Magnetic resonance imaging‐determined synovial membrane and joint effusion volumes in rheumatoid arthritis and osteoarthritis. Comparison with the macroscopic and microscopic appearance of the synovium

Østergaard, Mikkel; Stoltenberg, Michael; Løvgreen‐Nielsen, Preben; Volck, B; Jensen, Claus Hjorth; Lorenzen, I.

doi:10.1002/art.1780401020

Cited by 221 publications

(151 citation statements)

References 32 publications

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“…There is growing evidence that MRI is a valid method and can be used as the imaging gold standard against which other measures are compared (1,14). Close correlation between findings with gadolinium-enhanced MRI and histologic findings has been demonstrated in knees (36)(37)(38) and MCP joints (39). Reliability of semiquantitative MRI scores has proven to be good, depending on the design of the study and reader training (9,40).…”

Section: Us Scoring Of Finger Joint Synovitis In Ramentioning

confidence: 99%

A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis

Scheel¹,

Hermann²,

Kahler³

et al. 2005

Arthritis & Rheumatism

236

187

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Objective. To develop an ultrasonographic (US) synovitis scoring system suitable for evaluation of finger joint inflammation in patients with active rheumatoid arthritis (RA) and to compare semiquantitative US scoring with quantitative US measurements.Methods. US was performed at the palmar and dorsal sides of the second through fifth metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints in 10 healthy subjects and in the clinically more affected hand in 46 RA patients. Ten patients additionally underwent magnetic resonance imaging (MRI). Synovitis was measured, standardized, and scored according to a semiquantitative method. The 2 methods (semiquantitative US scoring, quantitative US) were compared and statistical cutoffs were identified using receiver operating characteristic (ROC) curve analysis. MRI results were compared with semiquantitative US scoring and quantitative US results. The optimal US scoring method from 6 joint combinations was identified (ROC curve analysis).Results. Synovitis was most frequently detected in the palmar proximal area (86% of affected joints). We found no significant differences between individual PIP joints or between individual MCP joints, indicating that all fingers within each of these joint groups should be treated equally for statistical calculations, although each joint group as a whole should be treated separately. The optimal cutoff point to distinguish between "health" and "pathology" was 0.6 mm both for MCP joints (sensitivity 94%, specificity 89%) and for PIP joints (sensitivity 90%, specificity 88%). There was no significant difference between semiquantitative US scores and quantitative US measurements. The best results for joint combinations were achieved using the "sum of 4 fingers" (second through fifth MCP and PIP joints) and "sum of 3 fingers" (second through fourth MCP and PIP joints) methods. Comparison of MRI results with semiquantitative US scores revealed high concordance.Conclusion. US evaluation of finger joint synovitis can be considerably simplified by focusing on the palmar side and by applying semiquantitative grading instead of quantitative measurements. For evaluation of treatment efficacy based on synovitis in RA patients, we recommend using the "sum of 3 fingers" method in longitudinal trials.

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Section: Us Scoring Of Finger Joint Synovitis In Ramentioning

confidence: 99%

A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis

Scheel¹,

Hermann²,

Kahler³

et al. 2005

Arthritis & Rheumatism

236

187

View full text Add to dashboard Cite

show abstract

“…In addition, contrast enhancement with gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA) administered intravenously (IV) allows MRI to effectively measure inflammation (4). The technique of dynamic gadolinium-enhanced MRI (DEMRI) provides a quantitative assessment of inflammation based on analysis of changes in the signal intensity (SI) resulting from Gd-DTPA enhancement that are proportional to the Gd-DTPA concentration (7)(8)(9)(10). DEMRI, combined with computer-assisted quantitative analysis, provides a measure of blood perfusion, capillary permeability, and extracellular volume, all of which reflect the inflammatory process of synovitis (11,12).…”

mentioning

confidence: 99%

Comparative assessment of leflunomide and methotrexate for the treatment of rheumatoid arthritis, by dynamic enhanced magnetic resonance imaging

