Presence Of Bone Edema Research Articles

The Role of Bone Edema in Plantar Fasciitis Treated with Temperature-Controlled High-Energy Adjustable Multi-Mode Emission Laser (THEAL) and Exercise: A Prospective Randomized Clinical Trial.

Plantar fasciitis is one of the most common causes of foot pain; in 35% of cases, it is also associated with bone edema of the heel. The aim of this study was to investigate the relationship between bone edema and the outcomes of temperature-controlled high-energy adjustable multi-mode emission laser (THEAL) and/or exercises in patients with plantar fasciitis. A prospective randomized clinical trial was designed, in which 48 patients suffering from plantar fasciitis, with or without bone edema, were treated with temperature-controlled high-energy adjustable multi-mode emission laser and exercises (the laser group) or with exercises only (the control group). The patients were evaluated at recruitment (T0) and at 2 (T1) and 6 months (T2), monitoring pain (with the Visual Analogue Scale), functionality (with the Foot Function Index), perception of improvement (with the Roles and Maudsley Score), and fascia thickness (with ultrasound examination). In both groups, there was a significant improvement in pain, functional recovery, perception of remission, and a reduction in plantar fascia thickness at T1 and T2. The laser group presented statistically better values at T2 for the Roles and Maudsley Score (z: 2.21; 0.027). The regression analysis showed that a greater reduction in fascia thickness occurred in the laser group (p-value: 0.047). In conclusion, the two conservative treatments were effective in patients suffering from plantar fasciitis, even in the presence of bone edema, but with lesser results.

Poster 284: Investigating the Frequency and Extent of Articular Cartilage Injury Following Patellar Dislocation: A Comparison of Recurrent vs. First-Time Dislocations

Objectives: In cases of patellar dislocation, surgical intervention is typically reserved for patients with recurrent instability, unless a chondral or osteochondral fragment is identified following the initial dislocation. There is concern that multiple dislocation events may result in a higher incidence of articular cartilage injury. The purpose of this study is to compare the incidence of articular cartilage damage in patients with a single patellar dislocation to those with multiple patellar dislocations, and secondarily to compare the location and severity of chondral injury between the groups. Methods: Patients diagnosed with patellar dislocation were retrospectively identified by ICD-9 & ICD-10 codes from 2017-2021. Inclusion criteria were patients with a documented history of patellar dislocation with an MRI of the affected knee available for review. Patients with articular cartilage injury prior to dislocation event were excluded. Medical records were reviewed to determine the number of previous patellar dislocations. Articular cartilage injury was graded using a validated system, AMADEUS (mean total Area Measurement And DEpth & Underlying Structures, a scale from 0 to 100; 100 = no injury). Parametric continuous data was calculated by performing t tests. Nonparametric continuous data was calculated by performing Mann-Whitney tests. Chi-Square or Fisher’s Exact tests were used to calculate p values for categorical data. Results: After chart and imaging review, 233 patients were included: 117 with a primary dislocation and 116 with recurrent dislocations. Fifty-one (43.6%) of the primary dislocations and 68 (58.6%) of the recurrent dislocations were found to have articular cartilage injuries (p=0.068). When comparing the primary and recurrent groups, there was no difference in age, BMI, race, or laterality, but the recurrent group contained a significantly larger proportion of females (46.2% vs. 65.5%, P=0.004). There was no difference in lesion size, subchondral bone defect, presence of bone edema, or total AMADEUS score between groups (p=0.231). Subgroup analysis revealed that when cartilage damage is present, patients from the primary group had significantly more full-thickness lesions (p<0.001) and lower AMADEUS scores (p=0.016). The primary group had an increased proportion of medial facet and lateral femoral condyle lesions (p=0.026). Conclusions: There is a high percentage of cartilage injury in patients with a history of primary and recurrent patellar instability, with 43.6% and 58.6% of patients respectively, showing articular cartilage injury on MRI. Chondral injury primarily affected the medial and lateral patellar facets, and the lateral femoral condyle in both the primary and recurrent dislocation groups. However, the primary group demonstrated an increased number of full thickness lesions and subchondral bone defects. There was no difference in lesion size, presence of bone edema, or total AMADEUS score between the primary and recurrent groups. [Table: see text][Table: see text]

