Structural and inflammatory sonographic findings in erosive and non-erosive osteoarthritis of the interphalangeal finger joints

Objective The objectives were: (1) to determine if ultrasound (US) can detect more erosions in erosive osteoarthritis (EOA) of the interphalangeal (IP) joints than conventional radiography (CR); and (2) to explore the frequency of structural and inflammatory findings in EOA and non-EOA. Methods Structural changes and the anatomical phase were scored on CR in IP joints of 31 patients with EOA and 7 patients with non-EOA. Structural and inflammatory changes were scored by US. The frequency of sonographic findings was compared between the anatomical phases and between EOA and non-EOA by generalised estimation equation (GEE) modelling. Results US detected 68 of 72 (94.4%) erosions seen on CR. US detected 45 additional erosive joints in EOA. The frequency of joint effusion and power Doppler signal was similar in EOA compared to non-EOA (p=0.91 and p=0.68, respectively). Statistically significantly more synovitis was present in full erosive phase compared to non-erosive phases in EOA (p=0.04). No differences in inflammatory findings were found between non-erosive phases in EOA and non-EOA. Conclusion US is capable of detecting erosions in radiographic non-erosive phases. The highest frequency of synovitis is present in erosive joints but inflammatory findings are common in all anatomical phases of EOA and non-EOA

Morbid anatomy of 'erosive osteoarthritis' of the interphalangeal finger joints : an optimised scoring system to monitor disease progression in affected joints

Objectives To develop and validate a quantitative radiographic scoring system, the Ghent University Scoring System (GUSS), with better ability to detect progression over a shorter period of time in erosive osteoarthritis (OA) of the interphalangeal (IP) finger joints compared with the existing anatomic phase scoring system. Methods Thirty IP finger joints showing erosive features at baseline or follow-up were selected from 18 patients with erosive hand OA. Posteroanterior radiographs of these joints obtained at baseline, 6 and 12 months-totalling 90 images-were used for the study. All joints were first scored according to the original anatomic phase scoring system. Erosive progression and signs of repair or remodelling were then scored by indicating the proportion of normal subchondral bone, subchondral plate and joint space on an 11-point rating scale (range 0-100 with 10 unit increases). Inter-and intrareader reproducibility was studied using intraclass correlation coefficients (ICCs). Based on the within-variance of two readers, the smallest detectable change (SDC) was calculated and allowed identification of joints with changes above the SDC as 'progressors'. Results Longitudinal inter-reader ICC scores rated well for all variables and the total score (ICC 0.86-0.93). To identify 'real' change over background noise, a change of at least 40 units on the total score (range 0-300) over 12 months (SDC 0-12: 36.0), and 50 units over 6 months (SDC 0-6: 47.6) had to be present. 60% of the 30 joints were identified as 'progressors' over 6 months compared with 33.3% with the classical anatomical scoring system, and 70% versus 56.6%, respectively, over 12 months. Conclusion GUSS, is a reliable method to score radiographic change over time in erosive IP OA and detects more progression over a shorter period of time than the classical scoring system

Systemic levels of IL-23 are strongly associated with disease activity in rheumatoid arthritis but not spondyloarthritis

Objectives Th17 cells are an effector T-cell population that plays a role in chronic inflammatory conditions and is dependent on IL-23 for their survival and expansion. More recently, a genetic association was discovered between polymorphisms in the gene coding for the IL-23 receptor and spondyloarthritis. This study aimed to evaluate the role of Th17-associated cytokines in spondyloarthritis pathogenesis by measuring their levels in the joints and circulation as well as correlating them with disease activity parameters. Methods Paired synovial fluid (SF), serum and synovial biopsies were obtained from 30 non-PsA (psoriatic arthritis) spondyloarthritis, 22 PsA and 22 rheumatoid arthritis (RA) patients. IL-17, IL-23 and CCL20 were measured by ELISA in the SF and serum of patients and correlated with systemic and local parameters of disease activity. Results Concentrations of CCL20, a major Th17-attracting chemokine, tended to be higher in the joints of RA than in spondyloarthritis patients. Interestingly, levels of CCL20 were markedly higher in SF as opposed to serum. In addition, there was a remarkable association between the expression of the Th17 cytokine system and the presence of intimal lining layer hyperplasia in RA. Also in the serum, there was a tendency for higher IL-23 levels in RA, which correlated strongly with disease activity parameters. Conclusions Th17-related cytokines are expressed in joints of spondyloarthritis as well as RA patients. IL-23 levels, however, correlate with disease activity parameters in RA only. These results point towards a differential regulation of the Th17 cytokine system in spondyloarthritis compared with RA

