Total Synovitis Score Research Articles

Anti-carbamylated Protein Antibodies and Serum Level of 14-3-3 Protein for Early Detection of Rheumatoid Arthritis Patient in Correlation with Rheumatoid Factor, Anti-CCP Antibodies, Disease Activity and Joint Damage using High Frequency Musculoskeletal Ultrasound

Background: Rheumatoid arthritis (RA) is a common progressive chronic inflammatory autoimmune disease which affects mostly small joints, causing pain, swelling, deformity, and disability. Although progress has been made in exploring RA nature, still there is a lot to know about the disease pathogenesis, diagnosis, and treatment. Aim of the Work: To investigate the role of serum anti-carbamylated protein antibodies and 14-3-3η in the diagnosis of RA compared to rheumatoid factor (RF), anti-CCP antibodies, and highfrequency musculoskeletal ultrasound used to assess the disease activity and joint damage. Methods: Serum anti-carbamylated protein antibodies and 14-3-3η were measured using ELISA in 61 RA patients and 26 normal controls. RA Disease Activity Score (DAS 28), X-ray and musculoskeletal ultrasound (hands and feet), carotid ultrasound (Intima-Media Thickness IMT) were used in assessing the RA disease. Results: Anti-carbamylated protein antibodies were significantly elevated in RA patients 4.5 (4.1- 8.9 U⁄ml) compared to the control 3.2(1.9- 4.3 U⁄ml) (p< 0.001) but 14-3-3η showed no significant difference. There was a significant positive correlation between anti-carbamylated protein antibodies, 14-3-3η levels and disease activity score assessed by DAS 28, increased IMT measured by carotid duplex, total synovitis and total erosion score were assessed by musculoskeletal ultrasound. There was no correlation between RF and anti-CCP antibodies. Anti-carbamylated protein antibodies were found to have 66.7% sensitivity and 85.2% specificity in RA diagnosis, while 14- 3-3η had 51.9% sensitivity and 72.1% specificity. Conclusion: Anti-carbamylated protein antibodies and 14-3-3η have a high sensitivity and specificity in RA diagnosis and had a correlation with the disease activity and joint damage.

Double-inversion recovery with synthetic magnetic resonance: a pilot study for assessing synovitis of the knee joint compared to contrast-enhanced magnetic resonance imaging.

To investigate the agreement between double-inversion recovery (DIR) with synthetic magnetic resonance imaging (MRI) and T1-weighted contrast-enhanced (CE)-MRI for the assessment of knee synovitis. T1-weighted CE-MRI and synthetic MRI of 30 patients were compared. Synthetic DIR image reconstruction was performed with two inversion times (280-330ms and 2800-2900ms). Subjective image quality, visibility of synovium, detection of synovitis, and total synovitis score in the knee joint were evaluated on both MR images. The relative signal intensity (SI) and relative contrast of synovium, joint effusion, and bone marrow for two imaging were assessed. Differences in data between two imaging were assessed by using Wilcoxon's signed-rank test and chi-square test/Fisher's exact test. Interobserver agreement was expressed as weighted kappa value. Accuracy of synthetic DIR image was calculated by using CE-MRI as reference standard. T1-weighted CE-MRI yielded better image quality than synthetic DIR imaging (p < 0.001). Interobserver agreements for detecting synovitis diagnosis/sum of the synovitis score were moderate to almost perfect (κ = 0.58/0.44, synthetic DIR; κ = 0.83/0.65, T1-weighted CE-MRI). There were no statistical differences in visibility of synovium (p = 0.058-0.190), detection of synovitis (p < 0.001), and relative SI of structures between two imaging (p = 0.086-0.360). Synovium-to-effusion contrast was higher in synthetic DIR (p = 0.003) and synovium-to-bone marrow contrast was higher in CE-MRI (p < 0.001). Synthetic DIR imaging showed a moderate degree of interobserver agreement and good accuracy for detecting synovitis. Though it has limitations, it may play a role in imaging of degenerative joint disease or larger cohort scientific studies where gadolinium application is not feasible. • Synthetic double-inversion recovery (DIR) imaging avoids the use of contrast agent. • There was no significant difference between T1-weighted CE-MRI and synthetic DIR imaging in evaluating presence of synovitis in knee joint. • Synthetic DIR imaging showed moderate degree of interobserver agreement and good accuracy for detecting synovitis compared to CE-MRI, and it may facilitate evaluation of some regions of peripatellar synovitis.