High incidence of superficial and deep medial collateral ligament injuries in \u2018isolated\u2019 anterior cruciate ligament ruptures: a long overlooked injury

PurposeIn anterior cruciate ligament (ACL) injuries, concomitant damage to peripheral soft tissues is associated with increased rotatory instability of the knee. The purpose of this study was to investigate the incidence and patterns of medial collateral ligament complex injuries in patients with clinically ‘isolated’ ACL ruptures.MethodsPatients who underwent ACL reconstruction for complete ‘presumed isolated’ ACL rupture between 2015 and 2019 were retrospectively included in this study. Patient’s characteristics and intraoperative findings were retrieved from clinical and surgical documentation. Preoperative MRIs were evaluated and the grade and location of injuries to the superficial MCL (sMCL), dMCL and the posterior oblique ligament (POL) recorded. All patients were clinically assessed under anaesthesia with standard ligament laxity tests.ResultsHundred patients with a mean age of 22.3 ± 4.9 years were included. The incidence of concomitant MCL complex injuries was 67%. sMCL injuries occurred in 62%, dMCL in 31% and POL in 11% with various injury patterns. A dMCL injury was significantly associated with MRI grade II sMCL injuries, medial meniscus ‘ramp’ lesions seen at surgery and bone oedema at the medial femoral condyle (MFC) adjacent to the dMCL attachment site (p < 0.01). Logistic regression analysis identified younger age (OR 1.2, p < 0.05), simultaneous sMCL injury (OR 6.75, p < 0.01) and the presence of bone oedema at the MFC adjacent to the dMCL attachment site (OR 5.54, p < 0.01) as predictive factors for a dMCL injury.ConclusionThe incidence of combined ACL and medial ligament complex injuries is high. Lesions of the dMCL were associated with ramp lesions, MFC bone oedema close to the dMCL attachment, and sMCL injury. Missed AMRI is a risk factor for ACL graft failure from overload and, hence, oedema in the MCL (especially dMCL) demands careful assessment for AMRI, even in the knee lacking excess valgus laxity. This study provides information about specific MCL injury patterns including the dMCL in ACL ruptures and will allow surgeons to initiate individualised treatment.Level of evidenceIII.

MRI features of low-grade and high-grade chondrosarcoma in enchondromatosis

To identify magnetic resonance imaging (MRI) features which aid differentiation of low-grade chondral tumours (LGCT-enchondroma and grade 1 chondrosarcoma) from high-grade chondral tumours (HGCT) in patients with enchondromatosis. Approval from our local Research and Innovation Centre of The Institute of Orthopaedics was gained. Patients with enchondromatosis who had biopsy and/or resection of chondral lesions over a 13-year period were identified. The pre-biopsy MRI study was assessed by two experienced musculoskeletal radiologists for tumour origin (intramedullary or surface), cortical expansion, cortical destruction, bone marrow oedema, periosteal reaction, soft tissue mass and soft tissue oedema. MRI features were compared with the final histopathological diagnosis. The study group comprised 25 males and 16 females, with a mean age of 34.9 years (range 6-81 years). Fifty-nine lesions were assessed (12 patients had > 1 tumour treated), including 43 LGCT and 16 HGCT. Significant MRI features suggesting malignant transformation to HGCT for both observers included bone oedema (p = < 0.001 and 0.002), periosteal reaction (p = 0.01) and soft tissue oedema (p = 0.001 and 0.05). Cortical destruction and soft tissue mass were predictors of HGCT in major long bones, but no significant differentiating features were identified in the hands and feet. The presence of bone oedema, periosteal reaction and soft tissue oedema on MRI may indicate a high-grade malignant transformation of chondral tumours in patients with enchondromatosis.

