Background High-Resolution peripheral Quantitative Computed Tomography (HR-pQCT) is a promising imaging technique for assessing erosive disease in rheumatoid arthritis (RA). We have shown that the diagnostic accuracy in detecting erosive disease of HR-pQCT of two joints corresponds to conventional radiography (CR) of 44 joints in established RA (1). No data assessing HR-pQCT as a tool for predicting erosive radiographic progression in a large cohort of established RA has been published. Objectives To assess the association between erosive disease identified using either CR or HR-pQCT at baseline and erosive progression using CR during 1-year follow-up in established RA. Methods This observational cohort study included 220 patients with RA (disease duration ≥ 5 yrs) at the Department of Rheumatology, Aarhus University Hospital, between Mar. 2018 and Oct. 2020. All participants had demographic information collected, together with HR-pQCT at baseline and CR made at baseline and 1-year follow-up. Erosive assessment using HR-pQCT was performed at the second and third metacarpophalangeal (MCP) joint (2). The Sharp/van der Heijde score (SHS) method was used to assess erosive status and erosive progression using CR of hands, wrists and feet (3). Results In total, 220 participants with RA (median age 66 yrs, interquartile range (IQR) 57-72; 71% women) were included and 212 completed their follow-up visit in Dec. 2021 (dropout n=8 (4 %)). During follow-up (median 1 yrs, range 0.7-1.4), erosive progression on CR was detected in 24 of 211 (11%) (missing baseline CR, n=1). Characteristics of the study population by erosive progression are shown in Table 1. In unadjusted regression analyses, number of erosions on HR-pQCT at baseline and erosion score (per 10) using CR at baseline were associated with erosive progression (yes/no) on CR at 1-year (Odds ratio (OR) 1.1; 95%CI 1.0-1.1; p<.05 and OR 1.1; 95%CI 1.0-1.2; p<.01 ). After adjusting for age and sex, erosion score remained associated with erosive progression (OR 1.1; 95%CI 1.1-1.2; p<.01 ), but number of erosions did not (OR 1.0; 95%CI 1.0-1.1; p=.07 ). Table 1. Demographics at baseline Progression on CR No progression on CR P value No 24/211 (11) 187/211 (89) Age, yrs 66 (57-73) 66 (57-71) .80 Women 15/24 (63) 134/187 (72) .35 Disease Duration, yrs 20 (8-28) 15 (9-23) .44 DAS28-CRP 1.7 (1.5-2.5) 1.8 (1.5-2.5) .53 Erosive on CR 24/24 (100) 141/187 (75) < .01 Erosive 2 nd /3 rd MCP on CR * 17/23 (74) 62/185 (34) < .001 Erosive on HR-pQCT 22/23 (96) 153/185 (83) .14 Erosion score (per 10 ) 4 (2-7) 1 (0-3) < .0001 Erosion number 10 (5-17) 3 (1-10) < .01 Total erosion volume, mm 3 128 (19-201) 26 (2-111) < .05 Data are no. (%) or median with interquartile range. P-values: Mann-Whitney U or Fisher’s exact test. Missing HR-pQCT, n=3. CR = conventional radiography, DAS28-CRP = disease activity score of 28 joints based on C-reactive protein, HR-pQCT = high-resolution peripheral quantitative computed tomography * Same hand as HR-pQCT scanned Conclusion In established RA, baseline CR of 44 joints is superior to baseline HR-pQCT of two joints in identifying individuals at risk of erosive progression on CR. This underlines the need for a head-to-head comparison between progression identified by HR-pQCT and CR to fully assess the clinical utility of HR-pQCT in predicting erosive progression compared to CR. References [1]Klose-Jensen R, Therkildsen J, Blavnsfeldt AG, et al. Diagnostic accuracy of high-resolution peripheral quantitative computed tomography and X-ray for classifying erosive rheumatoid arthritis. Rheumatology (Oxford, England). 2021 [2]Barnabe C, Feehan L. High-resolution peripheral quantitative computed tomography imaging protocol for metacarpophalangeal joints in inflammatory arthritis: the SPECTRA collaboration. The Journal of rheumatology. 2012;39(7):1494-5 [3]van der Heijde D. How to read radiographs according to the Sharp/van der Heijde method. The Journal of rheumatology. 