Erken romatoid artrit hastalarının klinik ve ultrasonografik bulguları: 18 aylık takip çalışması

Objectives: The aim of our study is to perform the clinical, functional and ultrasonographic (US) follow-up of the early and very early RA patient which is naive among the disease modifying antirheumatic drugs (DMARDs) for 18 months and evaluate the relationship of these parameters with the radiological final state. Material and methos: This prospective study included 48 early RA (15 very early RA) patients. Gray scale US (GSUS), Power Doppler US (PDUS) examinations, DAS 28, HAQ, ESR, CRP were repeated at each visit (baseline, 1, 3, 6, 9, 12, 18 months). Hand, wrist, elbow, shoulder, knee joints and hand, wrist tendon structures were evaluated via GSUS and PDUS. Results: The improvement in the ESR, CRP levels is observed in the 1st month of the treatment (p=0.006). The statistically significant improvement in the HAQ, DAS 28 scores, total GSUS synovitis score, total PDUS tenosynovitis score, total GSUS tenosynovitis score, and total PDUS tenosynovitis score begins only in the 3rd month (p=0.007, p=0.003, p=0.001, p=0.009, p=0.002, p=0.004 respectively). In the laboratory, US monitoring of very early RA patients, it is similar to early RA patients. In the multiple linear regression model, only total GSUS synovitis scores, total PDUS synovitis scores at baseline and 1st continued to show an effect on the radiographic progression scores in the early RA patients (β=0.417, p=0011; β=0.549, p=0.028; β=0.476, p=0015; β=0.358, p=0.017, respectively). Conclusions: Radiographic damage progresses at the similar severity in early and very early RA patients. The most important factor affecting the radiographic damage progression is the severity of US synovitis at the baseline and in the 1st month, independently of the disease activity.

Evolution of synovitis in osteoarthritic knees and its association with clinical features

To investigate the course of synovitis on contrast-enhanced magnetic resonance images (CE-MRI) in osteoarthritic knees over 2 years, and its association with pain and cartilage deterioration. Consecutive patients (n=39, mean age 61 years, 79% woman, median (range) body mass index (BMI) 29 (24-48)kg/mm2) with clinical osteoarthritis (OA) were included. Baseline and follow-up CE-MRI (3T) were scored paired in chronological order for synovitis (semi-quantitatively at 11 sites (range 0-22)), cartilage deterioration and bone marrow lesions (BMLs) (semi-quantitatively according to Knee Osteoarthritis Scoring System (KOSS)). Changes in sum scores were calculated. Cartilage deterioration was defined as change of ≥2 above the smallest detectable change (SDC). Pain was assessed by standardized questionnaires. Analysis of covariance (ANCOVA) and linear regression models were used to investigate association between synovitis change and cartilage deterioration and between synovitis change or cartilage deterioration and change in pain. The total synovitis score did not change over 2 years (mean change 0.2 (standard deviation (SD) 3.2)), although changes in individual patients were observed. Cartilage deterioration was observed in 51% of patients. Synovitis change score was lower in patients without compared to patients with cartilage deterioration, taking BML change in account (mean difference -2.1 (-4.1 to-0.1)). Change in synovitis was not associated with change in pain, whereas cartilage deterioration was associated with change in Intermittent and Constant OsteoArthritis Pain (ICOAP) constant pain in adjusted models (unstandardised coefficient (B) (95% confidence interval (CI)) 2.8 (0.4-5.3)). In individual patients synovitis fluctuates during disease course. Synovitis change was not associated with change in pain. Increase in synovitis is associated with cartilage deterioration, suggesting a role for synovitis as a target for disease-modifying treatment.