Clinical outcome and subchondral bone oedema presence at two-year follow-up after high density autologous chondrocyte implantation treatment in the knee

BackgroundRecently, a new approach of autologous chondrocyte implantation technique (using as biomaterial a collagen type I/III membrane) based on increasing cell density called HD-ACI (high density autologous chondrocyte implantation) has been described. The objective of this paper was to study the clinical outcome and incidence of subchondral bone oedema in patients with cartilage lesions in the knee treated with HD-ACI at 1–2 years of follow-up. MethodsThis is a retrospective study performed with forty patients with chondral injuries grade III-IV. All patients were treated with HD-ACI with a cellular dose of 5×106 chondrocytes/cm2 of lesion. The subjective perception of improvement of symptoms and functionality was measured with the IKDC score (International Knee Documentation Committee). The presence of bone oedema was assessed at 6, 12 and 24 months of follow-up by magnetic resonance imaging. ResultsIKDC values showed a significant improvement at 12 and 24 months (p<.001). The mean difference of IKDC between the baseline visit and 12 months was 26.3 points, and 31.6 points at 24 months. Twenty-seven point five percent of the patients presented subchondral bone oedema at 2 years of follow-up. ConclusionsHD-ACI is an effective and safe treatment that improves pain, clinical perception and functionality of the joint. No correlation was found between the presence of bone oedema and the patients’ clinical outcome.

Evolución clínica y presencia de edema óseo subcondral a los dos años de tratamiento con implante de condrocitos autólogos de alta de densidad en la rodilla

BackgroundRecently, a new approach of autologous chondrocyte implantation technique (using as biomaterial a collagen type i/iii membrane) based on increasing cell density called HD-ACI (High Density Autologous Chondrocyte Implantation) has been described. The objective of this paper was to study the clinical outcome and incidence of subchondral bone oedema in patients with cartilage lesions in the knee treated with HD-ACI at 1-2 years of follow-up. MethodsThis is a retrospective study performed with forty patients with chondral injuries grade iii-iv. All patients were treated with HD-ACI with a cellular dose of 5×106 chondrocytes /cm2 of lesion. The subjective perception of improvement of symptoms and functionality was measured with the IKDC score (International Knee Documentation Committee). The presence of bone oedema was assessed at 6, 12 and 24 months of follow-up by magnetic resonance imaging. ResultsIKDC values showed a significant improvement at 12 and 24 months (P<.001). The mean difference of IKDC between the baseline visit and 12 months was 26.3 points, and 31.6 points at 24 months. Twenty-seven point five percent of the patients presented subchondral bone oedema at 2 years of follow-up. ConclusionsHD-ACI is an effective and safe treatment that improves pain, clinical perception and functionality of the joint. No correlation was found between the presence of bone oedema and the patients’ clinical outcome.

Radiographic Predictors of Elbow Injury and Surgery in Major League Baseball Pitchers

