Assessment of Cortical Interruptions in the Finger Joints of Patients With Rheumatoid Arthritis Using HR-pQCT, Radiography, and MRI

Abstract

Small cortical interruptions may be the first sign of an erosion, and more interruptions can be found in patients with rheumatoid arthritis (RA) compared with healthy subjects. First, we compared the number and size of interruptions in patients with RA with healthy subjects using high-resolution peripheral quantitative CT (HR-pQCT). Second, we investigated the association between structural damage and inflammatory markers on conventional radiography (CR) and MRI with interruptions on HR-pQCT. Third, the added value of HR-pQCT over CR and MRI was investigated. The finger joints of 39 patients with RA and 38 healthy subjects were examined through CR, MRI, and HR-pQCT. CRs were scored using the Sharp/Van der Heijde method. MRI images were analyzed for the presence of erosions, bone marrow edema, and synovitis. HR-pQCT images were analyzed for the number, surface area, and volume of interruptions using a semiautomated algorithm. Descriptives were calculated and associations were tested using generalized estimating equations. Significantly more interruptions and both a larger surface area and the volume of interruptions were detected in the metacarpophalangeal joints of patients with RA compared with healthy subjects (median, 2.0, 1.42 mm , and 0.48 mm versus 1.0, 0.69 mm , and 0.23 mm , respectively; all p < 0.01). Findings on CR and MRI were significantly associated with more and larger interruptions on HR-pQCT (prevalence ratios [PRs] ranging from 1.03 to 7.74; all p < 0.01) in all subjects, and were consistent in patients with RA alone. Having RA was significantly associated with more and larger interruptions on HR-pQCT (PRs, 2.33 to 5.39; all p < 0.01), also after adjustment for findings on CR or MRI. More and larger cortical interruptions were found in the finger joints of patients with RA versus healthy subjects, also after adjustment for findings on CR or MRI, implying that HR-pQCT imaging may be of value in addition to CR and MRI for the evaluation of structural damage in patients with RA. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc.

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

“…Nutritional channels may appear as pseudoerosion on MR if their orifice is displayed as a little T2-weighted hyperintense spot [51]. Their superficial orifice is often located at a roughness of the calcified zones which as a whole may simulate an erosion [11,34,87]. Some of these iuxtaarticular surface roughnesses may be specified as crests or ridges that correspond to attachment sites for redundant joint capsule [55].…”

“…Although X-ray is most commonly used in the diagnosis of RA it is CT which can be regarded as the best imaging modality for differentiating pseudoerosions from true erosions [53,62,63,[90][91][92][93][94]. Several studies [34,[95][96][97][98] describe a significant decrease of trabecular volume and number and an increased trabecular heterogeneity in patients with rheumatoid arthritis by using HRpqCT. This trabecular bone loss as the intramedullary component of bone erosions may contribute the largest part and may therefore be a reason for misinterpretation of erosions or pseudoerosions in radiographs as this imaging method is relatively insensitive to trabecular bone loss [60,99].…”

“…Why erosions occur at these sites is commonly explained by immunological and anatomical models [29][30][31]. The latter mainly refer to the thinning of cartilage near capsular insertions at bones (bare areas) and to microdamage [32][33][34][35][36]. Following immunologically-based concepts, erosion formation is explained by increased bone resorption and decreased bone formation at certain locations in the subchondral bone [37].…”

The Utility of Multi-Stack Alignment and 3D Longitudinal Image Registration to Assess Bone Remodeling in Rheumatoid Arthritis Patients from Second Generation HR-pQCT Scans

“…These artifacts may increase the difficulty in analyzing bone erosions that span two stacks by causing a misalignment, thereby impacting determination of the erosion volume, and potentially impacting the assessment of the presence of an erosion. Prior studies have addressed this issue by only analyzing erosions contained within a single stack, or by discarding scans with stack shift artifacts (14)(15)(16). In a study that proposes an automated method for quantifying longitudinal changes in erosions using 3D registration, 43% of HR-pQCT scans of the MCP joints had to be excluded due to severe motion artifact (6).…”

The utility of multi-stack alignment and 3D longitudinal image registration to assess bone remodeling in rheumatoid arthritis patients from second generation HR-pQCT scans

“…These artifacts may increase the difficulty in analyzing bone erosions that span two stacks by causing a misalignment, thereby impacting determination of the erosion volume, and potentially impacting the assessment of the presence of an erosion. Prior studies have addressed this issue by only analyzing erosions contained within a single stack, or by discarding scans with stack shift artifacts [14][15][16]. In a study that proposes an automated method for quantifying longitudinal changes in erosions using 3D registration, 43% of HR-pQCT scans of the MCP joints had to be excluded due to severe motion artifact [6].…”