Automated assessment of synovitis in 0.2 T magnetic resonance images of the wrist

According to the current recommendations in diagnosis of rheumatoid arthritis (RA), Magnetic Resonance (MR) images of wrist joints are used to evaluate three main types of lesions: synovitis, bone edema and bone erosions. In the clinical practice, the RA-related lesions seen in MR images are assessed manually with the semi-quantitative RAMRIS scoring system. In this paper we present an automated method for inflamed synovial membrane volume determination, based on the analysis of pre- and post-contrast MR images and segmentation of wrist bones seen in MR images. We found that the correlation between the automatically quantified volume of synovitis and RAMRIS scores was in the range from 0.76 to 0.87 for the total RAMRIS synovitis score. This can be compared with the correlation between the manually quantified volume of synovitis and RAMRIS scores which was in the range from 0.75 to 0.81 for the total synovitis score. The results of the study demonstrate that computer assisted methods for assessment of synovitis have great potential for clinical applications.

Cadherin-11 involves in synovitis and increases the migratory and invasive capacity of fibroblast-like synoviocytes of osteoarthritis.

To detect the expression of cadherin-11 and its correlation with synovitis in osteoarthritis (OA), to explore the mechanism of over expression of cadherin-11 and its role in migratory or invasive capacity of fibroblast-like synoviocytes (FLS). Synovitis severity was recorded according to Krenn's scoring system in 25 osteoarthritis patients undergoing total knee arthroplasty. Cadherin-11 expression in OA synoviums and its correlation with synovitis score and systemic inflammation markers were explored. After induction with Interleukin-1 beta (IL-1β) or tumor necrosis factor-alpha (TNF-α),cadherin-11 expression on OA FLS was assessed by qPCR and western blot,the capacity of migration and invasion of OA FLS was tested by transwell assay, and matrix metalloproteinase-2 production was assessed with ELISA as cadherin-11 expression was up regulated after infection with cadherin-11 cDNA-containing lentivirus, also when cadherin-11 expression was knocked down after infection with cadherin 11 shRNA containing lentivirus. Cadherin-11 expression in OA synovium showed significant differences among different grades of synovitis. Cadherin-11 in the lining layer was positively correlated with hyperplasia of the lining layer, density of the resident cells, inflammatory infiltrate, total synovitis score and D-dimer. Cadherin-11 in the sublining layer was positively correlated with the density of the resident cells, inflammatory infiltrate, total synovitis score and erythrocyte sedimentation rate. IL-1β or TNF-α could up-regulate cadherin-11 expression on OA FLS at transcriptional and protein level. Over expression of cadherin-11 increased migratory or invasive capacity of OA FLS, while cadherin-11 knock down reduced migratory or invasive capacity and MMP-2 production in OA FLS. The over expression of cadherin-11 in osteoarthritis is positively correlated with synovitis severity, and can be driven by proinflammatory cytokines on OA FLS; cadherin-11 increases migratory or invasive capacity and MMP-2 production of fibroblast-like synoviocytes of osteoarthritis.

Association of pain in knee osteoarthritis with distinct patterns of synovitis.

To determine possible patterns of synovitis on contrast-enhanced magnetic resonance imaging (CE-MRI) and its relation to pain and severity in patients with radiographic knee osteoarthritis (OA). In total, 86 patients (mean age 62 years, 66% women, median body mass index 29 kg/m(2) ) with symptomatic knee OA (Kellgren/Lawrence radiographic score 3) were included. T1-weighted, gadolinium-chelate-enhanced MRI with fat suppression was used to semiquantitatively score the extent of synovitis at 11 knee sites (total score range 0-22). Self-reported pain was assessed with 3 standardized questionnaires. Principal components analysis (PCA) was used to investigate patterns (the location and severity) of synovitis. Subsequently, these patterns were assessed for associations with pain measures and radiographic severity in adjusted logistic regression models. Synovitis was observed in 86 patients and was found to be generally mild on CE-MRI (median total synovitis score 7, range 0-16). The median pain scores were 53 (range 0-96) on the visual analog scale for pain, 51.4 (range 2.8-97.2) on the Knee Injury and Osteoarthritis Outcome Score (KOOS) for pain, 35 (range 0-75) on the Intermittent and Constant Osteoarthritis Pain (ICOAP) score for constant pain, and 40.6 (range 0-87.5) on the ICOAP score for intermittent pain. PCA resulted in extraction of 3 components, explaining 53.4% of the variance. Component 1 was characterized by synovitis at 7 sites (mainly medial parapatellar involvement) and was associated with scores on the KOOS pain subscale and the ICOAP constant pain subscale. Component 2 was characterized by synovitis at 4 sites (mainly the site adjacent to the anterior cruciate ligament), but was not associated with pain measures or with radiographic severity. Component 3, characterized by synovitis at 3 sites (mainly at the loose body site), was associated with radiographic severity. Different patterns of synovitis in knee OA were observed. The pattern that included several patellar sites was associated with pain, whereas other patterns showed no association, suggesting that pain perception in patients with knee OA is a localized response.

