Grey Scale Synovitis Research Articles

O histograma de imagens coloridas permite melhor visualização de danos ecotexturais pelo ultrassom

The colored ultrasound images can better highlight the joint echotexture damage. To detect echotexture changes in joints of patients with rheumatic diseases, through a color histogram, and to correlate the area measurements with the gray scale (GS). Four patients with chondrocalcinosis, 5 patients with osteoarthritis and 1 patient with psoriatic arthritis were evalutated. A total of 104 synovitis (SYN) and calcifications (calcif) measurements in cm2 were performed in the dorsal radiocarpal joint (DRR); triangular fibrocartilage complex (TFC); dorsal metacarpophalangeal joints (MCP) and lateral and medial knee suprapatellar recesses. For each GS measure, one was performed for each standard color image. Spearman was used for correlation analysis. Mean±SD of image patterns: RGB (Red, Green and Blue) SYN 16.96±0.25cm2; indigo SYN 6.43±0.07cm2, RGB Calcif 0.03±0.00cm2; indigo Calcif 0.06±0.03cm2; GS SYN 16.13±0.35cm2 and GS Calcif 0.56±0.01cm2. Correlations of color images patterns RGB DRR SYN and indigo DRR SYN: r=1, p<0.001; indigo DRR SYN and RGB suprapattelar SYN: r=1, p<0.001; RGB MCP SYN and indigo MCP SYN: r=1, p<0.001; indigo DRR calcif and RGB TFC calcif: r=1 p<0.001; the RGB and indigo measurement standards when correlated with GS for SYN and calcifs were not statistically significant (p=0.333 to 0.667). The RGB and indigo patterns seem to better define these echotexture damage.

Is articular pain in rheumatoid arthritis correlated with ultrasound power Doppler findings?

The study is addressed to determine if there is a correlation between intra-articular power Doppler (PD) and pain symptoms in patients with rheumatoid arthritis (RA). A cross-sectional study of patients with established RA was rolled out. Seventy-two patients with chronic swelling at metacarpophalangeal (MCP) joints were consecutively enrolled in the study and divided into two groups (painful and painless). In the painful group, the inclusion criteria were pain in the visual analog scale (VAS), from 0 to 10 cm, of at least 4 cm and 0 in the painless group. All two to five MCP joints, bilaterally, were scanned by ultrasound (US) searching for intra-articular PD presence. Any value of p < 0.05 was considered significant. Patients in the painful group had longer morning stiffness, worse 28-joint disease activity score (DAS 28), and health assessment questionnaire (HAQ) indexes. There were no association between pain and gray scale (GS) synovitis, odds ratio (OR) = 0.9 (0.6-1.2), p = 0.485; and pain and intra-articular PD, OR = 0.8 (0.6-1.2), p = 0.244. Intra-articular PD was not correlated with pain symptom in this study.

Ultrasound-detected inflammation predicts radiographic progression in hand osteoarthritis after 5 years

ObjectiveTo examine whether ultrasound predicts radiographic hand osteoarthritis (OA) progression after 5 years.MethodsWe included 78 participants (71 women, mean (SD) age 67.8 (5.2) years) from the Oslo Hand OA cohort...

Angiogenic gene expression and vascular density are reflected in ultrasonographic features of synovitis in early Rheumatoid Arthritis: an observational study.

