Is synovial hypertrophy without Doppler activity sensitive to change? Post-hoc analysis from a rheumatoid arthritis ultrasound study

Abstract Background To explore to what extent synovial hypertrophy in joints without Doppler activity is a sign of active disease, we investigated the sensitivity to change of synovial hypertrophy without Doppler activity during biological disease-modifying antirheumatic drug (bDMARD) treatment in rheumatoid arthritis (RA) patients. Method RA patients initiating or switching bDMARD treatment had ultrasound (US) performed on 36 joints at baseline, and at 3 and 6 months. Synovial hypertrophy by grayscale US and Doppler activity were graded separately from 0 to 3 at the joint level for all time points. Changes in synovial hypertrophy in joints without Doppler activity during treatment were assessed and compared with changes in synovial hypertrophy in joints with Doppler activity. Results We included 151 patients (82.8% women, 80.1% seropositive for anticyclic citrullinated peptide) with a mean ± standard deviation age of 51.4 ± 13.2 years, a disease duration of 9.9 ± 7.9 years, and baseline Disease Activity Score 28-joint count C-reactive peptide (DAS28-CRP) of 4.14 ± 1.32. At baseline, 44.8% of all joints examined (n = 5225) had synovial hypertrophy ≥ 1 and 50.7% of these had synovial hypertrophy without Doppler activity. The improvement in synovial hypertrophy was similar in joints with and without Doppler activity but, when adjusting for the baseline score of synovial hypertrophy, joints with synovial hypertrophy without Doppler had a higher tendency towards a decrease than joints with synovial hypertrophy with Doppler activity independent of grade (3 months: p < 0.0001; 6 months: p = 0.0003). Conclusion Joints with synovial hypertrophy without Doppler activity improve during treatment, independent of the grade. Thus, SH without Doppler activity is not a sign of inactive disease. These findings indicate that joints with synovial hypertrophy without Doppler activity should also be taken in to account when assessing disease activity by US

Low incidence of malignancy in patients with suspected polymyalgia rheumatica or giant cell arteritis, examined with FDG-PET/CT

IntroductionThe need to systematically examine patients suspected of polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) for malignancy is controversial. The aim of this study was to assess the frequency of malignancy in patients with suspected PMR and/or GCA who have been referred to a 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography with computed tomography (FDG-PET/CT) as part of the diagnostic investigation.MethodThe records of all patients referred to FDG-PET/CT from Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup with the suspicion of PMR and/or GCA during a two-year period, were retrospectively reviewed. Data was analyzed with descriptive statistics, and a standard incidence ratio was calculated based on background cancer incidences extracted from the NORDCAN database.Results220 patients were included in the study. Findings suspicious of malignancy were found in 19 of the examinations, and in seven cases (3.2%), malignancy was confirmed. In three out of the seven cases the patients were diagnosed with PMR concomitantly with malignancy. The estimated standardized incidence ratio (SIR) for cancer compared to the background incidence of cancer in Denmark was 1.58 (95% CI 0.63–2.97), i.e., not statistically significant. There were no statistically significant differences in characteristics of the patients that were diagnosed with malignancy compared with those that were not.ConclusionThe frequency of malignancy in this cohort of patients with suspected PMR/GCA who underwent PET/CT was low. Our results, though based on a small cohort, do not suggest that all patients with suspected PMR/GCA should systematically be examined with FDG-PET/CT for excluding malignancy

Ultrasound assessment of degenerative muscle sarcopenia: the University of Barcelona ultrasound scoring system for sarcopenia

AimThis study aimed to (1) determine the intraobserver and interobserver reliability of ultrasonographic measurement of muscle thickness (MT) and cross-sectional area (CSA) of the rectus femoris and biceps brachii, correlating these values with manual measurements on dissected cadavers and (2) develop the first semiquantitative musculoskeletal ultrasound (MSUS) scoring system of muscle morphology in sarcopenia and assess its intraobserver and interobserver reliability. In addition, the MSUS morphology score was compared with the corresponding histological images to verify concurrent validity.MethodsTen cryopreserved limbs of 10 cadavers aged 68-91 years were evaluated. The MSUS scoring system was based on the severity of muscle degeneration on a 3-point qualitative scale: grade 1 (normal), grade 2 (moderate changes) and grade 3 (severe changes). Reliability was assessed with intraclass correlation coefficient (ICC) for the MT and CSA and with Cohen's kappa coefficients (& kappa;) for the MSUS scoring system. Concurrent validity was analysed with ICC.ResultsThe results showed excellent intraobserver and interobserver reliability for both the MSUS evaluation of MT and CSA (ICC & GE;0.93). The MSUS scoring system showed excellent intraobserver reliability (& kappa;=1.0) and very good interobserver reliability (& kappa;=0.85). There was also a high intra- and inter-observer reliability for the histological scorings (& kappa; & GE;0.85 and mean & kappa;=0.70, respectively), as well as high reliability between the histology and MSUS scoring systems (ICC=0.92). All results were statistically significant (p & LE;0.001).ConclusionMSUS measures of MT and CSA and the novel MSUS scoring system for degenerative muscle changes in sarcopenia was found to be reliable and strongly associated with histological findings

Artificial intelligence model for segmentation and severity scoring of osteophytes in hand osteoarthritis on ultrasound images

