Rheumatoid Arthritis Monitoring Research Articles

Automatic 3D joint erosion detection for the diagnosis and monitoring of rheumatoid arthritis using hand HR-pQCT images.

Rheumatoid arthritis (RA) is a chronic inflammatory disease. It leads to bone erosion in joints and other complications, which severely affect patients' quality of life. To accurately diagnose and monitor the progression of RA, quantitative imaging and analysis tools are desirable. High-resolution peripheral quantitative computed tomography (HR-pQCT) is such a promising tool for monitoring disease progression in RA. However, automatic erosion detection tools using HR-pQCT images are not yet available. Inspired by the consensus among radiologists on the erosions in HR-pQCT images, in this paper we define erosion as the significant concave regions on the cortical layer, and develop a model-based 3D automatic erosion detection method. It mainly consists of two steps: constructing closed cortical surface, and detecting erosion regions on the surface. In the first step, we propose an initialization-robust region competition methods for joint segmentation, and then fill the surface gaps by using joint bone separation and curvature-based surface alignment. In the second step, we analyze the curvature information of each voxel, and then aggregate the candidate voxels into concave surface regions and use the shape information of the regions to detect the erosions. We perform qualitative assessments of the new method using 59 well-annotated joint volumes. Our method has shown satisfactory and consistent performance compared with the annotations provided by medical experts.

P048 Assessing the health equity impacts of smartphone-based remote monitoring in people with rheumatoid arthritis: a stakeholder engagement workshop

Abstract Background/Aims REmote Monitoring of Rheumatoid Arthritis (REMORA) is a smartphone-app for daily symptom-tracking which is linked to the electronic health record, aiming to improve clinical decision-making and disease activity in people with rheumatoid arthritis (RA). Given well-established sociodemographic inequities which influence access to smartphones and the ability to utilise and benefit from them for health purposes, we engaged with stakeholder-representatives to assess the potential impact of REMORA on health equity and identify mitigation strategies. Methods We organised a 3-hour stakeholder-engagement workshop, inviting people with RA, healthcare professionals (HCPs) and digital health researchers. The workshop was guided by the validated Health Equity Impact Assessment-Digital Health Supplement (HEIA-DH), aiming to explore for REMORA: Groups at-risk of digital health inequities; Potential inadvertent positive/negative impacts; Strategies to mitigate negative impacts. We captured suggestions on a virtual whiteboard and kept field-notes using a pre-defined template for thematic analysis. Results Table 1 presents the workshop results. We identified multiple groups at-risk of digital health inequities (e.g., people with physical disabilities; non-native English speakers; people with information-processing difficulties) for whom stakeholders also highlighted unintended positive impacts (e.g., reduced travel to appointments; supporting verbal discussions with HCPs; opportunities to prepare for consultations). Suggested strategies to mitigate negative impacts included: ensuring app compatibility with larger devices; early explanation of medical terminology; adapting data-inputting/data-summary design features. Conclusion Our results highlight important considerations relevant to the wider field of smartphone-based remote monitoring for long-term conditions. In addition to identifying sociodemographic groups at-risk of digital health inequities, we recognised risks for groups with specific health problems such as physical/sensory disabilities. Our proposed mitigation strategies can be broadly classified into: app adaptations; considerations during app prescription; sign-posting users towards sources of support. We also found that whilst REMORA aims to improve communication between all patients and HCPs, there may be an unexpected additional benefit for groups with specific communication challenges. Our findings demonstrate the utility of HEIA-DH in assessing the potential health equity impact of smartphone-based remote monitoring; further workshops are planned with specific at-risk groups. Regular re-evaluation will help gauge the effectiveness of our strategies and identify further unanticipated equity impacts of REMORA. Disclosure M. Al-Attar: None. A. Crawford: None. A. Gambin: None. S.M. Ali: None. W.G. Dixon: Consultancies; W.G.D. has received consultancy from Google, unrelated to this work. S.N. van der Veer: None.

