Are MRI-detected erosions specific for RA? A large explorative cross-sectional study

Boeters, Debbie M.; Nieuwenhuis, W.P.; Steenbergen, H.W. van; Reijnierse, M.; Landewé, Robert; Mil, Annette H M van der Helm-van

doi:10.1136/annrheumdis-2017-212252

Cited by 16 publications

(20 citation statements)

References 38 publications

(31 reference statements)

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“…First, the lack of other imaging tools, such as magnetic resonance imaging (MRI) or computed tomography (CT), to confirm the presence of bone erosions, especially when <2 mm. This may have been useful especially in light of the fact that bone erosions have been found in healthy subjects, both on US and MRI (34)(35)(36). However, particular attention in the assessment of cortical bone breaks of small size was paid by the sonographers to avoid misinterpretation of the US findings (i.e., anatomical necks or vascular bone channels).…”

Section: Discussionmentioning

confidence: 99%

Ultrasound erosions in the feet best predict progression to inflammatory arthritis in anti-CCP positive at-risk individuals without clinical synovitis

et al. 2020

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ObjectivesTo investigate, in anti-cyclic citrullinated peptide antibody positive (CCP+) at-risk individuals without clinical synovitis, the prevalence and distribution of ultrasound (US) bone erosions (BE), their correlation with subclinical synovitis and their association with the development of inflammatory arthritis (IA).MethodsBaseline US scans of 419 CCP+ at-risk individuals were analysed. BE were evaluated in the classical sites for rheumatoid arthritis damage: the second and fifth metacarpophalangeal (MCP2 and MCP5) joints, and the fifth metatarsophalangeal (MTP5) joints. US synovitis was defined as synovial hypertrophy (SH) ≥2 or SH ≥1+power Doppler signal ≥1. Subjects with ≥1 follow-up visit were included in the progression analysis (n=400).ResultsBE were found in ≥1 joint in 41/419 subjects (9.8%), and in 55/2514 joints (2.2%). The prevalence of BE was significantly higher in the MTP5 joints than in the MCP joints (p<0.01). A significant correlation between BE and US synovitis in the MTP5 joints was detected (Cramer’s V=0.37, p<0.01). The OR for the development of IA (ever) was highest for the following: BE in >1 joint 10.6 (95% CI 1.9 to 60.4, p<0.01) and BE and synovitis in ≥1 MTP5 joint 5.1 (95% CI 1.4 to 18.9, p=0.02). In high titre CCP+ at-risk individuals, with positive rheumatoid factor and BE in ≥1 joint, the OR increased to 16.9 (95% CI 2.1–132.8, p<0.01).ConclusionsIn CCP+ at-risk individuals, BE in the feet appear to precede the onset of clinical synovitis. BE in >1 joint, and BE in combination with US synovitis in the MTP5 joints, are the most predictive for the development of clinical arthritis.

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Section: Discussionmentioning

confidence: 99%

Ultrasound erosions in the feet best predict progression to inflammatory arthritis in anti-CCP positive at-risk individuals without clinical synovitis

et al. 2020

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“…Such clinically oriented annotations, examples are the scaphoid waist and the metacarpal neck as typical sites for fractures, have been in use in traumatology and may be of help in the assessment of arthritis-related erosions, too (list of described pseudoerosions in Table 3, an overview of anatomical pseudoerosions in the hand may also be found in Figure 4). Pseudoerosions have to be differentiated from other pathologies as ganglion cysts, crystal-induced arthropathies, tuberculosis or other infections, and from degenerative lesions in the form of erosions, subchondral (pseudo)cysts or beak-shaped osteophytes as there are so many similarities in location [38,60]. Intraosseous ganglion cysts are common and almost always have a continuity with a ligament which underwent mucous degeneration [73,74].…”

Section: Anatomic Pseudoerosionsmentioning

confidence: 99%

“…Intraosseous ganglion cysts are common and almost always have a continuity with a ligament which underwent mucous degeneration [73,74]. Especially in the elderly population, the more prevalent degenerative changes of the bone may be difficult to be differentiated from RA-related erosions [38,75]. However, in children interpretational problems may arise.…”

Section: Anatomic Pseudoerosionsmentioning

confidence: 99%

“…Following immunologically-based concepts, erosion formation is explained by increased bone resorption and decreased bone formation at certain locations in the subchondral bone [37]. Werner et al [32] showed a correlation between cortical micro-channels and the occurrence of bone erosions in bare areas.Especially in early, preclinical or undifferentiated arthritis with small or no erosions, it is necessary to differentiate a true rheumatic erosion from the various forms of normal erosion-simulating concavities of the bony surface and therefor avoid false-positive statements [38,39]. Such so-called pseudoerosions [40] have been described to be smooth and well demarcated on radiographs, ultrasound, computed tomography (CT) and MRI [41].…”

mentioning

confidence: 99%

“…Especially in early, preclinical or undifferentiated arthritis with small or no erosions, it is necessary to differentiate a true rheumatic erosion from the various forms of normal erosion-simulating concavities of the bony surface and therefor avoid false-positive statements [38,39]. Such so-called pseudoerosions [40] have been described to be smooth and well demarcated on radiographs, ultrasound, computed tomography (CT) and MRI [41].…”