ObjectiveTo develop an artificial intelligence (AI) model able to perform both segmentation of hand joint ultrasound images for osteophytes, bone, and synovium and perform osteophyte severity scoring following the EULAR-OMERACT grading system (EOGS) for hand osteoarthritis (OA).MethodsOne hundred sixty patients with pain or reduced function of the hands were included. Ultrasound images of the metacarpophalangeal (MCP), proximal interphalangeal (PIP), distal interphalangeal (DIP), and first carpometacarpal (CMC1) joints were then manually segmented for bone, synovium and osteophytes and scored from 0 to 3 according to the EOGS for OA. Data was divided into a training, validation, and test set. The AI model was trained on the training data to perform bone, synovium, and osteophyte identification on the images. Based on the manually performed image segmentation, an AI was trained to classify the severity of osteophytes according to EOGS from 0 to 3. Percent Exact Agreement (PEA) and Percent Close Agreement (PCA) were assessed on individual joints and overall. PCA allows a difference of one EOGS grade between doctor assessment and AI.ResultsA total of 4615 ultrasound images were used for AI development and testing. The developed AI model scored on the test set for the MCP joints a PEA of 76% and PCA of 97%; for PIP, a PEA of 70% and PCA of 97%; for DIP, a PEA of 59% and PCA of 94%, and CMC a PEA of 50% and PCA of 82%. Combining all joints, we found a PEA between AI and doctor assessments of 68% and a PCA of 95%.ConclusionThe developed AI model can perform joint ultrasound image segmentation and severity scoring of osteophytes, according to the EOGS. As proof of concept, this first version of the AI model is successful, as the agreement performance is slightly higher than previously found agreements between experts when assessing osteophytes on hand OA ultrasound images. The segmentation of the image makes the AI explainable to the doctor, who can immediately see why the AI applies a given score. Future validation in hand OA cohorts is necessary though

The DANIsh VASculitis cohort study: protocol for a national multicenter prospective study including incident and prevalent patients with giant cell arteritis and polymyalgia rheumatica

The DANIsh VASculitis cohort study, DANIVAS, is an observational national multicenter study with the overall aim to prospectively collect protocolized clinical data and biobank material from patients with polymyalgia rheumatica (PMR) and giant cell arteritis (GCA) diagnosed and/or followed at Danish rheumatology departments. A long-term key objective is to investigate whether the use of new clinically implemented diagnostic imaging modalities facilitates disease stratification in the GCA-PMR disease spectrum. In particular, we aim to evaluate treatment requirements in GCA patients with and without large-vessel involvement, treatment needs in PMR patients with and without subclinical giant cell arteritis, and the prognostic role of imaging with respect to aneurysm development. Hence, in GCA and PMR, imaging stratification is hypothesized to be able to guide management strategies. With an established infrastructure within rheumatology for clinical studies in Denmark, the infrastructure of the Danish Rheumatologic Biobank, and the possibility to cross-link data with valid nationwide registries, the DANIVAS project holds an exceptional possibility to collect comprehensive real-world data on diagnosis, disease severity, disease duration, treatment effect, complications, and adverse events. In this paper, we present the research protocol for the DANIVAS study.Clinical trial registration: https://clinicaltrials.gov/, identifier NCT05935709

OMERACT Definitions for Ultrasonographic Pathology and Elementary Lesions Of Rheumatic Disorders Fifteen Years On

Objective. The Outcome Measures in Rheumatology (OMERACT) ultrasound (US) working group (WG) operates research activities for the validation of US as an outcome measurement instrument according to the Filter 2.0 framework Methods. From the onset of the WG research in 2005 through now, original publications on definitions and scoring systems for pathophysiological manifestations and elementary lesions of various rheumatic disorders were reviewed Results. Definitions and scoring systems according to new terminology are provided Conclusions. We have redefined OMERACT definitions of US pathology and elementary lesions as well as scoring systems which are now proposed for OMERACT approval for application in clinical trial

Current state of musculoskeletal ultrasound training and implementation in Europe: results of a survey of experts and scientific societies

Objective. To document the current state of musculoskeletal US (MSUS) training and extent of implementation among rheumatologists in the member countries of EULAR. Methods. An English-language questionnaire, divided into five sections (demographics, clinical use of MSUS, overall MSUS training for rheumatologists, MSUS education in the rheumatology training curriculum and education in MSUS offered by the national rheumatology society) was sent by e-mail to three different groups: (i) all national rheumatology societies of EULAR; (ii) all national societies of the European Federation of Societies for Ultrasound in Medicine and Biology; and (iii) 19 senior rheumatologists involved in MSUS training from 14 European countries. Results. Thirty-one (70.5%) out of 44 countries responded to the questionnaire (59.1% of national rheumatology societies, 34.5% of the national US societies and 100% of expert ultrasonographers). Rheumatology was listed among medical specialities that mainly perform MSUS in 20 (64.5%) countries; however, in most [19 (63.3%)] countries <10% of rheumatologists routinely perform MSUS in clinical practice. Training varies widely from country to country, with low rates of competency assessment. MSUS education is part of the rheumatology training curriculum in over half the surveyed countries, being compulsory in 7 (22.6%) countries and optional in 11 (35.5%). Conclusions. This study confirms the high uptake of MSUS across Europe. The reported variation in training and practice between countries suggests a need for standardization in areas including training guideline