Objectives:To evaluate predictive ability of asymptomatic screening MRI’s of Major League Baseball (MLB) pitchers and compare associated findings with future DL placement, pitching statistics, and elbow surgery.Methods:A total of 40 consecutive asymptomatic elbow MRI’s in MLB pitchers at a single organization were analyzed from 2005 - 2017. Asymptomatic MRI was defined as a screening MRI at time of contract signing having been performed at least 6 months prior to DL placement for any elbow-related injury. Publicly available DL data, career innings pitched, career games started, career pitch count, and career max velocity of pitch were obtained. A blinded investigator examined each MRI for pathological signals. Data was analyzed on players that were eventually placed on the DL compared to those with no DL placement.Results:40 consecutive elbow MRIs of MLB players were reviewed. The average age of the injured cohort was 28.3 ± 3.2 years (16 players) and 28.8 ± 5.5 years (24 players) for the non-injured cohort. There was no statistical difference in age, handedness, height, weight, or pitching stats between the injured and non-injured cohorts. Abnormal radiographic signal intensity in the UCL (p<0.001) and humeral elevation of the UCL (p=0.01) were significantly associated with future DL placement. Those injured spent an average of 200.7 days and 191.7 days in the DL with signal in the UCL and those with humeral elevation of the UCL, respectively. Ulnar elevation/signal of the UCL (p=0.06), and posteromedial impingement (p=0.08) were approaching statistical significance. Of those injured 68.8% (11/16) underwent elbow surgery. Findings of ligament signal intensity (p<0.001), ulnar-sided UCL elevation (p=0.018), humeral-sided UCL elevation (p=0.002), and posteromedial impingement (p=0.042) were all significantly associated with future surgery. There was no significant correlation between injury and radiocapitellar or ulnohumeral chondral lesion, bone edema, loose bodies, or flexor-pronator mass muscle defect. The presence of a flexor-pronator mass muscle defect was associated with a significantly reduced number of innings pitched (53.7 ± 74.3 vs. 304.4 ± 305.5 innings, p=0.0317), games started (5 ± 7.1 vs. 40.1 ± 49.0 games, p=0.004), and pitch count (680.5 ± 919.9 vs. 40.1 ± 49.0 pitches, p=0.022). The presence of ligament signal (26.2 ± 37.1 vs. 51.7 ± 56.5 games, p=0.036) and ulnar elevation (6.3 ± 9.3 vs. 41.2 ± 9.3 games, p=0.003) was associated with significantly fewer games started. The presence of bone edema was associated with significantly decreased pitch count (1451.2 ± 1746.8 vs. 4128.0 ± 4718.0 pitches, p=0.023). There was no association between humeral UCL elevation, flexor-pronator mass tendon, or posteromedial impingement with innings pitched, games started, or pitch count.Conclusion:The heavy demand placed on the elbow joint in professional pitching produces degenerative changes visible on MRI prior to any symptoms, as demonstrated in previous studies. Specific degenerative changes in the UCL Ligament, particularly humeral sided elevation of the UCL, are significantly associated with future injury.Radiographic Findings on Elbow MRI as Related to Placement on Disabled List and Pitching StatsN (%): Injury vs. Non-InjuryRelation to Injury (p)Relation to DL days (p)Relation to Future Surgery (p)Relation to inningsPitched (p)Relation to GamesStarted (p)Relation to Pitch Count (p)Relation to Max Pitching Velocity (p)Radiocapitellar Chondral LesionDiffuse: 1 (6.25%)0 (0%) Focal: 2 (12.5%)3 (12.5%) None: 13 (81.3%)21 (87.5%)N.S.N.S.N.S.N.S.N.S.N.S.N.S.Ulnohumeral Chondral LesionDiffuse: 0 (0%)0(0%) Focal: 1 (6.25%)0 (0%) None: 15 (93.8%)24 (100%)N.S.N.S.N.S.N.S.N.S.N.S.N.S.ArticularCartilage Bone Edema3 (18.8%)3 (12.5%)0.66780.596110.56610.9471 0.0227 0.0788 UCL Ligament Signal Heterogeneity/Hyperintensity15 (93.8%)1 (4.2%) p < 0.001 N.S. p < 0.001 0.0563 0.1487 0.0357 0.8186Ulnar-Sided Elevation/Signal3 (18.8%)0 (0%) 0.06373 0.3591 0.0177 0.1010 0.0032 0.18290.8683Humeral-Sided Elevation/Signal9 (56.3%)3 (12.5%) 0.0103 0.7240 0.0018 0.77780.71340.21670.9052Frank UCL Tear0 (0%)0 (0%)N.S.N.S.N.S.N.S.N.S.N.S.N.S.Flexor-Pronator Mass Defect1 (6.3%)1 (4.2%)1N.S.1 0.0317 0.0035 0.0223 N.S.Flexor-Pronator Mass Tendon Signal8 (50%)2 (29.2%)0.2046 0.0261 10.83110.79510.96570.7875

Vasoactive Intestinal Peptide in Early Spondyloarthritis: Low Serum Levels as a Potential Biomarker for Disease Severity.

Spondyloarthritis (SpA) is a family of inflammatory diseases sharing clinical, genetic, and radiological features. While crucial for tailoring early interventions, validated prognostic biomarkers are scarce in SpA. We analyze the correlation between serum levels of vasoactive intestinal peptide (VIP) and disease activity/severity in patients with early chronic inflammatory back pain. The study population comprised 54 patients enrolled in our early chronic inflammatory back pain register. We collected demographic information, clinical data, laboratory data, and imaging findings. VIP levels were measured by enzyme immunoassay in serum samples from 162 visits. The association between independent variables and VIP levels was analyzed using longitudinal multivariate analysis nested by patient and visit. No significant differences were observed in VIP levels between these two groups. Lower levels of VIP were significantly associated with a higher Bath Ankylosing Spondylitis Disease Activity Index (BASFI) score, presence of bone edema in magnetic resonance imaging (MRI) scan, and lower hemoglobin levels. Coexistence of cutaneous psoriasis was independently associated with lower VIP levels, and similar trend was observed for enthesitis. We conclude that SpA patients with low serum VIP levels had worse 2-year disease outcome, suggesting that serum VIP levels could be a valid prognostic biomarker.