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Pseudoerosions of Hands and Feet in Rheumatoid Arthritis: Anatomic Concepts and Redefinition

Hirtler

Rath

Platzgummer

et al. 2019

JCM

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Rheumatoid arthritis is a chronic inflammatory disease characterized by the development of osseous and cartilaginous damage. The correct differentiation between a true erosion and other entities—then often called “pseudoerosions”—is essential to avoid misdiagnosing rheumatoid arthritis and to correctly interpret the progress of the disease. The aims of this systematic review were as follows: to create a definition and delineation of the term “pseudoerosion”, to point out morphological pitfalls in the interpretation of images, and to report on difficulties arising from choosing different imaging modalities. A systematic review on bone erosions in rheumatoid arthritis was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following search terms were applied in PubMed and Scopus: “rheumatoid arthritis”, “bone erosion”, “ultrasonography”, “radiography”, “computed tomography” and “magnetic resonance imaging”. Appropriate exclusion criteria were defined. The systematic review registration number is 138826. The search resulted ultimately in a final number of 25 papers. All indications for morphological pitfalls and difficulties utilizing imaging modalities were recorded and summarized. A pseudoerosion is more than just a negative definition of an erosion; it can be anatomic (e.g., a normal osseous concavity) or artefact-related (i.e., an artificial interruption of the calcified zones). It can be classified according to their configuration, shape, content, and can be described specifically with an anatomical term. “Calcified zone” is a term to describe the deep components of the subchondral, subligamentous and subtendinous bone, and may be applied for all non-cancellous borders of a bone, thus representing a third type of the bone matrix beside the cortical and the trabecular bone.

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Walking Disabilities in Association With Tenosynovitis at the Metatarsophalangeal Joints: A Longitudinal Magnetic Resonance Imaging Study in Early Arthritis

Dakkak

Wouters

Matthijssen

et al. 2022

Arthritis Care & Research

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Objective The relationship between functional disability and magnetic resonance imaging (MRI) inflammation has been studied for the hands, but has not been well established for the feet, even though walking difficulties are common. Therefore, our objective was to study whether walking difficulties were associated with MRI inflammation at metatarsophalangeal (MTP) joints in early arthritis patients, at diagnosis and during 24 months of follow‐up. Methods A total of 532 consecutive patients presenting with early arthritis reported on the presence and severity of walking difficulties (Health Assessment Questionnaire question 4a, scale 0–3), and underwent unilateral contrast‐enhanced MRI of MTP joints 1–5 at baseline. In total, 107 patients had clinical and MRI data at follow‐up (4, 12, and 24 months). MRI inflammation (synovitis, tenosynovitis, and osteitis) was scored in line with the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring system. At baseline, the association of walking disability with MRI inflammation was assessed using regression. Longitudinally, the association between a change in walking disability with a change in MRI inflammation was studied with linear mixed models. Results At baseline, 81% of patients with walking disabilities had MRI inflammation at MTP joints, versus 68% without walking disabilities (P < 0.001). Total MRI inflammation (i.e., the sum of tenosynovitis, synovitis, and osteitis) was associated with severity of walking disability (β = 0.023, P < 0.001). Studying the MRI features separately, tenosynovitis, synovitis, and osteitis were all univariably associated with severity of walking disability (P < 0.001, P < 0.001, and P = 0.014, respectively). In multivariable analysis, the association was strongest for tenosynovitis. During follow‐up, a decrease in MTP inflammation was associated with a decrease in walking disability (β = 0.029, P = 0.001); in multivariable analyses only, tenosynovitis was independently associated (β = 0.073, P = 0.049). Conclusion Of the different inflamed tissues in MTP joints, predominantly MRI‐detected tenosynovitis was associated with walking disabilities. Likewise a reduction in tenosynovitis related to a decrease in walking disabilities. These results increase our understanding of the involvement of tenosynovitis in walking disabilities in early arthritis.

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Are MRI-detected erosions specific for RA? A large explorative cross-sectional study

Abstract: Total erosion scores of individual persons were largely overlapping. Erosion characteristics specific for RA were identified, but were infrequently present. Caution is needed not to overestimate the value of MRI erosions in the diagnostic process.

Cited by 16 publications

References 38 publications

Ultrasound erosions in the feet best predict progression to inflammatory arthritis in anti-CCP positive at-risk individuals without clinical synovitis

Ultrasound erosions in the feet best predict progression to inflammatory arthritis in anti-CCP positive at-risk individuals without clinical synovitis

Pseudoerosions of Hands and Feet in Rheumatoid Arthritis: Anatomic Concepts and Redefinition

Walking Disabilities in Association With Tenosynovitis at the Metatarsophalangeal Joints: A Longitudinal Magnetic Resonance Imaging Study in Early Arthritis

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