2000;27(1):261-3 Acknowledgements The Danish Rheumatism Association (R179-A6365-B1668), The Health Research Foundation of Central Denmark Region (R64-A3145-B1504 and R49-A2254-B1504), The Novo Nordic Founda-tion, A.P. Møller Fonden, The Becket fund (20-2-5756), The Aase and Einar Danielsens fund (20-10-0254), The Family Hede Nielsens fund, The Grosserer L.F. Foghts fund and Aarhus University funded this project. The authors would like to thank all study participants and the clinical staff involved in this project. Disclosure of Interests Josephine Therkildsen: None declared, Rasmus Klose-Jensen: None declared, Anne-Birgitte Blavnsfeldt: None declared, Bente Langdahl Speakers bureau: BLL has received honorariums from Amgen, UCB, Eli Lilly, Gedeon-Richter and Astellas., Consultant of: BLL has worked as a consultant for Amgen, UCB, Gedeon-Richter, Eli Lilly and Gedeon., Grant/research support from: BLL has received financial grants from Amgen and the Novo Nordic Foundation., Anna Zejden: None declared, Jesper Thygesen: None declared, Kresten Keller: None declared, Ellen-Margrethe Hauge Speakers bureau: EMH has received honorariums and/or consulting fees from AbbVie, Sanofi, Sobi, and SynACT Pharma., Grant/research support from: EMH has received research grants to Aarhus University Hospital from Danish Regions Medicine Grants, Roche, Novartis, and the Novo Nordic Foundation.
To investigate whether high-resolution peripheral quantitative CT (HR-pQCT) of two metacarpophalangeal (MCP) joints can more accurately classify patients as having erosive RA compared with conventional radiography (CR) of 44 joints in the hands, wrists and feet.In this single-centre cross-sectional study, patients with established RA (disease duration ≥5 years) were investigated by HR-pQCT and CR. The second and third MCP joints of the dominant hand were assessed for erosions by HR-pQCT. CR of the hands, wrists and feet were scored according to the Sharp-van der Heijde (SHS) method.In total, 353 patients were included; 66 (18.7%) patients were classified as having non-erosive RA, and 287 (81.3%) had erosive RA by CR. The sensitivity and specificity (95% CI) of HR-pQCT for classifying patients as having erosive RA when standard CR of hands, wrists and feet was used as the reference was 89% (84, 92%) and 30% (20, 43%), respectively. Using HR-pQCT as the reference, the sensitivity and specificity of CR for classifying patients having erosive RA were 85% (80, 89%) and 38% (25, 52%), respectively. McNemar's χ2 test showed no significant difference between the sensitivities of patients classified as having erosive RA by HR-pQCT or by CR (2.14, P = 0.177).The diagnostic accuracy of HR-pQCT scanning of only two MCP joints and CR of 44 joints suggests the two modalities were comparable for classifying patients with established RA as having erosive disease.ClinicalTrials.gov (NCT03429426).
Abstract Spondyloarthritis (SpA) is a group of diseases characterized by back pain, spinal inflammation, human leukocyte antigen-B27 positivity, and peripheral findings such as dactylitis, enthesitis, and uveitis. It includes ankylosing spondylitis, psoriatic arthritis, reactive arthritis, arthritis associated with inflammatory bowel disease, and undifferentiated SpA. The role of imaging in the diagnosis, management, and follow-up of patients with SpA has become dramatically more important with the introduction of new therapies such as tumor necrosis factor-α inhibitors. Although in many instances differentiating between the SpA entities is straightforward based on the clinical presentation, often such differentiation remains challenging, and categorization of an individual patient into a subset of SpA can be difficult. Imaging, mainly radiography and magnetic resonance imaging, serves as an important diagnostic tool. Diseases in the spondyloarthritis complex share common presentation but at the same time may have distinct radiographic phenotypes. We present these common and distinct imaging manifestations that may potentially help distinguish between the entities in the diagnostic work-up.
