Skip to main content

Advertisement

SpringerLink
Log in

Increased frequency of temporal acoustic window failure in rheumatoid arthritis: a manifestation of altered bone metabolism?

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

Assessment of intracranial vessels includes transcranial Doppler (TCD). TCD performance requires intact temporal acoustic windows (TAW). Failure of TAW (TAWF) is present in 8–20% of people. There have been no reports on TAWF in rheumatoid arthritis (RA). Altogether, 62 female RA patients were included. Among them, 20 were MTX-treated and biologic-free, 20 received infliximab, and 22 tocilizumab. The controls included 60 non-RA women. TAWF, temporal bone thickness, and texture were determined by ultrasound and CT. BMD and T-scores of multiple bones were determined by DEXA. Several bone biomarkers were assessed by ELISA. In RA, 54.8% of the patients had TAWF on at least one side. Neither TAW could be identified in 34% of RA subjects. In contrast, only 20.0% of control subjects had TAWF on either or both sides (p < 0.001). In RA vs controls, 53.0 vs 2.9% of subjects exerted the trilayer, “sandwich-like” structure of TAW (p < 0.001). Finally, in RA vs controls, the mean temporal bone thickness values of the right TAW were 3.58 ± 1.43 vs 2.92 ± 1.22 mm (p = NS), while those of the left TAW were 4.16 ± 1.56 vs 2.90 ± 1.16 mm (p = 0.001). There was close association between TAWF, bone thickness, and texture (p < 0.05). These TAW parameters all correlated with age; however, TAW failure and texture also correlated with serum osteoprotegerin. TAW bone thickness inversely correlated with hip BMD (p < 0.05). TAWF, thicker, and heterogeneous temporal bones were associated with RA. These features have been associated with bone loss and OPG production. Bone loss seen in RA may result in OPG release and stimulation of bone formation around TAW.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Symmons DP (2002) Epidemiology of rheumatoid arthritis: determinants of onset, persistence and outcome. Best Pract Res Clin Rheumatol 16(5):707–722

    Article  PubMed  Google Scholar 

  2. Shoenfeld Y, Gerli R, Doria A, Matsuura E, Cerinic MM, Ronda N, Jara LJ, Abu-Shakra M, Meroni PL, Sherer Y (2005) Accelerated atherosclerosis in autoimmune rheumatic diseases. Circulation 112(21):3337–3347. https://doi.org/10.1161/CIRCULATIONAHA.104.507996

    Article  PubMed  Google Scholar 

  3. Szekanecz Z, Kerekes G, Vegh E, Kardos Z, Barath Z, Tamasi L, Shoenfeld Y. Autoimmune atherosclerosis in 3D: how it develops, how to diagnose and what to do. Autoimmun Rev 2016, Epub 2016 Mar 12

  4. Kerekes G, Szekanecz Z, Der H, Sandor Z, Lakos G, Muszbek L, Csipo I, Sipka S, Seres I, Paragh G et al (2008) Endothelial dysfunction and atherosclerosis in rheumatoid arthritis: a multiparametric analysis using imaging techniques and laboratory markers of inflammation and autoimmunity. J Rheumatol 35(3):398–406

    CAS  PubMed  Google Scholar 

  5. Guan J, Zhang S, Zhou Q, Li C, Lu Z (2013) Usefulness of transcranial Doppler ultrasound in evaluating cervical-cranial collateral circulations. Interv Neurol 2(1):8–18. https://doi.org/10.1159/000354732

    Article  PubMed  PubMed Central  Google Scholar 

  6. Marinoni M, Ginanneschi A, Forleo P, Amaducci L (1997) Technical limits in transcranial Doppler recording: inadequate acoustic windows. Ultrasound Med Biol 23(8):1275–1277. https://doi.org/10.1016/S0301-5629(97)00077-X

    Article  CAS  PubMed  Google Scholar 

  7. Bazan R, Braga GP, Luvizutto GJ, Hueb JC, Hokama NK, Zanati Bazan SG, de Carvalho Nunes HR, Leite JP, Pontes-Neto OM (2015) Evaluation of the temporal acoustic window for transcranial Doppler in a multi-ethnic population in Brazil. Ultrasound Med Biol 41(8):2131–2134. https://doi.org/10.1016/j.ultrasmedbio.2015.04.008

    Article  PubMed  Google Scholar 

  8. Postert T, Federlein J, Przuntek H, Buttner T (1997) Insufficient and absent acoustic temporal bone window: potential and limitations of transcranial contrast-enhanced color-coded sonography and contrast-enhanced power-based sonography. Ultrasound Med Biol 23(6):857–862. https://doi.org/10.1016/S0301-5629(97)00047-1

    Article  CAS  PubMed  Google Scholar 

  9. Kwon JH, Kim JS, Kang DW, Bae KS, Kwon SU (2006) The thickness and texture of temporal bone in brain CT predict acoustic window failure of transcranial Doppler. J Neuroimaging 16(4):347–352. https://doi.org/10.1111/j.1552-6569.2006.00064.x

    Article  PubMed  Google Scholar 

  10. Deal C (2012) Bone loss in rheumatoid arthritis: systemic, periarticular, and focal. Curr Rheumatol Rep 14(3):231–237. https://doi.org/10.1007/s11926-012-0253-7

    Article  CAS  PubMed  Google Scholar 

  11. Schett G, Saag KG, Bijlsma JW (2010) From bone biology to clinical outcome: state of the art and future perspectives. Ann Rheum Dis 69(8):1415–1419. https://doi.org/10.1136/ard.2010.135061

