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MR and CEUS monitoring of patients with severe rheumatoid arthritis treated with biological agents: a preliminary study

  • Magnetic Resonance
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Abstract

Purpose

This study was done to propose a study protocol for patients with rheumatoid arthritis (RA) treated with biological agents, by evaluating the contribution of contrast-enhanced magnetic resonance (CE-MR) imaging, a software programme that calculates the volume of synovitis on CE-MR images, and contrast-enhanced ultrasound (CEUS).

Materials and methods

Sixteen patients with RA receiving treatment with biologics were analysed. The patients underwent clinical examination, CE-MR imaging and CEUS on the same day. Images were postprocessed with the software and evaluated independently by three physicians in terms of RAMRIS (Rheumatoid Arthritis Magnetic Resonance Imaging Score), SAMIS (Simplified Rheumatoid Arthritis Magnetic Resonance Imaging Score) and CEUS grade. The techniques were correlated statistically.

Results

The RAMRIS and SAMIS scores were found to correlate statistically. CE-MR imaging correlated with the clinical data (p < 0.05), whereas CEUS did not. The data provided by the software did not correlate statistically with the other techniques. The most painful joint was consistently found to be the joint with most synovitis.

Conclusions

CE-MR imaging may be used prior to treatment and for long-term follow-up. CEUS might be useful in the short-term follow-up, as it seems to provide an indication of the presence or absence of disease, though not of its severity. The software is a very useful tool that can supplement, but not replace, the other techniques.

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References

  1. Alamanos Y, Drosos AA (2005) Epidemiology of adult rheumatoid arthritis. Autoimmun Rev 4(3):130–136

    Article  PubMed  Google Scholar 

  2. Backhaus M, Kamradt T, Sandrock D et al (1999) Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 42:1232–1245

    Article  CAS  PubMed  Google Scholar 

  3. Firestein GS (1999) Starving the synovium: angiogenesis and inflammation in rheumatoid arthritis. J Clin Invest 103:3–4

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  4. Stronger CM, Steak DG, Junky A et al (1999) Decreased angiogenesis and arthritic disease in rabbits treated with an alphavbeta3 antagonist. J Clin Invest 103:47–54

    Article  Google Scholar 

  5. Van Tuyl LH, Lems WF, Voskuyl AE et al (2008) Tight control and intensified COBRA combination treatment in early rheumatoid arthritis: 90 % remission in a pilot trial. Ann Rheum Dis 67:1574–1577

    Article  PubMed  Google Scholar 

  6. Klauser A, Demharter J, De Marchi A et al (2005) The IACUS study group. Contrast-enhanced gray-scale sonography in assessment of joint vascularity in rheumatoid arthritis: results from the IACUS study group. Euro Radiol 15:2404–2410

    Article  Google Scholar 

  7. Arnett FC, Edworthy SM, Bloch DA et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  CAS  PubMed  Google Scholar 

  8. Wakefield RJ, Brown AK, O’Connor PJ et al (2003) Power Doppler sonography: improving disease activity assessment in inflammatory musculoskeletal disease. Arthritis Rheum 48:285–288

    Article  PubMed  Google Scholar 

  9. Stone M, Bergin D, Whelan B et al (2001) Power Doppler ultrasound assessment of rheumatoid hand synovitis. J Rheumatol 28:1979–1982

    CAS  PubMed  Google Scholar 

  10. Schmidt WA, Volker L, Zacher J et al (2000) Colour Doppler ultrasonography to detect pannus in knee joint synovitis. Clin Exp Rheumatol 18:439–444

    CAS  PubMed  Google Scholar 

  11. Hirohata S, Sakakibara J (1999) Angioneogenesis as a possible elusive trigger factor in rheumatoid arthritis. Lancet 353:1331

    Article  CAS  PubMed  Google Scholar 

  12. Hermann KG, Backhaus M, Schneider U et al (2003) Rheumatoid arthritis of the shoulder joint: comparison of conventional radiography, ultrasound, and dynamic contrast-enhanced magnetic resonance imaging. Arthritis Rheum 48:3338–3349

    Article  PubMed  Google Scholar 

  13. Fiocco U, Ferro F, Cozzi L et al (2003) Contrast medium in power Doppler ultrasound for assessment of synovial vascularity: comparison with arthroscopy. J Rheumatol 30:2170–2176

    PubMed  Google Scholar 

  14. Suter LG, Fraenkel L, Braithwaite RS (2011) Cost-effectiveness of adding magnetic resonance imaging to rheumatoid arthritis management. Arch Intern Med 171:657–667

    PubMed  Google Scholar 

  15. Suter LG, Fraenkel L, Braithwaite RS (2011) Role of magnetic resonance imaging in the diagnosis and prognosis of rheumatoid arthritis. Arthritis Care Res (Hoboken) 63:675–688

    Article  Google Scholar 

  16. McQueen F, Lassere M, Edmonds J et al (2003) OMERACT rheumatoid arthritis magnetic resonance imaging studies. Summary of OMERACT 6 MR imaging module. Rheumatol 30:1387–1392