DESCRIPTION OF RHEUMATOID FACTOR IN THE ELDERLY IN THE WORKING AREA OF THE NORTH TOTO HEALTH CENTER

Rheumatoid factor (RF) is an immunoglobulin that reacts with the IgG molecule as its name indicates, RF is primarily used for the examination and monitoring of rheumatoid arthritis. Rheumatoid arthritis (rheumatism) is a disease where the immune system fails to distinguish its own tissue from foreign substances. The aim of the study was to determine the results of rheumatoid factor in the elderly in the working area of ​​the Toto Utara Public Health Center, Bone Bolango Regency, Gorontalo Province.
 The method used in this study is a descriptive qualitative approach, with primary data sources in the form of examination resultsrheumatoid factorin the serum of patients with rheumatoid arthritis in a number of 15 samplesobtained using the sampling technique that ispurposive sampling.
 The results of the examination of rheumatoid factor using serum obtained inOf the 15 samples of rheumatoid arthritis sufferers aged 60 to 63 years who were positive by examining the agglutination test using the glory diagnostic kit test tool, on the results of laboratory tests, there were 4 samples (26.6%) positive for rheumatoid factor, namely 3 were female (20%) and 1 was male. male sex (6.6%).

Automated Classification of Rheumatoid Arthritis, Osteoarthritis, and Normal Hand Radiographs with Deep Learning Methods.

Rheumatoid arthritis and hand osteoarthritis are two different arthritis that causes pain, function limitation, and permanent joint damage in the hands. Plain hand radiographs are the most commonly used imaging methods for the diagnosis, differential diagnosis, and monitoring of rheumatoid arthritis and osteoarthritis. In this retrospective study, the You Only Look Once (YOLO) algorithm was used to obtain hand images from original radiographs without data loss, and classification was made by applying transfer learning with a pre-trained VGG-16 network. The data augmentation method was applied during training. The results of the study were evaluated with performance metrics such as accuracy, sensitivity, specificity, and precision calculated from the confusion matrix, and AUC (area under the ROC curve) calculated from ROC (receiver operating characteristic) curve. In the classification of rheumatoid arthritis and normal hand radiographs, 90.7%, 92.6%, 88.7%, 89.3%, and 0.97 accuracy, sensitivity, specificity, precision, and AUC results, respectively, and in the classification of osteoarthritis and normal hand radiographs, 90.8%, 91.4%, 90.2%, 91.4%, and 0.96 accuracy, sensitivity, specificity, precision, and AUC results were obtained, respectively. In the classification of rheumatoid arthritis, osteoarthritis, and normal hand radiographs, an 80.6% accuracy result was obtained. In this study, to develop an end-to-end computerized method, the YOLOv4 algorithm was used for object detection, and a pre-trained VGG-16 network was used for the classification of hand radiographs. This computer-aided diagnosis method can assist clinicians in interpreting hand radiographs, especially in rheumatoid arthritis and osteoarthritis.

Monitoring of rheumatoid arthritis: a patient survey on disease insight and possible added value of an innovative inflammation monitoring device

To enable patients with rheumatoid arthritis (RA) and their healthcare professionals to choose the optimal treatment, it is crucial to accurately assess the current state of inflammatory activity. The objectives of this study were to (1) investigate the perspective of RA patients on their insight into the current status of their disease, and to (2) investigate the patients’ perspective on the possible added value of a monitoring device based on optical spectral transmission—called the HandScan—that measures the location and severity of joint inflammation. A survey was distributed online among patients with RA in the Netherlands. Four-hundred and eight patients with RA completed the survey. Of these, 298 (73%) felt they have sufficient insight into their current disease status. Most respondents perceived either a large (n = 242; 59%) or small (n = 148; 36%) added value of the HandScan in their monitoring process, mostly because the device provides additional knowledge on the presence of inflammation. This perceived added value was higher for respondents experienced with the device (n = 46; p = .04). Respondents preferred monitoring with the device on every (n = 192; 47%) or most (n = 171; 42%) visits to the outpatient clinic, or even more often than on every visit (n = 17; 4%). Monitoring RA using an optical spectral transmission device is seen by patients as a possibly valuable addition to the monitoring process of inflammatory activity during visits to an outpatient clinic. Their main reason was that the device can increase insight into their current disease status. More insight may support patients in discussing treatment options with their rheumatologist.