    Article  CAS  PubMed  Google Scholar 

  12. Suzuki Y, Mizushima Y Osteoporosis in rheumatoid arthritis. Osteoporos Int 1997, 7 Suppl 3:S217–S222

  13. Rass P, Pakozdi A, Lakatos P, Zilahi E, Sipka S, Szegedi G, Szekanecz Z (2006) Vitamin D receptor gene polymorphism in rheumatoid arthritis and associated osteoporosis. Rheumatol Int 26(11):964–971. https://doi.org/10.1007/s00296-006-0106-7

    Article  CAS  PubMed  Google Scholar 

  14. Schett G (2009) Osteoimmunology in rheumatic diseases. Arthritis Res Ther 11(1):210. https://doi.org/10.1186/ar2571

    Article  PubMed  PubMed Central  Google Scholar 

  15. Schett G, Gravallese E (2012) Bone erosion in rheumatoid arthritis: mechanisms, diagnosis and treatment. Nat Rev Rheumatol 8(11):656–664. https://doi.org/10.1038/nrrheum.2012.153

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Schett G, Redlich K, Hayer S, Zwerina J, Bolon B, Dunstan C, Gortz B, Schulz A, Bergmeister H, Kollias G et al (2003) Osteoprotegerin protects against generalized bone loss in tumor necrosis factor-transgenic mice. Arthritis Rheum 48(7):2042–2051. https://doi.org/10.1002/art.11150

    Article  CAS  PubMed  Google Scholar 

  17. Zwerina J, Hayer S, Tohidast-Akrad M, Bergmeister H, Redlich K, Feige U, Dunstan C, Kollias G, Steiner G, Smolen J, Schett G (2004) Single and combined inhibition of tumor necrosis factor, interleukin-1, and RANKL pathways in tumor necrosis factor-induced arthritis: effects on synovial inflammation, bone erosion, and cartilage destruction. Arthritis Rheum 50(1):277–290. https://doi.org/10.1002/art.11487

    Article  CAS  PubMed  Google Scholar 

  18. Wang SY, Liu YY, Ye H, Guo JP, Li R, Liu X, Li ZG (2011) Circulating Dickkopf-1 is correlated with bone erosion and inflammation in rheumatoid arthritis. J Rheumatol 38(5):821–827. https://doi.org/10.3899/jrheum.100089

    Article  CAS  PubMed  Google Scholar 

  19. Terpos E, Fragiadaki K, Konsta M, Bratengeier C, Papatheodorou A, Sfikakis PP (2011) Early effects of IL-6 receptor inhibition on bone homeostasis: a pilot study in women with rheumatoid arthritis. Clin Exp Rheumatol 29(6):921–925

    PubMed  Google Scholar 

Download references

Funding

The work was supported by the European Union and the State of Hungary co-financed by the European Social Fund in the framework of TAMOP-4.2.4.A/2-11/1-2012-0001 “National Excellence Program” (Z.S.), by research grant TÁMOP-4.2.2.A-11/1/KONV-2012-0031 financed by the European Union (Z.S.); an OTKA K10073 grant (H.P.B and Z.S.) donated by the Hungarian Scientific Research Fund; and also by the European Union grants GINOP-2.3.2-15-2016-00015 and GINOP-2.3.2-15-2016-00050 (Z.S.).

Author information

Author notes

  1. Zsófia Kardos and Csaba Oláh shared first authorship and equal contribution

Authors and Affiliations

  1. Department of Rheumatology, Borsod County Teaching Hospital, Miskolc, Hungary

    Zsófia Kardos & László Tamási

  2. Department of Neurosurgery, Borsod County Teaching Hospital, Miskolc, Hungary

    Csaba Oláh

  3. Department of Neurology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

    Csaba Oláh & Dániel Bereczki

  4. Department of Radiology, Borsod County Teaching Hospital, Miskolc, Hungary

    Mariann Sepsi, László Kostyál & Tünde Bóta

  5. Department of Neurology, Borsod County Teaching Hospital, Miskolc, Hungary

    Attila Sas

  6. Department of Laboratory Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

    Harjit Pal Bhattoa

  7. Department of Medicine, Division of Rheumatology, Faculty of Medicine, University of Debrecen, Nagyerdei str 22, Debrecen, H-4032, Hungary

    Katalin Hodosi & Zoltán Szekanecz

  8. Division of Angiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary

    György Kerekes

  9. Department of Neurology, Semmelweis University, Budapest, Hungary

    Dániel Bereczki

Authors
  1. Zsófia Kardos
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Csaba Oláh
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mariann Sepsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Attila Sas
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. László Kostyál
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Tünde Bóta
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Harjit Pal Bhattoa
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Katalin Hodosi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. György Kerekes
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. László Tamási
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Dániel Bereczki
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Zoltán Szekanecz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zoltán Szekanecz.

Ethics declarations

The Borsod County Teaching Hospital IRB approved this study (No. 13/2016).

All patients gave informed consent to the study and all of them gave consent to publish.

Disclosures

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kardos, Z., Oláh, C., Sepsi, M. et al. Increased frequency of temporal acoustic window failure in rheumatoid arthritis: a manifestation of altered bone metabolism?. Clin Rheumatol 37, 1183–1188 (2018). https://doi.org/10.1007/s10067-018-4003-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-018-4003-8

Keywords

Search

Navigation