IntroductionNeovascularization contributes to the development of sustained synovial inflammation in the early stages of Rheumatoid Arthritis. Ultrasound (US) provides an indirect method of assessing synovial blood flow and has been shown to correlate with clinical disease activity in patients with Rheumatoid Arthritis. This study examines the relationship of US determined synovitis with synovial vascularity, angiogenic / lymphangiogenic factors and cellular mediators of inflammation in a cohort of patients with early Rheumatoid Arthritis (RA) patients prior to therapeutic intervention with disease modifying therapy or corticosteroids.MethodsAn ultrasound guided synovial biopsy of the supra-patella pouch was performed in 12 patients with early RA prior to treatment. Clinical, US and biochemical assessments were undertaken prior to the procedure. Ultrasound images and histological samples were obtained from the supra-patella pouch. Histological samples were stained for Factor VIII and a-SMA (a-smooth muscle actin). Using digital imaging analysis a vascular area score was recorded. QT-PCR (quantitative-PCR) of samples provided quantification of angiogenic and lymphangiogenic gene expression and immunohistochemistry stained tissue was scored for macrophage, T cell and B cell infiltration using an existing semi-quantitative score.ResultsPower Doppler showed a good correlation with histological vascular area (Spearman r - 0.73) and angiogenic factors such as vascular endothelial growth factor- A (VEGF-A), Angiopoietin 2 and Tie-2. In addition, lymphangiogenic factors such as VEGF-C and VEGF-R3 correlated well with US assessment of synovitis. A significant correlation was also found between power Doppler and synovial thickness, pro-inflammatory cytokines and sub-lining macrophage infiltrate. Within the supra-patella pouch there was no significant difference in US findings, gene expression or inflammatory cell infiltrate between any regions of synovium biopsied.ConclusionUltrasound assessment of synovial tissue faithfully reflects synovial vascularity. Both grey scale and power Doppler synovitis in early RA patients correlate with a pro-angiogenic and lymphangiogenic gene expression profile. In early RA both grey scale and power Doppler synovitis are associated with a pro-inflammatory cellular and cytokine profile providing considerable validity in its use as an objective assessment of synovial inflammation in clinical practice.

Persistence of ultrasound synovitis in patients with rheumatoid arthritis fulfilling the DAS28 and/or the new ACR/EULAR RA remission definitions: Results of an observational cohort study

ObjectiveThe primary aim of the study was to evaluate whether rheumatoid arthritis (RA) patients considered to be in remission according to clinical criteria sets still had persisting ultrasound (US) synovitis. We further intended to evaluate the capacity of our US score to discriminate between the patients with a clinically active disease versus those in remission. MethodsThis is an observational study nested within the Swiss Clinical Quality Management in Rheumatic Diseases (SCQM) rheumatoid arthritis cohort. A validated US score (SONAR score) based on a semi-quantitative B-mode and Doppler (PwD) score as part of the regular clinical workup by rheumatologists in different clinical settings was used. To define clinically relevant synovitis, the same score was applied to 38 healthy controls and the 90st percentile was used as cut-off for ‘relevant’ synovitis. ResultsThree hundred and seven patients had at least one US examination and concomitant clinical information on disease activity. More than a third of patients in both DAS28 and ACR/EULAR remission showed significant gray scale synovitis (P=0.01 and 0.0002, respectively) and PwD activity (P=0.005 and 0.0005, respectively) when compared to controls. The capacity of US to discriminate between the two clinical remission groups and patients with active disease was only moderate. ConclusionThis observational study confirms that many patients considered to be in clinical remission according the DAS and the ACR/EULAR definitions still have residual synovitis on US. The prognostic significance of US synovitis and the exact place of US in patients reaching clinical remission need to be further evaluated.

AB0759 Efficacy of Intra-Articular Etanercept Injections in Active Monoarthritis Resistant to Intra-Articular Steroids in Otherwise Stable Psoriatic Arthritis Patients

BackgroundPersistent synovitis in one joint is a common clinical problem that could be debilitating and lead to joint destruction in otherwise stable patients with inflammatory arthritis on systemic immunosuppressive treatment....

AB0283 Articular Pain is Correlated with Ultrasound Power Doppler Findings?

BackgroundThe presence of power Doppler (PD) gives relevant information about the inflammatory status of the synovial tissue, but there is no evidence if it is correlated with pain symptom of...

SAT0180 Subclinical Inflammation in Rheumatoid Arthritis (RA) in Clinical Remission, Lack of Association between Cytokines Level and Ultrasound-Defined Synovitis

BackgroundThe presence of subclinical inflammation promotes the progression of morphostructural joint damage in RA patients. Currently, clinical remission is based on the count of swollen and painful joints associated with...

FRI0042 Validation of A Multi-Biomarker Disease Activity Score in Rheumatoid Arthritis in Relation to Imaging Inflammation and Damage

BackgroundA multi-biomarker disease activity (MBDA) score has been validated as a measure of disease activity in rheumatoid arthritis (RA).ObjectivesThis study aimed to further validate the MBDA score in relation to...