Reece¹,

Kraan²,

Radjenovic³

et al. 2002

Arthritis & Rheumatism

103

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Objective. Ethical constraints on the conduct of placebo-controlled trials evaluating new therapies for serious chronic diseases, such as rheumatoid arthritis (RA), indicate the need for discerning methods to assess treatment effect in active-controlled clinical trials. Dynamic gadolinium-enhanced magnetic resonance imaging (DEMRI) is a sensitive technique for the detection of synovial inflammation in RA. Therefore, this investigation was undertaken to evaluate DEMRI as an efficacy assessment tool for differentiating treatment effect in a randomized, active-controlled trial comparing leflunomide and methotrexate.Methods. Patients with active RA (n ‫؍‬ 39) were randomized in a 2-center, prospective, double-blind clinical trial to receive either leflunomide (n ‫؍‬ 18) or methotrexate (n ‫؍‬ 21) therapy for 4 months. DEMRI scans were obtained at baseline and at 4 months, and the initial rate of enhancement (IRE) and the maximal signal intensity (SI) enhancement (ME) were calculated from the SI curves. Clinical improvement was assessed by conventional outcome measures.Results. Thirty-four patients (17 treated with leflunomide and 17 with methotrexate) had usable baseline and end point DEMRI scans. Leflunomide treatment was associated with a significantly greater improvement in IRE compared with methotrexate treatment (P < 0.05). Average values of ME indicated reduction of inflammation with both leflunomide and methotrexate. The improvement in clinical signs and symptoms, as measured by traditional assessments, was comparable for both active treatments.Conclusion. Results of this study validate the sensitivity of DEMRI in detecting inflammatory changes in active RA in response to treatment. Improvement in synovial inflammation as measured by IRE was significantly better with leflunomide than with methotrexate over 4 months of therapy.

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“…The US analysis reliably detects both abnormalities and it is thus considered an accurate imaging method for the study of synovitis [19,[27][28][29]. Previous studies demonstrated that magnetic resonance analysis of a single sagittal slice and US measurements of synovial thickness in the suprapatellar bursa are reliable and accurate methods for the quantification of the severity of the inflammatory process in RA and in Sj6gren's syndrome patients [19,30,31].…”

Section: Resultsmentioning

confidence: 99%

Intra-articular methotrexate in the treatment of rheumatoid arthritis and psoriatic arthritis: a clinical and sonographic study

et al. 2006

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The aim of our study was to evaluate the effects of intra-articular methotrexate (MTX) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). Twenty-three consecutive patients, 10 with RA and 13 with PsA, with prevalent or unique arthritic involvement of one knee, were treated with intra-articular injections of MTX 10 mg every 7 days for 8 weeks. Before the beginning of the treatment and after 9 and 17 weeks, the patients underwent a clinical evaluation measuring maximal knee flexion angle, visual analog scale (VAS) and erythrocyte sedimentation rate (ESR). On the same days, an ultrasonographic examination of the involved knee was performed by two independent experienced operators. Synovial thickness in the suprapatellar bursa and the presence of joint effusion and Baker's cyst were assessed. An increase of the mean value of maximal knee flexion angle and a reduction of the mean values of ESR and VAS between TO, T9 and T17 were demonstrated. Ultrasonographic evaluation showed significant reduction of synovial thickness and joint effusion. No differences were detected for the presence of Baker's cyst. We may conclude that repeated intra-articular injections of MTX resulted in a decrease of local as well as systemic inflammatory signs. As far as we know, this is the first study that explores the effects of intra-articular MTX in RA and PsA both clinically and by ultrasonography.

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Magnetic resonance imaging‐determined synovial membrane and joint effusion volumes in rheumatoid arthritis and osteoarthritis. Comparison with the macroscopic and microscopic appearance of the synovium

Cited by 221 publications

References 32 publications

A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis

A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis

Comparative assessment of leflunomide and methotrexate for the treatment of rheumatoid arthritis, by dynamic enhanced magnetic resonance imaging

Intra-articular methotrexate in the treatment of rheumatoid arthritis and psoriatic arthritis: a clinical and sonographic study

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