The MRI Features in Patients with Rheumatoid Arthritis Treated with Tocilizumab, in Clinical Remission or Low Disease Activity State

Background: Subclinical inflammation and radiographic progression have been described in rheumatoid arthritis (RA) patients whose disease are in remission or are showing a low level of activity. The aim of this study was to evaluate in patients with rheumatoid arthritis RA in clinical remission or low disease activity (LDA) using composites scores, the synovitis and the bone oedema using MRI by OMERACT RAMRIS score (RAMRIS bone oedema and synovitis RAMRIS). Methods: In this longitudinal study, were included patients with rheumatoid arthritis according to the American College of Rheumatology ACR 2010 criteria with inadequate response or intolerance to conventional synthetic DMARD, treated with Tocilizumab (TCZ). Sociodemographic characteristics, clinical and laboratory for the disease were collected at baseline (M0) and 06 months (M6) of treatment. Clinical remission was defined by a DAS 28- ESR<2.6, a CDAI<2.8, a SDAI<3.3 and by ACR EULAR criteria. All patients underwent MRI of the dominant hand and wrist. MRI features were evaluated according to the Outcome Measure Clinical Trial in Rheumatoid Arthritis Rheumatoid Arthritis MRI Scoring system (OMERACT RAMRIS synovitis and bone oedema). Results: 22 patients with RA were included, 19 females (86.4%), with a mean of age 42 ± 13.7 years. The mean disease duration was 8 ± 5.2 years. The mean DAS 28 was 5.8 ± 0.94. Three patients were excluded from the study for serious side effects. At 06 months, the median SDAI was 18 (10-27).The median CDAI was 10 (5-20).The mean RAMRIS score was 2.23 ± 6.33 for bone oedema, 4.76 ± 4.02 for synovitis and 43.32 ± 30 for erosion. Using DAS28ESR as criteria of remission, it did not exist significant differences between the 3 groups of patients (remission/LDA/active disease) for the presence of synovitis on MRI (p=0.43). There was also no difference between the three groups for the presence of bone oedema (p=0.08). Moreover, defining remission by SDAI, CDAI or ACR EULAR criteria, the RAMRIS synovitis and bone oedema RAMRIS did not differ by the level of disease activity. Conclusion: This study suggests that patient in clinical remission or LDA evaluated by composites scores showed inflammation (synovitis and bone oedema) on MRI. Thus clinical remission would be different from the imaging remission. MRI and ultrasound are currently one of the criteria for remission in RA, further studies are needed in particular to determine the threshold definition of remission on MRI.

The use of MRI and CT in Imaging Occult Hip Fractures

Abstract Diagnosis of hip fractures is particularly important due to the high dependence on the integrity of this structure for people to function in their daily lives. Left unrecognized, patients face increasing morbidity and mortality as time from the original injury lengthens. A delay of just 2 days in surgical treatment for an acute hip fracture doubles mortality. In addition, an unrecognized non-displaced fracture may displace, requiring surgery of much higher risk. This may be part of the reason that the most frequent lawsuit against Emergency Physicians is for missed orthopedic injury. We reviewed the use of MRI and CT for occult hip fractures (OHF) detection at a major urban trauma unit. Our study is a retrospective review. Inclusion criteria: all patients presenting to the Emergency Clinical Hospital of Constanta with a suspected, posttraumatic, occult hip fracture, over a 5 years period were included. All patients had negative initial radiographs and underwent further imaging with either CT or MRI. A total of 185 cases meeting the inclusion criteria were identified. 72 occult hip fractures were detected with both imaging modalities. Although MRI certainly enables greater image detail, in our experience both modalities are able to provide satisfactory fracture characterization. The choice of imaging should be determined by availability and indication. MRI provides superior imaging of soft tissue but is less sensitive for degenerative changes in presence of bone edema.