Interstitial Lung Disease Associated With Autoimmune Rheumatic Diseases: Checklists for Clinical Practice.

Background: Interstitial lung diseases (ILDs) are often associated with rheumatic diseases. Their early diagnosis and management are not only difficult, but also crucial, because they are associated with major morbidity and mortality and can be the first cause of death in autoimmune rheumatic diseases (ARDs).Objectives: By using methodologies, such as Nominal Group Technique (NGT) and Delphi Survey, the aims of this study were (1) to measure consensus between pulmonologists, radiologists, and rheumatologists experienced in the management of ARD-ILD; (2) to highlight the importance of a multidisciplinary approach; and (3) to provide clinicians with a practical tool aimed at improving the prompt recognition and follow-up of ILD associated with ARDs and of any possible rheumatic conditions underlying ILD.Results: During the NGT round, the Steering Committee defined 57 statements to be used in the Delphi survey. A total of 78 experts participated in the Delphi survey, namely 28 pulmonologists, 33 rheumatologists, and 17 radiologists. During this round, consensus on agreement was reached in 47 statements, while disagreement was not reached in any statements. A secondary questionnaire was drafted by the Steering Committee to obtain clearer indications on ILD-ARD “red-flags” and follow-up. Delphi Panelists took part also in the second-questionnaire survey. Answers from both surveys were used to draft two checklists of “red flags” sign or symptom suggestive of ILD and ARD, respectively, and two checklists on identification and monitoring of rheumatoid arthritis (RA) and systemic sclerosis (SSc) ILD.Limitations: This study is a consensus work, which cannot produce empiric data, and is limited to the Italian scenario.Conclusions: This work showed a high level of agreement, but also shows some divergent opinions between different experts. This underlines the importance of a multidisciplinary approach. Eventually, we believe the drafted checklists can help clinicians in the diagnosis and follow-up of ILD-ARD.

CD3D, GZMK, and KLRB1 Are Potential Markers for Early Diagnosis of Rheumatoid Arthritis, Especially in Anti-Citrullinated Protein Antibody-Negative Patients.

Early diagnosis and monitoring of rheumatoid arthritis (RA) progress are critical for effective treatment. In clinic, the detection of rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA) are usually combined to diagnose early RA. However, the poor specificity of RF and high heterogeneity of ACPA make the early diagnosis of RA still challenging. Bioinformatics analysis based on high-throughput omics is an emerging method to identify novel and effective biomarkers, which has been widely used in many diseases. Herein, utilizing an integrated strategy based on expression correlation analysis and weighted gene coexpression network analysis (WGCNA), we identified 76 RA-trait different expression genes (DEGs). Combined with protein-protein interaction (PPI) network construction and clustering, new hub genes associated in RA synovia, CD3D, GZMK, and KLRB1, were identified. We verified the specificity of these genes in the synovium of RA patients through three external datasets. We also observed high sensitivity and specificity of them for ACPA-negative patients. CD3D, GZMK, and KLRB1 are potentially key mediators of RA pathogenesis and markers for RA diagnosis.

Future use of musculoskeletal ultrasonography and magnetic resonance imaging in rheumatoid arthritis.