Transplantation of viable meniscal allograft : survivorship analysis and clinical outcome of one hundred cases

Background: Few medium-term or long-term reports on meniscal allograft transplantations are available. In this study, we present the results of a survival analysis of the clinical outcomes of our first 100 procedures involving transplantation of viable medial and lateral meniscal allografts performed in ninety-six patients. Methods: Thirty-nine medial and sixty-one lateral meniscal allografts were evaluated after a mean of 7.2 years. Survival analysis was based on specific clinical end points, with failure of the allograft defined as moderate occasional or persistent pain or as poor function. An additional survival analysis was performed to assess the results of the sixty-nine procedures that involved isolated use of a viable allograft (twenty of the thirty-nine medial allograft procedures and forty-nine of the sixty-one lateral allograft procedures) and of the thirteen viable medial meniscal allografts that were implanted in combination with a high tibial osteotomy in patients with initial varus malalignment of the lower limb. Results: Overall, eleven (28%) of the thirty-nine medial allografts and ten (16%) of the sixty-one lateral allografts failed. The mean cumulative survival time (11.6 years) was identical for the medial and lateral allografts. The cumulative survival rates for the medial and lateral allografts at ten years were 74.2% and 69.8%, respectively. The mean cumulative survival time and the cumulative survival rate for the medial allografts used in combination with a high tibial osteotomy were 13.0 years and 83.3% at ten years, respectively. Conclusions: Transplantation of a viable meniscal allograft can significantly relieve pain and improve function of the knee joint. Survival analysis showed that this beneficial effect remained in approximately 70% of the patients at ten years. This study identified the need for a prospective study comparing patients with similar symptoms and clinical findings treated with and without a meniscal allograft and followed for a longer period with use of clinical evaluation as well as more objective documentation tools regarding the actual fate of the allograft itself and the articular cartilage

99mTc-labelled S-HYNIC certolizumab pegol in rheumatoid arthritis and spondyloarthritis patients : a biodistribution and dosimetry study

Background: Biologicals directed against tumour necrosis factor (TNF) have proven their efficacy in the treatment of spondyloarthritis and rheumatoid arthritis. We present a radiolabelling method for certolizumab pegol (CZP), a commercially available humanized Fab'-fragment directed against TNF. A biodistribution and dosimetry study was conducted. Tc-S-HYNIC CZP was synthesized. The in vitro TNF neutralizing activity was tested by exposing L929s-cells to various concentrations 99mTc-S-HYNIC CZP and measuring TNF-induced cytotoxicity. For biodistribution and dosimetry, WB images and blood and urine sampling were performed up to 24 h pi. Cumulative activities were estimated using mono-exponential fitting, and organ doses were estimated using OLINDA/EXM. The effective dose was calculated using the International Commission on Radiological Protection 103 recommendations. The uptake of the tracer in the peripheral joints was assessed visually and semiquantitatively. Results: In vitro tests showed blocking of TNF cytotoxicity by the Tc-99m-S-HYNIC CZP formulation comparable to the effect obtained with the unlabelled CZP with or without the HYNIC linker. We analysed eight patients with rheumatoid arthritis or spondyloarthritis. The highest mean absorbed organ doses were recorded for kidneys, spleen, and liver: 56 (SD 7), 34 (SD 6), and 33 (SD 7) mu Gy/MBq. The effective dose was 6.1 (SD 0.9) mSv for a mean injected activity of 690 (SD 35) MBq. The urinary excretion was 15.1% (SD 8.1) of the IA at 22.5 h. Blood analysis yielded a distribution half-life of 1.2 h (SD 1.5) and an elimination half-life of 26.9 h (SD 2.7). Visual analysis of the scans revealed marked tracer accumulation in the clinically affected peripheral joints. In addition, there was a statistically significant higher uptake of the tracer in the swollen joints (median uptake ratio compared to background of 3.3 in rheumatoid arthritis and 2.4 in peripheral spondyloarthritis) compared to clinically negative joints (respectively 1.3 and 1.6). Conclusions: We present a radiolabelling technique for CZP, a Fab'-fragment directed against TNF and currently used as a therapeutic agent in rheumatology. An effective dose of 6.1 mSv (SD 0.9) was estimated. We confirmed the uptake of this new radiopharmaceutical in clinically affected peripheral joints