SAT0216 Sensitivity and Specificity of Optical Spectral Transmission Imaging in Detecting Joint Inflammation in Rheumatoid Arthritis

BackgroundA fast, physician-independent, sensitive, reproducible tool for assessment of disease activity would be useful in rheumatoid arthritis (RA) clinical practice.ObjectivesThis study aimed to compare a new technique, optical spectral transmission...

SAT0193 Utility of Ultrasound in the Nuffield Orthopaedic Centre Emergency Rheumatology Clinic: Survey of Clinical Effectiveness

BackgroundThe aim of the survey was to evaluate the impact of clinic-based musculoskeletal ultrasonography (MSUS) on diagnosis and management of cases seen in the Nuffield Orthopaedic Hospital emergency rheumatology clinic.ObjectivesPrimary:...

SP0082 Do We Need A Different US Joint Count for Diagnosing, Monitoring and Remission in Ra?

Musculoskeletal ultrasound (US) is a valuable imaging modality for detecting and quantifying a range of joint pathologies occurring in rheumatic diseases, especially RA. Recently new imaging modalities such as US...

AB0976 Do Ultrasound Color Histograms Show Better Musculoskeletal Changes?

BackgroundUltrasonography with high frequency linear array probe, besides allowing a better resolution in the GS scale (grey scale), is able to identify color images standards. This is the case of...

FRI0229 High Prevalence of Subclinical Ultrasonographic Synovitis in Patients with Inflammatory Bowel Disease

BackgroundUltrasonography has proved more sensitive than physical examination to detect synovitis in rheumatoid arthritis, so we believe it can be useful to identify subclinical joint involvement in patients with Inflammatory...

SAT0188 Serum Calprotectin (S100A8/9) Correlates with Clinical and Ultrasound Outcomes in Patients with Early Rheumatoid Arthritis

BackgroundCalprotectin, a heterodimeric complex of S100A8/9 (MRP8/14), has been demonstrated as an important biomarker of clinical and laboratory disease activity and structural joint damage in rheumatoid arthritis (RA).1,2 Ultrasound is...

THU0325 Lack of Relation between Inflammation on Joint Level and Fibromyalgia Symptoms in Patients with Rheumatoid Arthritis

BackgroundFibromyalgia (FM) exists in a substantial number of patients with rheumatoid arthritis (RA) (approx. 15%), who have higher disease activity as measured by DAS-28, than RA patients without concomitant FM....

FRI0236 Ultrasonographic Assessment of Joint Inflammation in Rheumatoid Arthritis: Predictive Value in Response to Tumor Necrosis Factor-α Inhibitor Treatment

BackgroundTumor necrosis factor-α inhibitors (TNFi) are highly effective in patients with RA, while not effective in all, with predictors of response being necessary. Although genetic, inflammatory and serologic biomarkers are...

Ultrasonographic assessment reveals detailed distribution of synovial inflammation in Blau syndrome

IntroductionArthritis is the most frequent manifestation of Blau syndrome, an autoinflammatory disorder caused by the genetic mutation of NOD2. However, detailed information on arthritis in Blau syndrome on which the therapeutic strategy should be based on is lacking. This multi-center study aimed to accurately characterize the articular manifestation of Blau syndrome and also to demonstrate the utility of musculoskeletal ultrasound in Blau syndrome.MethodsPatients who had been diagnosed with Blau syndrome by genetic analysis of NOD2 were recruited. A total of 102 synovial sites in 40 joints were assessed semiquantitatively by ultrasound for gray-scale synovitis and synovial power Doppler (PD) signal.ResultsIn total, 10 patients whose age ranged from 10 months to 37 years enrolled in this study. Although only 4 joints (0.8%) were tender on physical examination, 81 joints (16.9%) were clinically swollen. Moreover, 240 (50.0%), and 124 (25.8%) joints showed gray-scale (GS) synovitis and synovial PD signal on ultrasound, respectively. Importantly, GS synovitis was present in 168 out of 399 non-swollen joints, in which 61 also exhibited synovial PD signal. Among 40 joint regions, the ankle, the wrist, and the proximal interphalangeal joints were the most frequently and severely affected joints. Comparisons between different synovial tissues demonstrated a significantly higher proportion of the joints with tenosynovitis as compared with that with intra-articular synovitis (41.5% versus 27.9%, P < 0.0001). In respect of age and treatment, synovial PD signals were minimal in the youngest patient and in the oldest two patients, and were relatively mild in patients receiving treatment with methotrexate plus TNF antagonists. In two patients who underwent the second ultrasound examination, total PD scores markedly decreased after initiating the treatment with a tumor necrosis factor (TNF) antagonist.ConclusionsThe detailed information on synovial inflammation obtained by ultrasound confirms the dissociation between pain and inflammation and the frequently involved joint regions and synovial tissue in the arthritis of Blau syndrome. Our data also demonstrate that ultrasonography can be a potent tool in monitoring the activity of synovial inflammation and in investigating the pathophysiology of arthritis in this rare but archetypical autoinflammatory condition.