AB0388 Drug Serum Levels of TNF Antagonists do not Correlate with Subclinical Synovitis by Ultrasound in Patients with Rheumatoid Arthritis and Psoriatic Arthritis in Clinical Remission or Low Disease Activity

ObjectivesTo study the relationship between serum trough levels of TNF antagonists -etanercept (ETN), adalimumab (ADA), infliximab (IFX)- and subclinical active-synovitis (SAS) by ultrasound (US) in patients diagnosed with RA and...

FRI0370 Over-Expression of Sublining Bcl6 Correlates with Hyperplasia of Synovitis in Rheumatoid Arthritis

BackgroundThe pathological basis in RA is synovitis characterized by hyperplasia of synovial lining and synovial stroma with neovascularisation and inflammatory infiltration. B-cell lymphoma (Bcl) 6 is a nuclear sequence-specific transcriptional...

SAT0379 Effects of Abatacept on Synovitis as Assessed by Magnetic Resonance Imaging (MRI) in Psoriatic Arthritis - Preliminary Analysis from A Single Centre, Placebo-Controlled, Crossover Study

BackgroundAbatacept, a soluble, fully human fusion protein which selectively inhibits T-cell activation via competitive binding to CD80/CD86, decreases serum levels of cytokines and inflammatory proteins implicated in the pathogenesis of...

Risk factors of persistent synovitis development in early undifferentiated arthritis patients

BackgroundPersistent synovitis (PS) may lead to erosive joint damage and result in functional disability.ObjectivesThe aim of the study was to identify the risk factors for development of PS in early undifferentiated arthritis patients (EUA) attending Al Sharqia Governorate Hospitals, Egypt.Patients and methodsA total of 80 EUA patients comprised the patients group. Assessment was performed twice (baseline and after 1 year) using clinical, laboratory, functional, and radiological [high resolution ultrasonography (HRUS) and power Doppler (PD)] assessments.ResultsAmong 80 patients assessed, 20 (25%) showed evidence of self-limiting arthritis and 60 (75%) had PS (PS):16 (27%) developed rheumatoid arthritis, 14 (23%) progressed to spondyloarthropathy, and 30 (50%) remained undifferentiated (UA). Baseline tender and swollen Joint Counts (TJC and SJC) and anti-CCP2 titer were significantly evident in PS patients. Baseline HRUS total score of synovitis and PD total score were significantly higher in PS patients. Family history of any specific rheumatic disease, SJC, anti-CCP2 titer, HRUS total synovitis score, and PD total score were the significant risk factors of PS development. The most significant risk factor of PS (logistic regression analysis) was the baseline PD total score.ConclusionBaseline PD total score is the most significant risk factor for development of PS in EUA patients.RecommendationPD examination of all patients presenting with EUA should be performed.

Elevated serum IgG4 defines specific clinical phenotype of rheumatoid arthritis.