THU0076 Vasoactive Intestinal Peptide in Serum: A Potential Disease Severity Marker in Patients with Early Spondyloarthritis

BackgroundSpondyloarthritis (SpA) comprises a heterogeneous group of diseases sharing several clinical, biochemical and radiological features. Biomarkers for SpA are scarce and their validation in real practice is essential in predicting...

SP0063 Imaging Biomarkers in Undifferentiated Arthritis. Are Mri/Us Useful Tools?

Ultrasonography (US)In a systematic literature search up to 2009 [1], no US publications on pure undifferentiated populations and only 2 publications in mixed populations (not optimal) [2,3] were available. In...

A86: Total Body MRI, A Guide to Diagnosis in Patients With Osteo‐Articular Pain and Inflammation

Background/Purpose:CRMO is an autoinflammatory bone disorder, characterized by aseptic multifocal osteitis. MRI is classically used in measuring the extent and activity of the bone lesions and possible soft tissue involvement. Additionally, MRI may be essential to exclude other causes of osteoarticular inflammation. We want to demonstrate the usefulness of MRI in the differential diagnosis of recurrent bone pain with inflammation in children.Methods:evaluation of 2 patients with osteoarticular pain and inflammation.Results:Two patients were referred to our pediatric rheumatology outpatient clinic with the presumed diagnosis of CRMO. Since several months, they experienced episodes of articular pain and joint swelling (patient 1) and recurrent back pain and fatigue (patient 2). In the first patient initial blood evaluation showed mildly increased inflammatory parameters (CRP 75 mg/L) with a mild microcytic anemia (Hb 11 g/dL) and thrombocytosis (557×10e6/μl) with a normal leukocyte count. Conventional X‐ray showed no abnormalities. MRI confirmed arthritis/synovitis of both ankles with presence of bone edema in ankle and tarsal bones. Initial treatment with NSAIDs was successful. In patient 2 additional investigations showed also increased inflammatory parameters (CRP 136 mg/L) with a mild anemia, slightly increased thrombocytosis and normal leukocyte count. Initial MRI showed mildly intense signaling of different vertebrae on STIR images. Bone scintigraphy demonstrated multifocal hypercaptation at the right skull, coracoied bone and multiple vertebrae. Additional bone marrow puncture was normal. NSAIDs were started systematically with success.In patient 1, pain returned. PET‐CT showed increased metabolism at multiple skeleton foci. Additional bone marrow puncture in the posterior iliac crest returned normal with no arguments for a lymphoproliferative disorder. Persistent and worsening of clinical symptoms prompted us to perform total body MRI which showed multiple, symmetric T1‐hypointens signals in the peripheral bones (lower legs, underarms, feet, knees and elbows). Guided by these findings, a targeted bone marrow puncture was performed in the tibia which showed a malignant lymphoproliferative disorder, namely a pre‐B ALL.Also in patient 2, pain returned and became progressive over a few weeks. A total body MRI showed a progressive disease with intermediate signal intensity on STIR and hypointense signaling on T1‐weighted images at different vertebrae and the sacral bone. A second bone marrow puncture at the crista returned to be negative. Guided by the MRI images a bone biopsy was performed in the sacral bone and was compatible with the diagnosis of an ALCL.Conclusion:CRMO remains a diagnosis of exclusion in patients with osteoarticular pain and inflammation. In case of persistent and/or progressive pain, the physician should keep a high index of suspicion for malignancy. Total body MRI can precisely define the characteristics and extent of the bone lesions (aspect and localization) as well as help in choosing the optimal localization for bone marrow puncture and/or bone biopsy.

THU0421 Influence of clinical, laboratory and image findings on the criteria-based diagnosis and classification of patients in new-onset spondyloarthritis units: Results from the esperanza cohort

ObjectivesTo identify clinical, laboratory, and radiological findings that may increase the probability of making a diagnosis of spondyloarthritis (SpA) by the treating rheumatologist. Additionally, the association of the same variables...