    Google Scholar 

  17. Cyteval C, Miquel A, Hoa D (2010) Rheumatoid arthritis of the hand: monitoring with a simplified MR imaging scoring method—preliminary assessment. Radiology 256:863–869

    Article  PubMed  Google Scholar 

  18. Østergaard M, Peterfy C, Conaghan P et al (2003) OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies: core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system. J Rheumatol 30:1385–1386

    PubMed  Google Scholar 

  19. Scott DL, Laasonen L, Priolo F et al (1997) The radiological assessment of rheumatoid arthritis. Clin Exp Rheumatol 15:S53–S61

    PubMed  Google Scholar 

  20. Stramare R, Raffeiner B, Ciprian L et al (2012) Evaluation of finger joint synovial vascularity in patients with rheumatoid arthritis using contrast-enhanced ultrasound with water immersion and a stabilized probe. J Clin Ultrasound 40:147–154

    Article  PubMed  Google Scholar 

  21. Leech SJ, Gukhool J, Blaivas M (2003) ED ultrasound evaluation of the index flexor tendon: a comparison of water bath evaluation technique (WET) versus direct contact ultrasound. Acad Emerg Med 10:573

    Article  Google Scholar 

  22. Van der Heide A, Jacobs JW, Bijlsma JW et al (1996) The effectiveness of early treatment with “second-line” antirheumatic drugs: a randomized, controlled trial. Ann Intern Med 124:699–707

    Article  PubMed  Google Scholar 

  23. Nell VP, Machold KP, Eberl G et al (2004) Benefit of very early referral and very early therapy with disease-modifying anti-rheumatic drugs in patients with early rheumatoid arthritis. Rheumatology (Oxford) 43:906–914

    Article  CAS  Google Scholar 

  24. Aletaha D, Funovits J, Keystone EC, Smolen JS (2007) Disease activity early in the course of treatment predicts response to therapy after one year in rheumatoid arthritis patients. Arthritis Rheum 56:3226–3235

    Article  CAS  PubMed  Google Scholar 

  25. Möttönen T, Hannonen P, Leirisalo-Repo M et al (1999) Comparison of combination therapy with single drug therapy in early rheumatoid arthritis: a randomized trial—FIN-RACo trial group. Lancet 353:1568–1573

    Article  PubMed  Google Scholar 

  26. Narváez JA, Narváez J, De Lama E, De Albert M (2010) MR imaging of early rheumatoid arthritis. Radiographic 30:143–163

    Article  Google Scholar 

  27. Ostergaard M, Hansen M, Stoltenberg M et al (1999) Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum 42:918

    Article  CAS  PubMed  Google Scholar 

  28. Zeman MN, Scott PJ (2012) Current imaging strategies in rheumatoid arthritis. Am J Nucl Med Mol Imaging 2:174–220

    PubMed Central  PubMed  Google Scholar 

  29. Sommer OJ, Kladosek A, Weiler V et al (2005) Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radiographics 25:381–398

    Article  PubMed  Google Scholar 

  30. Freeston JE, Bird P, Conaghan PG (2009) The role of MRI in rheumatoid arthritis: research and clinical issues. Curr Opin Rheumatol 21:95–101

    Article  PubMed  Google Scholar 

  31. Lee SH, Suh J-S, Shin MJ et al (2008) Quantitative assessment of synovial vascularity using contrast-enhanced Power Doppler ultrasonography: correlation with histologic findings and MR imaging findings in arthritic rabbit knee model. Korean J Radiol 9:45–52

    Article  PubMed Central  PubMed  Google Scholar 

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Conflict of interest

Roberto Stramare, Alessandro Coran, Alex Faccinetto, Giulia Costantini, Livio Bernardi, Costantino Botsios, Egle Perissinotto, Enrico Grisan, Valeria Beltrame and Bernd Raffeiner declare no conflict of interest.

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Authors and Affiliations

  1. Section of Radiology, Department of Medicine, University of Padua, Via Giustiniani 2, 35128, Padua, Italy

    Roberto Stramare, Alessandro Coran, Alex Faccinetto, Giulia Costantini & Valeria Beltrame

  2. Rheumatology Unit, Department of Medicine, University of Padua, Padua, Italy

    Livio Bernardi & Costantino Botsios

  3. Department of Environmental Medicine and Public Health, University of Padua, Padua, Italy

    Egle Perissinotto

  4. Department of Information Engineering, University of Padua, Padua, Italy

    Enrico Grisan

  5. Rheumatology Unit, Department of Medicine, General Hospital of Bolzano, Bolzano, Italy

    Bernd Raffeiner

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  1. Roberto Stramare
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  2. Alessandro Coran
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  4. Giulia Costantini
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  7. Egle Perissinotto
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  8. Enrico Grisan
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  9. Valeria Beltrame
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  10. Bernd Raffeiner
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Corresponding author

Correspondence to Alessandro Coran.

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Stramare, R., Coran, A., Faccinetto, A. et al. MR and CEUS monitoring of patients with severe rheumatoid arthritis treated with biological agents: a preliminary study. Radiol med 119, 422–431 (2014). https://doi.org/10.1007/s11547-013-0369-5

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  • DOI: https://doi.org/10.1007/s11547-013-0369-5

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