Development of three-dimensional prints of arthritic joints for supporting patients’ awareness to structural damage

Abstract

BackgroundRheumatoid arthritis (RA) and psoriatic arthritis (PsA) result in severe joint destruction and functional disability if left untreated. We aim to develop tools that help patients with RA and PsA to understand and experience the impact of inflammatory joint disease on the integrity of their (juxta-articular) bone and increase adherence to medical treatment. In this study, we used high-resolution peripheral quantitative computed tomography (HR-pQCT) to develop 3D prototypes of patients’ finger joints.MethodsHR-pQCT (XtremeCT, Scanco) measurements were performed in healthy individuals and patients with inflammatory joint disease, followed by a 3D print using the objet30 printer. Healthy participants (n = 10), and patients (n = 15 with RA and 15 with PsA) underwent a detailed, standardized interview with demonstration of printed joints.ResultsUtilizing HR-pQCT images of metacarpophalangeal (MCP) heads, high quality and exact 3D prints as prototypes were created. Erosions in different sizes and the trabecular network printed in detail were visualized, demonstrating structural reduction in arthritic vs. healthy bone. After demonstration of 3D prints (healthy vs. erosive joint, visual and haptic) 26/39 (66%) participants (including healthy volunteers) were deeply affected, often quoting “shock”. Of the patients with RA and PsA, 13/15 (86%) and 11/15 (73%), respectively, stated that they would rethink their attitude to medication adherence. More importantly, 21/24 patients with RA or PsA (87.5%) expressed that they would have wished to see such 3D prints during their first disease-specific conversations.ConclusionUsing arthro-haptic 3D printed prototypes of joints may help to better understand the impact of inflammatory arthritides on bone integrity and long-term damage.Electronic supplementary materialThe online version of this article (doi:10.1186/s13075-017-1234-z) contains supplementary material, which is available to authorized users.

Online-Ultraschalllernmodule in der Rheumatologie

“…Neben diesem Lehrkonzept wurden bereits weitere innovative Lehransätze wie 3-D-Visualisierungen rheumatologischer Pathologien durch die Virtual Reality(VR)-Applikation Rheumality [4] oder durch 3-D-Druckmodelle arthritischer Gelenke [3]…”

High-resolution peripheral quantitative computed tomography in patients with rheumatoid arthritis

“…Prevention of these cortical breaks and their progression is one of the major endpoints in clinical trials 5 . Currently, CR of the hands and feet are the gold standard for imaging erosions in both research and clinical practice settings 4,[7][8][9] . CR is widely available, fast to perform, cheap, and easy to use 10 .…”

“…CR is widely available, fast to perform, relatively cheap, and extensively validated, however its sensitivity to detect structural bone changes is low compared to computed tomography (CT), MRI and ultrasound [4][5][6][7] . A novel, sensitive imaging technique is High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) 8 . HR-pQCT allows analysis of the cortical and trabecular microarchitecture of peripheral bones with an isotropic resolution of 82 micrometer (µm).…”

“…HR-pQCT allows analysis of the cortical and trabecular microarchitecture of peripheral bones with an isotropic resolution of 82 micrometer (µm). This technique is now also applied for 3-D assessment of the bone microarchitecture in the hand joints [8][9][10] . A study by Stach et al has demonstrated that HR-pQCT is more sensitive than CR in detecting cortical breaks in the hand joints in RA and also in healthy controls 8 .…”

“…Hence imaging plays an essential role in the evaluation of RA. Currently, conventional radiography (CR) of the hands and feet are the gold standard in the assessment of joint damage in clinical practice and research [5][6][7][8][9] . Although inexpensive and fast to perform, the use of CR has disadvantages.…”