MRI and X-ray in axial spondyloarthritis: the relationship between inflammatory and structural changes

Demonstration of an association between inflammation and spinal ankylosis has been challenging. Until the advent of MRI, prospective study was not possible due to inaccessibility of tissue. Recent studies using MRI have described an association between the presence of bone edema at vertebral corners on MRI and the subsequent development of syndesmophytes at the corresponding vertebral corners on radiography. Although reports have also highlighted the development of new syndesmophytes where the baseline MRI shows no inflammation, MRI has limited sensitivity for detection of spinal inflammation that is clearly evident on histopathology. There are also crucial methodological challenges because radiographic assessment is limited to the anterior corners of the cervical and lumbar spine while MRI lesions in the cervical spine are often small while spurious inflammatory signal is common in the lumbar spine. Follow-up MRI evaluation in two independent studies has also shown that inflammatory lesions that resolve after anti-TNF therapy are more prone to develop into syndesmophytes. It may be possible that very early inflammatory lesions resolve completely without sequelae if anti-TNF therapy is introduced before new bone formation becomes largely autonomous. For an individual patient the overall development of new bone during anti-TNF therapy may therefore depend on the balance between the number of early and more mature inflammatory lesions. Clinical trials of anti-TNF agents in early spondyloarthritis together with prospective MRI studies will allow more detailed testing of this hypothesis as a major priority for the research agenda in spondyloarthritis.

A Focus on the Diagnosis of Early Rheumatoid Arthritis

Nowadays it is worldwide accepted that early diagnosis and early treatment of Rheumatoid Arthritis (RA) can improve the prognosis in most of patients. In this way, the 2010 ACR/EULAR Rheumatoid Arthritis classification criteria have shown to be more sensitive than the ACR 1987 criteria and include better patients with early RA. Other important point to focus on is to identify predictive factors for outcome, in order to propose a more aggressive treatment for early RA patients who could develop a persistent and/or erosive disease. The presence of Rheumatoid Factors (RF) and Anticitrullinated peptides antibobies (ACPA), as well as the duration of the disease at the time of diagnosis, are independent risk factors for the development of erosive RA. As for imaging, both traditional X-ray and Magnetic Resonance Imaging (MRI) highlight respectively the Rapid Radiological Progression (RRP) and the presence of bone edema which are associated to a more aggressive disease. In the last years, the musculoskeletal ultrasonography (MSUS) has emerged as a useful imaging technique since it allows to identify synovitis and bone alteration earlier than the radiological examination. Interating clinical, serological and imaging data the clinician can define the effective disease activity of each patient.

Presence of bone edema on MRI might determine disease severity in patients with early RA

Presence of bone edema on MRI might determine disease severity in patients with early RA

MRI of the wrist and finger joints in inflammatory joint diseases at 1-year interval: MRI features to predict bone erosions.

The aim of this study was to assess the ability of MRI determined synovial volumes and bone marrow oedema to predict progressions in bone erosions after 1 year in patients with different types of inflammatory joint diseases. Eighty-four patients underwent MRI, laboratory and clinical examination at baseline and 1 year later. Magnetic resonance imaging of the wrist and finger joints was performed in 22 patients with rheumatoid arthritis less than 3 years (group 1) who fulfilled the American College of Rheumatology (ACR) criteria for rheumatoid arthritis, 18 patients with reactive arthritis or psoriatic arthritis (group 2), 22 patients with more than 3 years duration of rheumatoid arthritis, who fulfilled the ACR criteria for rheumatoid arthritis (group 3), and 20 patients with arthralgia (group 4). The volume of the synovial membrane was outlined manually before and after gadodiamide injection on the T1-weighted sequences in the finger joints. Bones with marrow oedema were summed up in the wrist and fingers on short-tau inversion recovery sequences. These MRI features was compared with the number of bone erosions 1 year later. The MR images were scored independently under masked conditions. The synovial volumes in the finger joints assessed on pre-contrast images was highly predictive of bone erosions 1 year later in patients with rheumatoid arthritis (groups 1 and 3). The strongest individual predictor of bone erosions at 1-year follow-up was bone marrow oedema, if present at the wrist at baseline. Bone erosions on baseline MRI were in few cases reversible at follow-up MRI. The total synovial volume in the finger joints, and the presence of bone oedema in the wrist bones, seems to be predictive for the number of bone erosions 1 year later and may be used in screening. The importance of very early bone changes on MRI and the importance of the reversibility of these findings remain to be clarified.