BACKGROUND: The phase of arthralgia is the earliest moment to clinically recognize patients who may develop Rheumatoid Arthritis (RA). Previous imaging studies in the arthralgia phase have shown that inflammation precedes RA development. It is unknown which symptoms/characteristics relate to subclinical joint inflammation as measured by MRI. Among all patients with arthralgia, those with clinically suspect arthralgia (CSA) are suspected to progress to arthritis according to the clinical judgement of their rheumatologists. We determined the symptoms/characteristics of patients with CSA who had inflammation on MRI. METHODS: 102 patients with CSA and without clinical arthritis were included. They completed questionnaires, underwent joint counts and unilateral 1.5 T MRI of MCP joints 2-4, wrist and MTP joints 1-5. Synovitis, bone marrow oedema (BME) and tenosynovitis were scored according to the OMERACT rheumatoid arthritis MRI scoring system. Symptoms and signs were related to MRI inflammation (based on MRI scores in symptom-free controls; a sum of synovitis, BME and tenosynovitis scores ≥3 was considered positive). Whether certain clinical characteristics frequently occurred together with MRI inflammation was studied by partial least squares analysis. RESULTS: MRI was performed in 93 patients with CSA, 44% of whom had subclinical MRI inflammation. Synovitis was the most prevalent inflammatory feature on MRI (20%). Patients with MRI inflammation were older and were more frequently positive for anti-citrullinated peptide antibodies than patients without MRI inflammation (p<0.001 and 0.049). In PLS analysis, including 16 clinical and serological characteristics as independent variables and MRI inflammation as dependent variable, no clear clusters of patients with and without MRI inflammation were identified. CONCLUSIONS: Subclinical inflammation as measured by MRI is present in 44% of patients with CSA. A combination of symptoms/characteristics incompletely differentiated patients with and without MRI inflammation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
BACKGROUND: The phase of arthralgia is the earliest moment to clinically recognize patients who may develop Rheumatoid Arthritis (RA). Previous imaging studies in the arthralgia phase have shown that inflammation precedes RA development. It is unknown which symptoms/characteristics relate to subclinical joint inflammation as measured by MRI. Among all patients with arthralgia, those with clinically suspect arthralgia (CSA) are suspected to progress to arthritis according to the clinical judgement of their rheumatologists. We determined the symptoms/characteristics of patients with CSA who had inflammation on MRI. METHODS: 102 patients with CSA and without clinical arthritis were included. They completed questionnaires, underwent joint counts and unilateral 1.5 T MRI of MCP joints 2-4, wrist and MTP joints 1-5. Synovitis, bone marrow oedema (BME) and tenosynovitis were scored according to the OMERACT rheumatoid arthritis MRI scoring system. Symptoms and signs were related to MRI inflammation (based on MRI scores in symptom-free controls; a sum of synovitis, BME and tenosynovitis scores ≥3 was considered positive). Whether certain clinical characteristics frequently occurred together with MRI inflammation was studied by partial least squares analysis. RESULTS: MRI was performed in 93 patients with CSA, 44% of whom had subclinical MRI inflammation. Synovitis was the most prevalent inflammatory feature on MRI (20%). Patients with MRI inflammation were older and were more frequently positive for anti-citrullinated peptide antibodies than patients without MRI inflammation (p<0.001 and 0.049). In PLS analysis, including 16 clinical and serological characteristics as independent variables and MRI inflammation as dependent variable, no clear clusters of patients with and without MRI inflammation were identified. CONCLUSIONS: Subclinical inflammation as measured by MRI is present in 44% of patients with CSA. A combination of symptoms/characteristics incompletely differentiated patients with and without MRI inflammation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Entities:
Keywords:
Arthritis; Inflammation; Magnetic Resonance Imaging; Rheumatoid Arthritis
Authors: Fenne Wouters; Florus J van der Giesen; Xanthe M E Matthijssen; Ellis Niemantsverdriet; Annette H M van der Helm-van Mil Journal: Ann Rheum Dis Date: 2019-05-02 Impact factor: 19.103
Authors: Elizabeth W Karlson; Dirkjan van Schaardenburg; Annette H van der Helm-van Mil Journal: Rheumatology (Oxford) Date: 2014-08-04 Impact factor: 7.580
Authors: F Wouters; Xme Matthijssen; D M Boeters; R M Ten Brinck; Ahm Van Der Helm-Van Mil; E Niemantsverdriet Journal: Scand J Rheumatol Date: 2020-06-02 Impact factor: 3.641
Authors: Yousra J Dakkak; Xanthe M E Matthijssen; Désirée van der Heijde; Monique Reijnierse; Annette H M van der Helm-van Mil Journal: J Rheumatol Date: 2019-09-15 Impact factor: 4.666
Authors: Hanna W van Steenbergen; José A Pereira da Silva; Tom W J Huizinga; Annette H M van der Helm-van Mil Journal: Nat Rev Rheumatol Date: 2017-11-09 Impact factor: 20.543
Authors: Aleid C Boer; Robin M Ten Brinck; Andrea W M Evers; Annette H M van der Helm-van Mil Journal: Arthritis Res Ther Date: 2018-05-03 Impact factor: 5.156
Authors: Robin M Ten Brinck; Hanna W van Steenbergen; Myrthe A M van Delft; Marije K Verheul; Rene E M Toes; Leendert A Trouw; Annette H M van der Helm-van Mil Journal: Rheumatology (Oxford) Date: 2017-12-01 Impact factor: 7.580
Authors: Fenne Wouters; Marc P Maurits; Laurette van Boheemen; Marloes Verstappen; Kulveer Mankia; Xanthe M E Matthijssen; Annemarie L Dorjée; Paul Emery; Rachel Knevel; Dirkjan van Schaardenburg; René E M Toes; Annette H M van der Helm-van Mil Journal: Ann Rheum Dis Date: 2021-07-20 Impact factor: 19.103