Objectives. To explore the correlation of serum IgG4 (sIgG4) with clinical manifestations or therapeutic response in rheumatoid arthritis (RA). Methods. Consecutive 136 RA patients were recruited and followed up at regular interval. SIgG4 was detected by immunonephelometry. Serial synovial tissue sections from 46 RA patients were stained immunohistochemically for IgG4. Results. Forty-six percent of 136 RA patients had elevated sIgG4. Patients with elevated sIgG4 had higher sIgG4/sIgG ratio, C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, and anticyclic citrullinated peptide antibodies than those with normal sIgG4 (all P < 0.05). Among 45 patients who received methotrexate and leflunomide therapy, 50% (9/18) of patients with elevated sIgG4 and 85% (23/27) of patients with normal sIgG4 reached therapeutic target (disease activity score of 28 joints < 3.2) at 6-month visit (χ 2 = 6.508, P = 0.011). IgG4-positive plasma cell count correlated positively with sIgG4, total synovitis score, and CD3-, CD20-, and CD38-positive cell counts (all P < 0.05). Conclusions. Our results showed that elevated sIgG4 in RA is common and disproportional to total IgG and RA with elevated sIgG4 may be a specific clinical phenotype with higher disease activity, higher level of autoantibodies, and poor response to methotrexate and leflunomide therapy.

FRI0303 Degree of synovitis on MRI is correlated with histological and macroscopic features of synovial tissue inflammation in knee osteoarthritis

BackgroundSynovitis is often present on MRI of OA knees and is an important determinant of pain.ObjectivesTo evaluate the association between synovitis at contrast enhanced (CE) MRI with microscopic and macroscopic...

Degree of synovitis on MRI is correlated with histological and macroscopic features of synovial tissue inflammation in knee osteoarthritis

Background and objectivesSynovitis is often present on MRI of OA knees and is an important determinant of pain. To better understand the nature of synovitis seen on MRI the authors...

CIP2A expression is associated with synovial hyperplasia and invasive function of fibroblast-like synoviocytes in rheumatoid arthritis

Cancerous inhibitor of protein phosphatase 2A (CIP2A) is a recently identified oncoprotein that leads to cellular proliferation in cancer cells. We aim to investigate CIP2A expression in fibroblast-like synoviocytes (FLS) and its association with the histopathological grade of synovitis and the invasive function of FLS in rheumatoid arthritis (RA). CIP2A protein expression was measured in 8 RA FLS and 8 OA FLS using Western blot analysis. CIP2A mRNA expression from 19 RA FLS and 7 OA FLS was measured using real-time PCR. Synovitis score of RA FLS-matched synovial tissues was semiquantitatively measured by two independent pathologists. An in vitro cell invasion assay was performed using RA FLS treated with CIP2A small interfering RNA (siRNA) or with control vector. Western blot analysis showed that CIP2A is more frequently overexpressed in RA FLS compared with OA FLS. CIP2A mRNA expression was higher in RA FLS compared with those in OA FLS, but did not reach statistical significance (P = 0.076). In RA, total synovitis score was strongly correlated with FLS CIP2A mRNA expression (rs = 0.849, P = 0.043). TNF-α treatment induced a robust increase in the invasive function of control FLS (P = 0.0021), but no significant effect was observed in CIP2A siRNA-treated FLS. Our data demonstrate that CIP2A expression is closely associated with the histopathological score of synovitis and invasive function of FLS in RA. These results suggest that CIP2A may play a critical role in the destructive process in RA and warrant further investigation of CIP2A as a therapeutic target.

