIP] and carpometacarpal [CMC]-1 joints), with smaller, predefined joint scores, assessing 22 joints (wrists, MCPs and PIPs or PIPs, DIPs and CMC-1), 10 joints (MCP 2–3, PIP 2–3 and CMC-1 or PIP 2–3, DIP 2–3 and CMC-1) and 6 joints (DIP 2–3, CMC-1), respectively. The US findings were correlated with radiographic scores for erosions and osteophytes. Radiographic osteophyte scores correlated well with all the US scores mentioned earlier (R = 0.381 to 0.645, p < 0.05), despite low sensitivity for detection of osteophytes (43.5%) and erosions (28.9%), compared with the 32 joint US score. Both 10 joint US protocols (assessing MCP 2–3, PIP 2–3 and CMC-1 or PIP 2–3, DIP 2–3 and CMC-1 joints) performed better than conventional radiography, by identifying osteophytes in an additional 25.6% and 23.9% of patients, respectively. The conclusion of this study is that the US examination of 10 preselected hand joints is more sensitive than conventional radiography in diagnosing hand OA in patients who do not fulfill American College of Radiology clinical criteria, a finding likely to have practical implications for facilitating diagnosis of hand OA.

Soluble TAM receptor tyrosine kinases in rheumatoid arthritis: correlation with disease activity and bone destruction.

The TAM receptor tyrosine kinases (TAM RTK) are a subfamily of receptor tyrosine kinases, the role of which in autoimmune diseases such as systemic lupus erythematosus has been well explored, while their functions in rheumatoid arthritis (RA) remain largely unknown. In this study, we investigated the role of soluble TAM receptor tyrosine kinases (sAxl/sMer/sTyro3) in patients with RA. A total of 306 RA patients, 100 osteoarthritis (OA) patients and 120 healthy controls (HCs) were enrolled into this study. The serum concentrations of sAxl/sMer/sTyro3 were measured by enzyme-linked immunosorbent assay (ELISA), then the associations between sAxl/sMer/sTyro3 levels and clinical features of RA patients were analysed. We also investigated whether sTyro3 could promote osteoclast differentiation in vitro in RA patients. The results showed that compared with healthy controls (HCs), sTyro3 levels in the serum of RA patients were elevated remarkably and sMer levels were decreased significantly, whereas there was no difference between HCs and RA patients on sAxl levels. The sTyro3 levels were correlated weakly but positively with white blood cells (WBC), immunoglobulin (Ig)M, rheumatoid factor (RF), swollen joint counts, tender joint counts, total sharp scores and joint erosion scores. Conversely, there were no significant correlations between sMer levels and the above indices. Moreover, RA patients with high disease activity also showed higher sTyro3 levels. In-vitro osteoclast differentiation assay showed further that tartrate-resistant acid phosphatase (TRAP)+ osteoclasts were increased significantly in the presence of sTyro3. Collectively, our study indicated that serum sTyro3 levels were elevated in RA patients and correlated positively with disease activity and bone destruction, which may serve as an important participant in RA pathogenesis.

Magnetic resonance imaging-assessed synovial and bone changes in hand and wrist joints of rheumatoid arthritis patients.

Background/AimsMagnetic 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.MethodsMRI 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.ResultsThe 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.ConclusionsThis 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.

The value of high-sensitivity C-reactive protein in hand and knee radiographic osteoarthritis: data from the Dong-gu Study.

Due to the inconsistent association between high-sensitivity C-reactive protein (hs-CRP) and osteoarthritis (OA), we evaluated the relationship between hs-CRP and various radiographic findings in older adults with OA. This cross-sectional study recruited 2376 participants from the population-based Dong-gu cohort. The scores of radiographic features in OA on X-rays of the knees and hands were computed using a semi-quantitative grading system. The hs-CRP levels were measured using a particle-enhanced immunonephelometry assay. Correlations showing the relationship between hs-CRP and OA were calculated using multiple linear correlation analysis. The hs-CRP levels were significantly higher in older subjects (p < 0.001), those with a higher body mass index (BMI) (p < 0.001), current smokers (p < 0.001), current alcohol drinkers (p = 0.011), those who were less physically active (p = 0.002), and those with a lower level of education (p = 0.043). After adjusting for BMI and other confounders, the total OA scores (knee, p = 0.022; hand, p = 0.029) and sclerosis score (knee, p = 0.007; hand, p = 0.030) in the knees and hands were all significantly positively correlated with hs-CRP. A significant association was also observed between hs-CRP and hand erosion score (p = 0.045), hand malalignment score (p = 0.015), and tibial attrition score (p = 0.039). In this large cross-sectional study, a higher hs-CRP level was significantly associated with radiographic OA severity. Of the various types of radiographic damage, all of sclerosis, erosion, and malalignment were significantly associated with hs-CRP levels.