The OMERACT MRI in Enthesitis Initiative: Definitions of Key Pathologies, Suggested MRI Sequences, and a Novel Heel Enthesitis Scoring System

Mathew, Ashish Jacob; Krabbe, Simon; Eshed, Iris; Gandjbakhch, Frédérique; Bird, Paul; Pedersen, Susanne Juhl; Stoenoiu, Maria; Foltz, Violaine; Glinatsi, Daniel; Lambert, Robert G.; Hermann, Kay-Geert A.; Maksymowych, Walter P.; Haugen, Ida K.; Jaremko, Jacob L.; Poggenborg, René Panduro; Paschke, Joel; Laredo, Jean‐Denis; Carron, Philippe; Conaghan, Philip G.; Østergaard, Mikkel

doi:10.3899/jrheum.181093

Cited by 44 publications

(38 citation statements)

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“…Therefore, inflammatory changes of pulleys could also be appropriate for the evaluation of disease-driven joint involvement [24]. In early 2019, Mathew et al introduced a preliminary enthesitis-based MRI scoring system, named "Heel Enthesitis Scoring System" (HEMRIS) that emphasizes the value of entheseal changes for the diagnosis and monitoring of PsA [26].…”

Section: Discussionmentioning

confidence: 99%

“…The Outcome Measures for Rheumatoid Arthritis Clinical Trials (OMERACT) working group has developed a semi-quantitative PsA MRI (sum-)score (PsAMRIS) that is highly sensitive for disease-related joint changes and is widely used for therapy monitoring [22][23][24]. However, until most recently, enthesitis was not included in any MRI score, despite being a hallmark of PsA [25,26]. Indeed, enthesitis is difficult to accurately evaluate in small joints using conventional MRI or with high-resolution MRI surface coils that can only visualize a small area.…”

Section: Introductionmentioning

confidence: 99%

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High-resolution MRI of flexor tendon pulleys using a 16-channel hand coil: disease detection and differentiation of psoriatic and rheumatoid arthritis

et al. 2020

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Background: To evaluate the value of 3 Tesla (T) magnetic resonance imaging (MRI) changes of flexor tendon pulleys for the differentiation of psoriatic (PsA) and rheumatoid arthritis (RA), using a novel 16-channel highresolution hand coil. Methods: Seventeen patients with active PsA, 20 patients with active RA, and 16 healthy controls (HC) underwent high-resolution 3 T MRI using the dedicated 16-channel hand coil. Images were analyzed by three independent readers for the degree of inflammatory changes, thickness of flexor tendon pulleys, and comparison to the outcome measures for RA clinical trials (OMERACT) PsA MRI score (PsAMRIS) and to its sub-scores. For correlation analyses, Spearman rho correlation was calculated. Results: Flexor tendon pulleys were thicker in PsA than in RA patients (mean difference 0.16 mm, p < 0.001) and HC (mean difference 0.2 mm, p < 0.001) and showed a higher degree of associated inflammatory changes (mean difference from RA 4.7, p = 0.048; mean difference from HC 14.65, p < 0.001). Additionally, there was a strong correlation of accessory pulley inflammation and PsAMRIS and its acute-inflammatory sub-scores, flexor tenosynovitis, synovitis, and periarticular inflammation (for the second digit synovitis ρ = 0.72, flexor tenosynovitis ρ = 0.7, overall PsAMRIS ρ = 0.72, p < 0.01). Similar robust correlations were evident in digits 3-5. Weaker correlations were evident in RA (synovitis ρ = 0.49, flexor tenosynovitis ρ = 0.49, periarticular inflammation ρ = 0.4). Conclusion: The assessment of MRI changes of flexor tendon pulleys is potentially beneficial for disease detection in PsA, as well as for its distinction from RA and HC.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High-resolution MRI of flexor tendon pulleys using a 16-channel hand coil: disease detection and differentiation of psoriatic and rheumatoid arthritis

et al. 2020

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“…The recently published OMERACT heel enthesitis scoring system (HEMRIS) is a promising scoring system for trained MRI readers [12]. HEMRIS includes in ammatory ndings and structural MRI ndings for the assessment of heel enthesitis, and the nal score depends on a consensus-based approach of MR images by the investigators.…”

Section: Discussionmentioning

confidence: 99%

Achilles tendon enthesitis evaluated by MRI assessments in patients with axial spondyloarthritis and psoriatic arthritis: a report of the methodology of the ACHILLES trial

