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Author Spotlight: Enhancing Rheumatoid Arthritis Research Through HR-pQCT Imaging Analysis
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Sequence of joint tissue inflammation during rheumatoid arthritis development
R M Ten Brinck1, H W van Steenbergen2, A H M van der Helm-van Mil2,3
1Department of Rheumatology C1-R, Leiden University Medical Centre, PO Box 9600, Leiden, 2300RC, the Netherlands. r.m.ten_brinck@lumc.nl.
Arthritis Research & Therapy
|November 23, 2018
Summary
Subclinical joint inflammation, including synovitis and tenosynovitis, is present in patients with arthralgia who later develop rheumatoid arthritis (RA). Synovitis and osteitis increase as RA progresses, suggesting an outside-in development pattern.
Area of Science:
- Rheumatology
- Immunology
- Radiology
Background:
- Subclinical joint inflammation in arthralgia predicts rheumatoid arthritis (RA) development.
- The precise temporal sequence of bone marrow edema (osteitis), synovitis, and tenosynovitis during RA progression remains unclear.
Purpose of the Study:
- To longitudinally assess the evolution of magnetic resonance imaging (MRI)-detected subclinical joint inflammation in patients progressing from clinically suspect arthralgia (CSA) to RA.
Main Methods:
- 31-T MRI scans of metacarpophalangeal, wrist, and metatarsophalangeal joints were obtained from patients at CSA presentation and upon RA diagnosis.
- MRIs were evaluated for osteitis, synovitis, tenosynovitis, and erosions by blinded readers.
- CSA MRI scores were compared to age-matched symptom-free controls.
Main Results:
- At CSA onset, synovitis and tenosynovitis scores were elevated compared to controls. Osteitis scores were higher in anti-citrullinated protein antibody (ACPA)-positive patients.
- During progression to RA, synovitis and osteitis significantly increased over time.
- Tenosynovitis and erosion scores did not significantly change during RA progression.
Conclusions:
- Elevated tenosynovitis and synovitis at CSA onset, with subsequent increases in synovitis and osteitis, suggest an 'outside-in' arthritis development, particularly in ACPA-negative RA.
- Further research is required for ACPA-positive RA to elucidate the inflammatory cascade.
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