Musculoskeletal ultrasonography (MSUS) and magnetic resonance imaging (MRI) play important roles in diagnosis, monitoring, and prognostication of rheumatoid arthritis. This review highlights recent literature in this field and aims to provide insight into the future use in clinical practice. Recent studies concerning the use of MSUS and MRI in clinical practice show how MSUS and MRI can improve diagnosis and monitoring of rheumatoid arthritis and how they can predict both radiographic progression and clinical outcome (e.g., successful tapering of medical treatment). Moreover, novel technical developments of the two imaging modalities, such as 3D ultrasonography, ultrasound image reading with convolutional neural network, image fusion (MSUS and MRI) and whole-body MRI show promising results. Further validation of these novel techniques is required prior to implementation. MSUS and MRI will be important parts of the future management of rheumatoid arthritis patients, mostly because of their ability to detect rheumatoid arthritis changes at a very early stage and to predict the course of disease. However, the exact role in routine clinical practice is still to be defined.

Evaluation and monitoring of established rheumatoid arthritis

Established rheumatoid arthritis (RA) is a term used to distinguish patients with longer disease duration versus early RA or undifferentiated arthritis that may progress to RA. Although, there is no uniform definition for early disease, a cut-off of 2 years is used in most clinical trials and observational studies. In the evaluation of established RA, clinicians should incorporate a comprehensive set of measures addressing: (1) disease activity, especially inflammation that may benefit of intensification of therapy, (2) health status, (3) comorbidities, and (4) damage. Ideally, measures should include the patient and physician perspectives and be feasible, reliable, valid and sensitive to change. Traditionally, measures have been incorporated in clinical research, but it would be worthwhile to integrate them into routine care. Data collection systems adapted to rheumatologists needs, could advance care for individual patients and facilitate large observational studies to evaluate interventions for the whole spectrum of RA.

Rheumatoid Arthritis Disease Activity Index-5: an easy and effective way of monitoring patients with rheumatoid arthritis

ObjectiveTo study the utility of the Rheumatoid Arthritis Disease Activity Index-5 (RADAI-5) as a valid tool for daily rheumatoid arthritis (RA) monitoring and to compare its predictability to assess RA activity with respect to Disease Activity Score 28 (DAS28) and Clinical Disease Activity Index (CDAI).Patients and methodsA total of 100 patients with RA (diagnosed as per American College of Rheumatology 1987 criteria) were enrolled in the study group. Each patient was assessed two times with 3-month interval for disease activity (DA) using DAS28, CDAI, and RADAI-5. Spearman’s correlation coefficient (p) for correlation and kappa for agreement between different activity measures were assessed.ResultsIn our study group, 19% patients were men and 81% patients were women, with male to female ratio of 1 :4.3. Their mean age was 44.4±11.8 years, and their mean disease duration was 67.5±59.8 months. On initial visit, that is, baseline, mean DA as per RADAI-5, DAS28, and CDAI were 5.14±2.17, 5.58±1.55, and 27.96±15.46, respectively, and on follow-up visit, the readings were 3.76±1.92, 4.54±1.41, and 17.67±12.46, respectively. The mean changes in DA at follow-up visit were -1.37 ±2.15 by RADAI-5, -1.04±1.58 by DAS28, and -10.29±15.75 by CDAI. Changes in DA indices correlated significantly with each other with p ranging from 0.8 to 0.9 (P<0.001). An average agreement was found among all three measures at different DA level.ConclusionRADAI-5 seems to be an effective tool with high tendency to assess the changes in RA DA in routine patient care in hospital settings as well as in home-based settings.

The rheumatoid hand in the light of fluorescence: a diagnostic technique of the future?

Fluorescence spectroscopy is usually applied in physics, chemistry and related sciences. However, in recent years we can observe a growing interest in fluorescence spectroscopy for medical diagnostics. Currently, it is beginning to be used in the monitoring of rheumatoid arthritis (RA) activity. As the knowledge on RA increases, growing importance is being placed on the evaluation of synovitis. Today, it is difficult to imagine contemporary rheumatology without ultrasound (US) and magnetic resonance imaging (MRI). However, it turns out that these are not the only methods allowing one to visualise subclinical lesions, particularly synovitis. Fluorescence optical imaging (FOI) is also useful for the evaluation of inflammatory lesions in the joints. In the future, FOI may become competitive with “traditional” imaging studies. It is characterised by low cost, short duration and similar sensitivity to US.