Correlation between FIHOA and AUSCAN and radiographic damage in patients with osteoarthritis of the hands

Objective: To explore the relationship between functionality, assessed by FIHOA and AUSCAN, and radiographic damage. Methods: Seventy persons with osteoarthritis (OA) of the hands completed the AUSCAN and FIHOA. All interphalangeal (IP)(n = 1260) and metacarpal joints (MCP)(n = 700) were characterized as being in the normal (N), stationary (S), loss of joint space (J), erosive (E), remodeled (R) or fused (F) anatomical phase, with a corresponding numerical score. A total score was attributed to each patient for both hands (all IP + MCP) and the dominant hand separately. Besides, separate scores were calculated per hand for the distal IP (DIP), proximal IP (PIP), all IP (PIP + DIP), and MCP joints. The thumb base joints (scapho-trapezial (TS) (n = 140) and trapezio-metacarpal (TMC) (n = 140)) are scored based on the OAC radiographic atlas for OA of the hand. Spearman’s rho correlations were calculated between radiographic scores and functional scores. Results: Correlations between radiographic scores and functionality (FIHOA and AUSCAN) were calculated (table 1). A difference in approaching functionality by either AUSCAN or FIHOA is observed. Correlation between radiographic score and functionality assessed by FIHOA is better than by AUSCAN (r = 0.405 and 0.310), for the total radiographic score, and r = 0.454 vs. 0.361 for the dominant radiographic score). Moreover, the correlation between functional impairment and radiographic score of the dominant hand is slightly better than the total score (both hands). Presence of affected IP joints, especially PIP joints, seems to contribute most to functional impairment (i.e. more than affected MCP and CMC joints). The correlation between functionality and radiographic score of the CMC joints is poor. The correlation between pain or stiffness and the radiographic score is low. Conclusion: The FIHOA seems to correlate better with structural damage than the AUSCAN. The contribution to functional impairment is the largest from affected PIP joints

Correlation between FIHOA and AUSCAN and radiographic damage in patients with osteoarthritis of the hands

Objective: To explore the relationship between functionality, assessed by FIHOA and AUSCAN, and radiographic damage. Methods: Seventy persons with osteoarthritis (OA) of the hands completed the AUSCAN and FIHOA. All interphalangeal (IP)(n = 1260) and metacarpal joints (MCP)(n = 700) were characterized as being in the normal (N), stationary (S), loss of joint space (J), erosive (E), remodeled (R) or fused (F) anatomical phase, with a corresponding numerical score. A total score was attributed to each patient for both hands (all IP + MCP) and the dominant hand separately. Besides, separate scores were calculated per hand for the distal IP (DIP), proximal IP (PIP), all IP (PIP + DIP), and MCP joints. The thumb base joints (scapho-trapezial (TS) (n = 140) and trapezio-metacarpal (TMC) (n = 140)) are scored based on the OAC radiographic atlas for OA of the hand. Spearman’s rho correlations were calculated between radiographic scores and functional scores. Results: Correlations between radiographic scores and functionality (FIHOA and AUSCAN) were calculated (table 1). A difference in approaching functionality by either AUSCAN or FIHOA is observed. Correlation between radiographic score and functionality assessed by FIHOA is better than by AUSCAN (r = 0.405 and 0.310), for the total radiographic score, and r = 0.454 vs. 0.361 for the dominant radiographic score). Moreover, the correlation between functional impairment and radiographic score of the dominant hand is slightly better than the total score (both hands). Presence of affected IP joints, especially PIP joints, seems to contribute most to functional impairment (i.e. more than affected MCP and CMC joints). The correlation between functionality and radiographic score of the CMC joints is poor. The correlation between pain or stiffness and the radiographic score is low. Conclusion: The FIHOA seems to correlate better with structural damage than the AUSCAN. The contribution to functional impairment is the largest from affected PIP joints