Ultrasound-guided synovial biopsy: a safe, well-tolerated and reliable technique for obtaining high-quality synovial tissue from both large and small joints in early arthritis patients

To determine the tolerability, safety and yield of synovial tissue in an early arthritis cohort using a minimally invasive, ultrasound (US)-guided, synovial biopsy technique in small, medium and large joints. 93 sequential biopsy procedures were assessed from a total of 57 patients (baseline and 36 repeat biopsies at 6 months) recruited as part of the 'Pathobiology of Early Arthritis Cohort' study. Patients completed a tolerability questionnaire prior to and following the synovial biopsy procedure. The synovial biopsy was performed under US guidance with US images of the joint recorded prior to each procedure. Synovial tissue was harvested for immunohistochemistry and RNA extraction. Five different joint sites were biopsied (knee, elbow, wrist, metacarpal phalangeal and proximal interphalangeal). No significant complications were reported following the procedure. No difference in pain, swelling and stiffness of the biopsied joint from before and after the procedure was demonstrated. A median of 14 biopsy samples was retrieved from each procedure with 93% of biopsy procedures yielding good quality tissue. RNA yield was good in all joints and in repeat biopsies. Multivariant analysis demonstrated a significantly greater yield of RNA and graded tissue in relation to a high prebiopsy, grey-scale synovitis score (0-3, semiquantitative). A minimally invasive approach to synovial tissue harvesting, using US guidance, is both safe and well-tolerated by patients. Tissue quality/RNA yield is preserved in subsequent biopsies following therapeutic intervention. A high US grey-scale synovitis score is a predictor of good quality/quantity of tissue and RNA.

EVALUATION OF ULTRASOUND REMISSION CRITERIA IN PATIENTS WITH RHEUMATOID ARTHRITIS DURING TOCILIZUMAB THERAPY

Objective: to study the association of ultrasound (US) remission criteria with the clinical and laboratory indicators of inflammatory activity, functional status, and X-ray changes in patients with rheumatoid arthritis (RA) during tocilizumab (TCZ) therapy. Subjects and methods. The trial included 36 patients with RA (meeting the 1987 American College of Rheumatology (ACR) criteria) who had received TCZ for 6 months. The authors made a clinical and laboratory assessment of RA activity (DAS28-CRP, and SDAI), functional impairments (HAQ index) and US verification of wrist joint synovitis (a Voluson-i device, GE, 4-13-MHz linear transducer) at baseline and 6 months after therapy. No signs of grey-scale (B-mode) and power Doppler (PD) synovitis (B = 0; PD = 0) or minimal B-mode synovitis, and not more one PD hypervascular signal (В ≤1; PD ≤1) were arbitrarily taken as US remission criteria. Destruction changes were evaluated by hand and foot X-ray using the Sharp method modified by van der Heijde (SHS). Results. After 6 months of therapy, about 80% of the patients in clinical remission retained moderate or significant synovitis, as evidenced by US studies. There were no clinical differences in clinical activity indices and functional impairments between the patients who were and were not in US remission (p > 0.05). The 12-month follow-up SHS score was significantly higher with the preservation of 6-month therapy signs of B-mode synovitis and PD hypervascularization (of not more than one signal) than that in US remission (p 0.05). Conclusion. Subclinical synovitis is observed even in clinical remission of RA. Destruction progression is significantly related to synovitis persistence, as shown by ultrasonography.