Osteitis and synovitis, but not bone erosion, is associated with proteoglycan loss and microstructure damage in the cartilage of patients with rheumatoid arthritis

Abstract

Objectives To investigate the relation between anatomic changes of the synovium, the bone, the bone marrow and the cartilage to biochemical properties of the cartilage in patients with rheumatoid arthritis (RA). Methods 33 patients with RA received 3-T MRI scans of the metacarpophalangeal joints. Two independent methods, (A) the delayed gadolinium enhanced MRI of the cartilage (dGEMRIC, T2-mapping), which was used to assess the biochemical properties of the cartilage; (B) synovitis, osteitis and bone erosions were quantified according to the RA MRI scoring (RAMRIS) method and cartilage thickness (CT), interbone joint space (IBJS, distance between proximal and distal bone surface) and intercartilage joint space (ICJS, distance between proximal and distal cartilage surface) were measured. Results Biochemical changes of the cartilage, corresponding to low dGEMRIC and high T2 values, were more likely to be seen in joints with decreased IBJS and ICJS as well as decreased CT. For instance, dGEMRIC was directly correlated to the IBJS ( p=0.001) and ICJS ( p=0.001), whereas T2 mapping was inversely correlated to IBJS and ICJS (both p=0.017). Moreover, the degree of osteitis, and to some extent synovitis, was correlated to biochemical cartilage changes as measured by dGEMRIC ( p=0.003) or the T2 mapping ( p=0.013). By contrast, bone erosions did not correlate to the degree of biochemical cartilage changes. Discussion These data support the concept that synovitis and osteitis may be two main triggers for cartilage damage. Thus, the actual inflammatory state of a joint, but not so much the degree of bone erosion, appears to influence cartilage properties in RA.

Comparison of Quantitative and Semiquantitative Dynamic Contrast-Enhanced MRI With Respect to Their Correlation to Delayed Gadolinium-Enhanced MRI of the Cartilage in Patients With Early Rheumatoid Arthritis

“…11 In the past, cartilage composition has been compared with the RAMRIS scoring. 4 A strong correlation between the degree of osteistis as well as synovitis with low dGEMRIC and high T2 values has been reported. 4 In their study, synovitis severity was assessed on a semiquantitative level.…”

“…4 A strong correlation between the degree of osteistis as well as synovitis with low dGEMRIC and high T2 values has been reported. 4 In their study, synovitis severity was assessed on a semiquantitative level. A validated method for the estimation of synovitis is dynamic contrastenchanced (DCE) MRI with its proven feasibility to describe the disease activity in RA patients.…”

“…[1][2][3] In particular, synovitis has been demonstrated to be associated with cartilage destruction. 4 Recently, early RA was reported to be associated with a loss of glycosaminoglycans (GAGs) in the absence of joint space narrowing. 3 However, changes in cartilage composition were also detectible in the absence of any inflammatory changes.…”

Contrast-enhanced CT facilitates rapid, non-destructive assessment of cartilage and bone properties of the human metacarpal

“…Therefore, we sought to use CECT imaging as method to examine the relationships between common cartilage and bone properties towards the development of the metacarpal as a new model for early-stage OA. Although previous publications showcase dGEMRIC for clinical examination of MCPJ cartilage [22–24], and a novel nanoparticle CT contrast agent reflected GAG distribution in metacarpal cartilage [25], no previous imaging reports directly examine the relationships between cartilage GAG content and mechanical properties with bony changes in the metacarpal. Herein, we propose the human metacarpal as an appropriate ex vivo model for the study of early OA by demonstrating the relationships between cartilage CECT attenuation, GAG content and distribution, compressive modulus, and subchondral bone properties using CECT imaging.…”

Rheumatoid Arthritis of Knee Joints: MRI–Pathological Correlation

“…Herz et al . reported that both synovitis and bone marrow edema were associated with cartilage damage in the metacarpophalangeal joints of patients with RA. Other researchers have suggested that the matrix metalloproteinase and matrix‐degrading enzymes released by the inflammatory cells in the synovium are responsible for cleaving cartilage components, with local chondrocytes subsequently synthesizing and locally releasing cytokines, which accelerates the switch from an anabolic to a catabolic state in the cartilage.…”