Aims This study aimed to quantify the shoulder kinematics during an apprehension-relocation test in patients with anterior shoulder instability (ASI) and glenoid bone loss using the radiostereometric analysis (RSA) method. Kinematics were compared with the patient’s contralateral healthy shoulder. Methods A total of 20 patients with ASI and > 10% glenoid bone loss and a healthy contralateral shoulder were included. RSA imaging of the patient’s shoulders was performed during a repeated apprehension-relocation test. Bone volume models were generated from CT scans, marked with anatomical coordinate systems, and aligned with the digitally reconstructed bone projections on the RSA images. The glenohumeral joint (GHJ) kinematics were evaluated in the anteroposterior and superoinferior direction of: the humeral head centre location relative to the glenoid centre; and the humeral head contact point location on the glenoid. Results During the apprehension test, the centre of the humeral head was 1.0 mm (95% CI 0.0 to 2.0) more inferior on the glenoid for the ASI shoulder compared with the healthy shoulder. Furthermore, the contact point of the ASI shoulder was 1.4 mm (95% CI 0.3 to 2.5) more anterior and 2.0 mm (95% CI 0.8 to 3.1) more inferior on the glenoid compared with the healthy shoulder. The contact point of the ASI shoulder was 1.2 mm (95% CI 0.2 to 2.6) more anterior during the apprehension test compared to the relocation test. Conclusion The humeral head centre was located more inferior, and the GHJ contact point was located both more anterior and inferior during the apprehension test for the ASI shoulders than the healthy shoulders. Furthermore, the contact point displacement between the apprehension and relocation test revealed increased joint laxity for the ASI shoulder than the healthy shoulders. These results contribute to existing knowledge that ASI shoulders with glenoid bone loss may also suffer from inferior shoulder instability. Cite this article: Bone Joint J 2024;106-B(10):1133–1140.
Diagnosing sacroiliitis by magnetic resonance imaging (MRI) in children/adolescents can be difficult due to the growth-related changes. This study analyzed the normal osseous anatomy of the sacroiliac joints (SIJ) in a juvenile population using computed tomography (CT). The anatomy of the SIJ was retrospectively analyzed in 124 trauma patients aged 9 months – <18 years by CT, based on 2 mm slices in axial, semi-axial and semi-coronal planes. The following anatomical features were recorded: intersegmental fusion of the sacral vertebral segments 1–3 (S1-S3), ossified nuclei (antero-superior at S1, lateral to the intervertebral spaces and lateral to S1 and S2) and joint facet defects larger than 3 mm. Fusion of S1/S2 started at the age of 6 years and was complete after the age of 13 years in most girls and after the age of 14 years in most boys. Fusion of S2/S3 started at the age of 9 years, but could remain incomplete up to 18 years in both genders. Ossified nuclei antero-lateral at S1 and/or in the joint space were observed until the age of 18 years and occurred in 77% of individuals ≥13 years with intraarticular localization in 64% of girls and 60% of boys. Joint facet defects >3 mm occurred in 21 children/adolescents (17%) located to both the iliac and sacral joint facets. Normal osseous SIJ structures in children and adolescents vary considerably. Attention to these normal anatomical structures during growth may help to avoid false positive findings by MRI.
The Back Pain Cohort of Southern Denmark (BaPa Cohort) was initiated with the aim of evaluating the clinical relevance of magnetic resonance imaging (MRI) in the diagnosis of early spondyloarthritis (SpA). In order to facilitate the collection of MRI data for this study, an electronic evaluation form was developed including both SpA-related and degenerative axial changes. The objective of the current study was to assess the intra- and inter-observer agreement of the MRI changes assessed. Three radiologists evaluated 48 MRI scans of the whole spine and the sacroiliac joints from a subsample of the BaPa Cohort, consisting of patients with non-specific low back pain and patients with different stages of SpA features. The spine was evaluated for SpA-related and degenerative MRI changes and the SIJ for SpA-related changes. Inter- and intra-observer agreements were calculated with kappa statistics. In the interpretation of the kappa coefficient, the standards for strength of agreement reported by Landis and Koch were followed. A total of 48 patients, 40% men and mean age of 31 years (range 18 – 40 years), were evaluated once by all three readers and re-evaluated by two of the readers after 4-12 weeks. For MRI changes in the spine, substantial to almost perfect observer agreement was found for the location and the size of vertebral signal changes and for disc degeneration and disc contour. For the sacroiliac joints, substantial or almost perfect observer agreement was found for the grading of bone marrow oedema and fatty marrow deposition, the depth of bone marrow oedema and for subchondral sclerosis. Global assessment of the SpA diagnosis had substantial to almost perfect observer agreements. The acceptable agreement for key MRI changes in the spine and sacroiliac joints makes it possible to use these MRI changes in the BaPa Cohort study and other studies investigating MRI changes in patients with non-specific low back pain and suspected SpA.
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