MRI and ultrasound in rheumatoid arthritis.

To overview the recent literature on the use of MRI and musculoskeletal ultrasonography (MSUS) in rheumatoid arthritis. Subclinical inflammation has been widely confirmed, even in the earliest phases of rheumatoid arthritis. The presence of osteitis has added benefits to modern diagnostic criteria, and anticitrullinated peptide antibody positive patients have demonstrated higher osteitis scores. A model for prediction of rheumatoid arthritis onset employing usual clinical data and power Doppler ultrasonography has been reported. The presence of tenosynovitis may also be an early finding in rheumatoid arthritis. Modern imaging continues to inform our concept of pathogenesis with reports on the direct relationship of synovitis to cartilage proteoglycan loss using compositional MRI measures. Growing data on the validity of MRI as an important predictor of clinical and radiographic damage endpoints has been reported and reflected in the growing use of this outcome in many contemporary biologic therapy trials. Much work has been presented on improved and validated MSUS scores with reduced and feasible joint counts. The role of ultrasonography in making sensible decisions when monitoring biologic use, and in tapering, has been reported. The recent literature demonstrates improved validity and utility for both MRI and MSUS in diagnosis, prognosis and monitoring of rheumatoid arthritis.

CORRELATION STUDY OF DISEASE ACTIVITY SCORE AND SERUM CARTILAGE OLIGOMERIC MATRIX PROTEINLEVELS OF RHEUMATOID ARTHRITIS PATIENTS IN BANDUNG, INDONESIA

ABSTRACTObjective: This study was designed to determine the correlation between Disease Activity Score (DAS 28) and the serum Cartilage Oligomeric MatrixProtein (COMP) levels in Indonesian Rheumatoid Arthritis (RA) patients. Methods: The subjects were patients who visit the rheumatology clinic at one governmental hospital in Bandung, Indonesia. DAS was determinedby the QxMD Software based on erythrocyte sedimentation rate, and serum COMP levels were determined by enzyme-linked immunosorbent assay.Statistical analysis was conducted with IBM SPSS Statistics 23. Results: DAS 28 value was 3.36 ± 0.16 which indicates the moderate disease activity. Serum COMP levels were 843.80 ± 35.79 ng/ml in RA patientsand 830.00 ± 48.92 ng/ml in normal controls. Conclusion: There is no correlation between DAS 28 and serum COMP levels in RA patients (p = 0.496 and rho = 0.129). Keywords: Autoimmune disease, Rheumatoid arthritis monitoring, Cartilage oligomeric matrix protein, Disease activity score 28

Laboratory diagnostics of systemic autoimmune diseases – Update 2013

Abstract This article discusses relevant and up-to-date issues for the clinical laboratory concerning arthritis activity and monitoring of rheumatoid arthritis, details for the new disease entity of IgG4-related diseases and Sjogren’s syndrome. The article puts the focus on the data of 2013.

L'imagerie dans la polyarthrite rhumatoïde

Imaging is an essential complement to the clinical and laboratory examination for the diagnosis and monitoring of rheumatoid arthritis (RA). New imaging techniques such as MRI and ultrasonography have better sensitivity than a clinical examination or conventional radiography in the detection of synovitis and erosions. When conventional radiographs appear normal and if diagnostic doubt persists, it is recommended to look for possible erosions by more sensitive tools such as Doppler ultrasound or MRI. Given the difficulties of access, MRI is not recommended as first-line imaging test. Ultrasound remains an easy tool to use, inexpensive and more convenient tool than MRI.