Baraliakos

Sewerin

Miguel

et al. 2020

Preprint

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Background: The currently available scoring methods for enthesitis are often measures of pain but not of inflammation at entheseal sites. The Outcome Measures in Rheumatology Clinical Trials (OMERACT) psoriatic arthritis (PsA) magnetic resonance imaging (MRI) scoring system (PsAMRIS) assesses inflammation and damage in PsA and was particularly developed for the hands. The ACHILLES trial used clinical measures for heel enthesitis in combination with MRI scoring based on PsAMRIS.Methods: Patients (age ≥ 18 years) with spondyloarthritis (SpA) and PsA were included in the trial if they presented with clinical and MRI-positive heel enthesitis. MRI of the affected heel was performed at three time points: screening, Week 24 and Week 52. Inflammatory MRI findings (tendinitis, bursitis and bone marrow oedema [BME]) in the area of the Achilles tendon and/or plantar aponeurosis, periarticular inflammation of the ankle joint and heel erosion were assessed qualitatively (absent/present). In addition, BME and bone erosion were quantitatively assessed based on PsAMRIS, where their proportion was compared to the volume of the affected bone. Mean scores of BME and bone erosion quantification were calculated, and the mean composite score (based on PsAMRIS) was calculated based on the individual score of each subject for periarticular inflammation, BME and bone erosion and further extended for bursitis and tendinitis. Modifications to PsAMRIS were introduced by categorising oedema length as ≤/> 0.5 cm and locating bone erosion.Conclusions: In ACHILLES, MRI was used to assess and evaluate heel enthesitis. Due to the lack of a validated scoring system for heel enthesitis at the time of ACHILLES initiation, this trial applied quantitative scoring based on PsAMRIS, with specific adaptations for the heel.Trial registration: National Clinical Trial Registry, NCT02771210. Registered 13 May 2016. https://clinicaltrials.gov/ct2/show/NCT02771210

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“…The findings suggested a need for reliable and validated MRI scoring system for enthesitis. Subsequently, The OMERACT MRI group developed consensus definitions of key pathologies and three heel enthesitis multi-reader scoring exercises were done, separated by discussion, training and calibration [4]. In a final exercise, median pairwise single-measures intra-class correlation coefficients (ICCs; patient-level) for entheseal inflammation status/change scores were 0.83/0.82 for all readers.…”

Section: Referencesmentioning

confidence: 99%

“…For radiologists and selected rheumatologists ICCs were 0.91/0.84 and quadratic-weighted kappas (lesion-level) 0.57-0.91/0.45-0.81. It was concluded that the proposed definitions and heel enthesitis scoring system (OMER-ACT HEMRIS) are reliable among trained readers and promising for clinical trials [4]. This talk will briefly review the evidence behind the use of MRI for diagnosis and monitoring enthesitis, describe the recently developed OMERACT consensus definitions of key pathologies, and provide examples of these pathologies, aiming for the attendees to learn to be able to recognize them.…”

Section: Referencesmentioning

confidence: 99%

Sp0094 diseases on Sale – How I Deal With All My Conditions

Wilhelmer¹

2019

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In her speech Tanita will explain how she experiences life with multiple conditions. There are a lot more than just symptoms of the main condition and emotions to deal with. Although being diagnosed with Adult Onset Stills Disease (AOSD), she suffers from additional morbidities. Like many other young people with RMD”s she has to manage all conditions at once. The list of comorbidities to “choose from” is very long, but there are some that made it to the top three: fatigue, depression and anxiety.The obstacles that come with this situation can be personal, interpersonal, concerning work, school or university. More illnesses lead to more doctors appointments, this results in missing work or private events. Helping others to understand the condition and communicating the needs is a big topic, as well as planning ahead and staying positive. Tanita will adress these issues and give best practice examples.Disclosure of Interests:None declared

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The OMERACT MRI in Enthesitis Initiative: Definitions of Key Pathologies, Suggested MRI Sequences, and a Novel Heel Enthesitis Scoring System

Cited by 44 publications

References 14 publications

High-resolution MRI of flexor tendon pulleys using a 16-channel hand coil: disease detection and differentiation of psoriatic and rheumatoid arthritis

High-resolution MRI of flexor tendon pulleys using a 16-channel hand coil: disease detection and differentiation of psoriatic and rheumatoid arthritis

Achilles tendon enthesitis evaluated by MRI assessments in patients with axial spondyloarthritis and psoriatic arthritis: a report of the methodology of the ACHILLES trial

Sp0094 diseases on Sale – How I Deal With All My Conditions

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