288 IMPACT OF HALLUX VALGUS SEVERITY ON GENERAL AND FOOT-SPECIFIC HEALTH-RELATED QUALITY OF LIFE

as follows: 0=none; 1=mild; 2=moderate; 3=severe. Twenty of thirty-four patients underwent Gd-MRI. Synovial membrane inflammation was investigated in 5 ROIs. Thickening of the inflamed synovial membrane was determined in each ROI and grade on a 4-point scale. A correlation analysis was conducted by Spearman’s correlation coefficient. Results: The synovitis of the knee joint was evaluated by a histological analysis and Gd-MRI. A statistically significant correlation was observed between the total composite score of synovitis by the histological analysis and the synovitis score evaluated by Gd-MRI in patients of this study (r=0.88, p<0.01). Next, the possible correlation between synovial inflammation and the symptoms and the disability of the patients was assessed. The pain VAS score of patients was not correlated with either the mean total synovitis score evaluated by the histological analysis nor that evaluated by Gd-MRI (r=0.25, p=0.18 and r=0.08, p=0.75, respectively). On the other hand, the total JKOM score of the patients showed a significant positive correlation with both the mean total synovitis score evaluated by the histological analysis and that evaluated by Gd-MRI (r=0.55, p<0.01 and r=0.71, p<0.01, respectively). To further examine whether the WOMAC could obtain a similar result, fourteen of thirty-four patients were evaluated for any disability by both the JKOM and WOMAC. The WOMAC of the fourteen patients did not show a significant correlation with either the mean total synovitis score evaluated by the histological analysis or that evaluated by Gd-MRI. Conclusions: The present study revealed the disability of Japanese patients with knee OA who required TKA using JKOM showed a significant correlation with the severity of synovitis in affected knee joint. This study further confirmed the superiority of the JKOM for evaluating the disability of Japanese patients with knee OA. Synovitis may play a crucial role, not only in the progression of disease, but also in the current functional impairment and disability in patients with end-stage knee OA who required TKA.

New low-field extremity MRI, compacTscan: comparison with whole-body 1.5 T conventional MRI

Low-field extremity magnetic resonance imaging (lfMRI) is currently commercially available and has been used clinically to evaluate rheumatoid arthritis (RA). However, one disadvantage of this new modality is that the field of view (FOV) is too small to assess hand and wrist joints simultaneously. Thus, we have developed a new lfMRI system, compacTscan, with a FOV that is large enough to simultaneously assess the entire wrist to proximal interphalangeal joint area. In this work, we examined its clinical value compared to conventional 1.5 tesla (T) MRI. The comparison involved evaluating three RA patients by both 0.3 T compacTscan and 1.5 T MRI on the same day. Bone erosion, bone edema, and synovitis were estimated by our new compact MRI scoring system (cMRIS) and the κ coefficient was calculated on a joint-by-joint basis. We evaluated a total of 69 regions. Bone erosion was detected in 49 regions by compacTscan and in 48 regions by 1.5 T MRI, while the total erosion score was 77 for compacTscan and 76.5 for 1.5 T MRI. These findings point to excellent agreement between the two techniques (κ = 0.833). Bone edema was detected in 14 regions by compacTscan and in 19 by 1.5 T MRI, and the total edema score was 36.25 by compacTscan and 47.5 by 1.5 T MRI. Pseudo-negative findings were noted in 5 regions. However, there was still good agreement between the techniques (κ = 0.640). Total number of evaluated joints was 33. Synovitis was detected in 13 joints by compacTscan and 14 joints by 1.5 T MRI, while the total synovitis score was 30 by compacTscan and 32 by 1.5 T MRI. Thus, although 1 pseudo-positive and 2 pseudo-negative findings resulted from the joint evaluations, there was again excellent agreement between the techniques (κ = 0.827). Overall, the data obtained by our compacTscan system showed high agreement with those obtained by conventional 1.5 T MRI with regard to diagnosis and the scoring of bone erosion, edema, and synovitis. We conclude that compacTscan is useful for diagnosis and estimation of disease activity in patients with RA.

New low-field extremity MRI, compacTscan: comparison with whole-body 1.5 T conventional MRI