SAT0519 Total Power Doppler Score-8 is a Useful Diagnostic Marker of Musculoskeletal Ultrasonography for Screening and Activity Measurement of Rheumatoid Arthritis

BackgroundMusculoskeletal ultrasonography (US) has been shown to be helpful for diagnosis and monitoring of rheumatoid arthritis (RA). Although several joint combinations have been demonstrated to be useful in the assessment...

Emerging optical and nuclear medicine imaging methods in rheumatoid arthritis

Molecular and multimodal imaging procedures that complement the use of existing anatomical modalities for the diagnosis and monitoring of rheumatoid arthritis (RA) have undergone substantial developmental advances. These techniques have the potential to greatly improve the management of patients with RA through early diagnosis and maximization of the newly available opportunities for early therapeutic intervention. Quantitative, noninvasive monitoring of biomarkers of the molecular events induced during the onset of RA could be used to guide the initial selection of therapy and for assessment of early therapeutic responses. Biomolecular imaging techniques that can reveal the pathophysiological features of RA--including infrared thermography, near-infrared molecular imaging, and PET--are being used to investigate the earliest cellular and biochemical inflammatory events in the development of the disease. Noninvasive imaging of abnormal specific molecular events in early RA could enable early targeted intervention that could be tailored to optimize patient responses before destructive anatomical changes occur. In this Review, we summarize new advances in biomolecular imaging techniques, with an emphasis on their current state of development in terms of the management of RA.

Adenosine Deaminase Isoenzymes in the Diagnosis and Monitoring of Rheumatoid Arthritis

Adenosine Deaminase Isoenzymes in the Diagnosis and Monitoring of Rheumatoid ArthritisThe aim of this study was determination of the catalytic activities of adenosine deaminase (ADA), ADA1 and ADA2 isoenzymes in the serum of patients suffering from rheumatoid arthritis (RA) who were and were not treated with methotrexate (MTX), and identification of the possibilities of using these biochemical parameters in diagnosing and monitoring the treatment effects in RA. Catalytic activities of total ADA (tADA) and ADA2 in serum were determined by a spectrophotometric method. A statistically significant correlation was found between the total ADA and ADA1 values, as well as between tADA and ADA2 in the serum of all patients suffering from RA. Determination of ADA1 and ADA2 isoenzyme catalytic activities in the serum of patients who might be suffering from RA improves the diagnostic value of total ADA catalytic activity determination. ADA2 catalytic activity in serum can be a useful biochemical marker in diagnosing and monitoring RA. Decrease in ADA1 isoenzyme catalytic activities in the serum of patients suffering from RA who were treated with MTX can help in the observation of MTX therapy effects.

Rheumatoid Arthritis: Ultrasound Versus MRI

Rheumatoid arthritis is a predominantly joint-based disease affecting approximately 1% of the world's population. This article will address the increasing use of both ultrasound and MRI in the diagnosis and monitoring of rheumatoid arthritis and will highlight both the strengths and weaknesses of these two imaging modalities, with particular reference to bone erosions and synovitis. Because they can detect early disease, both ultrasound and MRI will become increasingly important in the diagnosis and management of rheumatoid arthritis. Future studies with increased patient numbers will be necessary if one of these two modalities is to emerge as a clear winner as the imaging modality of choice.

Molecular Characterization of Rheumatoid Arthritis With Magnetic Resonance Imaging

Several recent advances in the field of magnetic resonance imaging (MRI) may transform the detection and monitoring of rheumatoid arthritis (RA). These advances depict both anatomic and molecular alterations from RA. Previous techniques could detect specific end products of metabolism in vitro or were limited to providing anatomic information. This review focuses on the novel molecular imaging techniques of hyperpolarized carbon-13 MRI, MRI with iron-labeled probes, and fusion of MRI with positron emission tomography. These new imaging approaches go beyond the anatomic description of RA and lend new information into the status of this disease by giving molecular information.