Significant improvement in MRI-proven bone edema is associated with protection from structural damage in very early RA patients managed using the tight control approach.

Significant improvement in MRI-proven bone edema is associated with protection from structural damage in very early RA patients managed using the tight control approach.

June 2012



Kita J, Tamai M, Arima K, Kawashiri SY, Horai Y, Iwamoto N, Okada A, Koga T, Nakashima Y, Suzuki T, Yamasaki S, Nakamura H, Origuchi T, Ida H, Aoyagi K, Uetani M, Eguchi K, Kawakami A.

Source

Unit of Translational Medicine, Department of Immunology and Rheumatology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.

Abstract

OBJECTIVE:

To identify the value of magnetic resonance imaging (MRI)-proven bone edema in patients with very early rheumatoid arthritis (RA).

METHODS:

All of the 13 patients included in the study were positive at entry for MRI-proven bone edema of the wrist and finger joints and anti-cyclic citrullinated peptide antibodies or IgM-rheumatoid factor. A tight control approach was applied for 12 months. Plain MRI and radiographs of both wrist and finger joints were examined every 6 months. MRI was scored by the RA MRI scoring (RAMRIS) technique and plain radiographs were scored using the Genant-modified Sharp score. Variables that were correlated with plain radiographic changes at 12 months were examined.

RESULTS:

Simplified disease activity index (SDAI) remission was achieved in 7 patients, and a significant reduction in the RAMRIS bone edema score, which declined to .... see article at link below. Program does not allow complete paragraph to be shown here.

CONCLUSIONS:

Improvement in  bone edema may be associated with protection against structural damage in very early RA patients managed using the tight control methods.

Singerlink

Bone Marrow Edema in the Cervical Spine of Symptomatic Rheumatoid Arthritis Patients

Bone Marrow Edema in the Cervical Spine of Symptomatic Rheumatoid Arthritis Patients

Semin Arthritis Rheum. 2008 Mar 11

Narváez JA, Narváez J, Albert MD, De Lama E, Serrallonga M, Nolla JM.
Department of Radiology, Hospital Universitario de Bellvitge-IDIBELL, Barcelona, Spain.

OBJECTIVE: To investigate the frequency and clinical significance of bone marrow edema (BME) in a series of patients with rheumatoid arthritis (RA) and symptomatic involvement of the cervical spine.

METHODS: We studied 19 consecutive RA patients with cervical spine magnetic resonance imaging (MRI) according to a specifically designed protocol that included short inversion time inversion recovery sequences. All cases had neck pain unresponsive to conventional treatment, neurological symptoms, or signs suggestive of cervical myelopathy, or cervical pain with evidence of atlantoaxial subluxation on radiographs.

RESULTS: The mean age of the 19 patients (15 women and 4 men) at time of the study was 59 +/- 12 years (range, 23-82) and the median disease duration was 14 +/- 7.4 years (range, 4-30). BME was observed in 74% (14/19) of the patients: at the atlantoaxial level alone in 16% of the patients; subaxially alone in 16%; and at both levels in 42% of the patients. At the atlantoaxial level, BME was usually observed involving the odontoid process, whereas subaxially BME was limited to the vertebral plates and the interapophyseal joints. Patients with BME had higher erythrocyte sedimentation rate (ESR) values at the time of MRI examination (P = 0.014) and more severe atlantoaxial joint MRI synovitis scores (P = 0.05) compared with the remaining patients; the frequency of odontoid erosions was also greater in this group, but the difference did not reach statistical significance. Altogether, these data suggest a more severe inflammatory response in these patients. In this group a significant correlation was found between BME scores at atlantoaxial level and (1) ESR values (r = 0.854; P = 0.001) and (2) atlantoaxial joint MRI synovitis scores (r = 0.691; P = 0.001).

CONCLUSION: BME is frequently observed in patients with established RA and symptomatic cervical spine involvement. Both atlantoaxial and subaxial levels are equally affected. Presence of BME seems related to the intensity of the inflammatory response and to the severity of the atlantoaxial joint synovitis.

PubMed

High grade MRI bone edema in rheumatoid arthritis patients undergoing joint replacement

High grade MRI bone edema is common within the surgical field in rheumatoid arthritis patients undergoing joint replacement and is associated with osteitis in subchondral bone.

Ann Rheum Dis. 2007 May 9
McQueen FM,
Gao A,
Ostergaard M,
King A,
Shalley G,
Robinson E,
Doyle A,
Clark B,
Dalbeth N.
Auckland University, New Zealand.

OBJECTIVES: /B> MRI bone oedema has been observed in early and advanced RA and may represent a cellular infiltrate (osteitis) in subchondral bone. We studied MRI scans from RA patients undergoing surgery, seeking to identify regions of bone oedema and examine its histopathological equivalent in resected bone.

METHODS: /B> Pre-operative contrast-enhanced MRI scans were obtained in 11 RA patients scheduled for orthopaedic surgery to the hands/wrists or feet. In 9, MRI scans were scored by 2 readers for bone oedema (RAMRIS system). Its distribution with respect to surgical site was investigated. In 4 patients, 7 bone samples were examined for a cellular infiltrate and this was compared with MRI bone oedema, scored for spatial extent and intensity.

RESULTS: /B> Inter-reader ICCs for bone oedema were 0.51 (all sites) and 0.98 (bone samples for histology). Bone oedema was observed at 60% of surgical sites vs 38% of non-surgical sites. High grade bone oedema (score = or >50% maximum) was strongly associated with the surgical field (OR 9.3 [3.5-24.2], P<0.0001). r="0.67," p="0.048)" r="0.86," p="0.01).">

CONCLUSION: High grade MRI bone oedema was common within the field of intended surgery and associated with pain. There was concordance between the presence and severity of MRI bone oedema and osteitis on histology, with an MRI threshold effect due to differences in image resolution.

PMID: 17491098 [PubMed - as supplied by publisher]