Low-field extremity magnetic resonance imaging (lfMRI) is currently commercially available and has been used clinically to evaluate rheumatoid arthritis (RA). However, one disadvantage of this new modality is that the field of view (FOV) is too small to assess hand and wrist joints simultaneously. Thus, we have developed a new lfMRI system, compacTscan, with a FOV that is large enough to simultaneously assess the entire wrist to proximal interphalangeal joint area. In this work, we examined its clinical value compared to conventional 1.5 tesla (T) MRI. The comparison involved evaluating three RA patients by both 0.3 T compacTscan and 1.5 T MRI on the same day. Bone erosion, bone edema, and synovitis were estimated by our new compact MRI scoring system (cMRIS) and the kappa coefficient was calculated on a joint-by-joint basis. We evaluated a total of 69 regions. Bone erosion was detected in 49 regions by compacTscan and in 48 regions by 1.5 T MRI, while the total erosion score was 77 for compacTscan and 76.5 for 1.5 T MRI. These findings point to excellent agreement between the two techniques (kappa = 0.833). Bone edema was detected in 14 regions by compacTscan and in 19 by 1.5 T MRI, and the total edema score was 36.25 by compacTscan and 47.5 by 1.5 T MRI. Pseudo-negative findings were noted in 5 regions. However, there was still good agreement between the techniques (kappa = 0.640). Total number of evaluated joints was 33. Synovitis was detected in 13 joints by compacTscan and 14 joints by 1.5 T MRI, while the total synovitis score was 30 by compacTscan and 32 by 1.5 T MRI. Thus, although 1 pseudo-positive and 2 pseudo-negative findings resulted from the joint evaluations, there was again excellent agreement between the techniques (kappa = 0.827). Overall, the data obtained by our compacTscan system showed high agreement with those obtained by conventional 1.5 T MRI with regard to diagnosis and the scoring of bone erosion, edema, and synovitis. We conclude that compacTscan is useful for diagnosis and estimation of disease activity in patients with RA.

A new low-field extremity magnetic resonance imaging and proposed compact MRI score: evaluation of anti-tumor necrosis factor biologics on rheumatoid arthritis

Magnetic resonance imaging (MRI) is a useful tool for evaluating disease activity and therapeutic efficacy in rheumatoid arthritis (RA). However, conventional whole-body MRI is inconvenient on several levels. We have therefore developed a new low-field extremity MRI (compact MRI, cMRI) and examined its clinical utility. Thirteen RA patients treated with anti-tumor necrosis factor (TNF) biologics were included in the study. The MRI was performed twice using a 0.21-T extremity MRI system. The MRI images were scored using our proposed cMRI scoring system, which we devised with reference to the Outcome Measures in Rheumatology Clinical Trials RA MRI score (OMERACT RAMRIS). In our cMRI scoring system, synovitis, bone edema, and bone erosion are separately graded on a scale from 0 to 3 by imaging over the whole hand, including the proximal interphalangeal joint. The total cMRI score (cMRIS) is then obtained by calculating the total bone erosion score × 1.5 + total bone edema score × 1.25 + total synovitis score. In this study, one patient showed a progression of bone destruction even under low clinical activity, as assessed by the disease activity score on 28 joints (DAS28); however, another patient’s cMRIS decreased concurrently with the decrease in DAS28, with the positive correlation observed between ΔDAS28 and ΔcMRIS (R = 0.055, P < 0.05). We conclude that cMRI and cMRIS are useful for assessing total disease activity and as a method linking MRI image evaluation to clinical evaluation.

A new low-field extremity magnetic resonance imaging and proposed compact MRI score: evaluation of anti-tumor necrosis factor biologics on rheumatoid arthritis

Magnetic resonance imaging (MRI) is a useful tool for evaluating disease activity and therapeutic efficacy in rheumatoid arthritis (RA). However, conventional whole-body MRI is inconvenient on several levels. We have therefore developed a new low-field extremity MRI (compact MRI, cMRI) and examined its clinical utility. Thirteen RA patients treated with anti-tumor necrosis factor (TNF) biologics were included in the study. The MRI was performed twice using a 0.21-T extremity MRI system. The MRI images were scored using our proposed cMRI scoring system, which we devised with reference to the Outcome Measures in Rheumatology Clinical Trials RA MRI score (OMERACT RAMRIS). In our cMRI scoring system, synovitis, bone edema, and bone erosion are separately graded on a scale from 0 to 3 by imaging over the whole hand, including the proximal interphalangeal joint. The total cMRI score (cMRIS) is then obtained by calculating the total bone erosion score × 1.5 + total bone edema score × 1.25 + total synovitis score. In this study, one patient showed a progression of bone destruction even under low clinical activity, as assessed by the disease activity score on 28 joints (DAS28); however, another patient’s cMRIS decreased concurrently with the decrease in DAS28, with the positive correlation observed between ΔDAS28 and ΔcMRIS (R = 0.055, P < 0.05). We conclude that cMRI and cMRIS are useful for assessing total disease activity and as a method linking MRI image evaluation to clinical evaluation.