Analysis of distribution and severity of inflammation in patients with osteoarthitis compared to rheumatoid arthritis by ICG-enhanced fluorescence optical imaging and musculoskeletal ultrasound: a pilot study

A-M Glimm, S G Werner, G R Burmester, M Backhaus, S Ohrndorf, A-M Glimm, S G Werner, G R Burmester, M Backhaus, S Ohrndorf

Abstract

Background: In rheumatoid arthritis (RA), hand synovitis appears especially in wrist, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. In hand osteoarthritis (OA), potential inflammatory changes are mainly present in PIP and distal interphalangeal (DIP) joints. Joint inflammation can be visualised by fluorescence optical imaging (FOI) and musculoskeletal ultrasound (US).

Objective: Comparison of the amount and distribution of inflammatory signs in wrist and finger joints of the clinically dominant hand in patients with OA and RA by FOI and gray-scale (GSUS) and power Doppler US (PDUS).

Methods: FOI and GSUS/PDUS were performed in 1.170 joints (wrists, MCP, PIP, DIP) in 90 patients (67 RA, 23 OA). Joint inflammation was graded by a semiquantitative score (0-3) for each imaging method.

Results: GSUS/PDUS showed wrist and MCP joints mostly affected in RA. DIP joints were graded higher in OA. In FOI, RA and OA featured inflammatory changes in the respective joint groups depending on the phase of fluorescence dye flooding.

Conclusions: US and FOI detected inflammation in both RA and OA highlighting the inflammatory component in the course of OA. The different inflammatory patterns and various shapes of fluorescence enhancement in FOI may offer opportunities to distinguish and determine the inflammatory status in both diseases.

Keywords: Osteoarthritis; Rheumatoid Arthritis; Synovitis; Ultrasonography.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Figures

Figure 1
Figure 1
(A and B) Examples for joint regions and grades 1–3 in fluorescence optical imaging. DIP, distal interphalangeal; FOI, fluorescence optical imaging; MCP, metacarpophalangeal; PIP, proximal interphalangeal.
Figure 2
Figure 2
(A–F) Score frequencies for grade 1–3 per joint in total for synovitis and tenosynovitis, dorsal and palmar side in ultrasound and fluorescence optical imaging for rheumatoid arthritis (RA) vs osteoarthritis (OA) cohort. DIP, distal interphalangeal; FOI, fluorescence optical imaging; GSUS, gray-scale US; MCP, metacarpophalangeal; p1, phase 1; p2, phase 2; p3, phase 3; PDUS, power Doppler US; PIP, proximal interphalangeal; PVM, Prima Vista-Mode.
Figure 3
Figure 3
(A and B) Phase 2 in fluorescence optical imaging (FOI) and the corresponding power Doppler US (PDUS) image of metacarpophalangeal (MCP) V left dorsal in patient with rheumatoid arthritis (RA). (A) Phase 2 shows planar signals in proximal interphalangeal (PIP), MCP and wrists in both hands. (B) PDUS activity grade 2 as a sign for active synovitis in left MCP V. (C and D) Phase 2 in FOI and corresponding PDUS of PIP IV right palmar in patient with osteoarthritis (OA). (C) Streaky FOI signals in DIP and PIP joints as degenerative signs as well as planar signal in PIP IV in token of an active inflammatory joint. FOI signals of higher level in right wrist compared to the left side. (D) PDUS of same right PIP joint shows synovitis and PDUS activity as well as osteophyte.

References

    1. Combe B, Landewe R, Lukas C, et al. . EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007;66:34–45. 10.1136/ard.2005.044354
    1. Smolen JS, Landewe R, Breedveld FC, et al. . EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs. Ann Rheum Dis 2010;69:964–75. 10.1136/ard.2009.126532
    1. Werner SG, Langer HE, Ohrndorf S, et al. . Inflammation assessment in patients with arthritis using a novel in vivo fluorescence optical imaging technology. Ann Rheum Dis 2012;71:504–10. 10.1136/annrheumdis-2010-148288
    1. Szkudlarek M, Wakefield RJ, Backhaus M, et al. . The discriminatory capacity of ultrasound in rheumatoid arthritis: active vs inactive, early vs advanced, and more. Rheumatology 2012;51(Suppl 7):vii6–9. 10.1093/rheumatology/kes334
    1. Iagnocco A. Ultrasound in osteoarthritis. Clin Exp Rheumatol 2014;32(1 Suppl 80):S48–52.
    1. Keen HI, Wakefield RJ, Grainger AJ, et al. . An ultrasonographic study of osteoarthritis of the hand: synovitis and its relationship to structural pathology and symptoms. Arthritis Rheum 2008;59:1756–63. 10.1002/art.24312
    1. Kortekaas MC, Kwok WY, Reijnierse M, et al. . Pain in hand osteoarthritis is associated with inflammation: the value of ultrasound. Ann Rheum Dis 2010;69:1367–9. 10.1136/ard.2009.124875
    1. Kellner H. Arthrosonographie: Von der Aussenseitermethode zum standardisierten und integrierten Bestandteil der bildgebenden Diagnostik in der Rheumatologie. Z Rheumatol 2001;60:137–8. 10.1007/s003930170061
    1. Ohrndorf S, Backhaus M. Advances in sonographic scoring of rheumatoid arthritis. Ann Rheum Dis 2013;72(Suppl 2):ii69–75. 10.1136/annrheumdis-2012-202197
    1. Szkudlarek M, Court-Payen M, Jacobsen S, et al. . Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003;48:955–62. 10.1002/art.10877
    1. Backhaus M, Kamradt T, Sandrock D, et al. . Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999;42:1232–45. 10.1002/1529-0131(199906)42:6<1232::AID-ANR21>;2-3
    1. Scheel AK, Hermann KG, Ohrndorf S, et al. . Prospective 7 year follow up imaging study comparing radiography, ultrasonography, and magnetic resonance imaging in rheumatoid arthritis finger joints. Ann Rheum Dis 2006;65:595–600. 10.1136/ard.2005.041814
    1. Wakefield RJ, Gibbon WW, Conaghan PG, et al. . The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 2000;43:2762–70. 10.1002/1529-0131(200012)43:12<2762::AID-ANR16>;2-#
    1. Haugen IK, Hammer HB. Role of modern imaging techniques in hand osteoarthritis research and clinical practice. Curr Rheumatol Rep 2014;16:399 10.1007/s11926-013-0399-y
    1. Iagnocco A, Naredo E. Osteoarthritis: research update and clinical applications. Rheumatology 2012;51(Suppl 7):vii2–5.
    1. Vlychou M, Koutroumpas A, Malizos K, et al. . Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis. Osteoarthritis Cartilage 2009;17:1283–7. 10.1016/j.joca.2009.04.020
    1. Fischer T, Ebert B, Voigt J, et al. . Detection of Rheumatoid Arthritis Using Non-Specific Contrast Enhanced Fluorescence Imaging. Acad Radiol 2010;17:375–81. 10.1016/j.acra.2009.09.016
    1. Werner SG, Langer HE, Schott P, et al. . Indocyanine green-enhanced fluorescence optical imaging in patients with early and very early arthritis: a comparative study with magnetic resonance imaging. Arthritis Rheum 2013;65:3036–44. 10.1002/art.38175
    1. Meier R, Thurmel K, Moog P, et al. . Detection of synovitis in the hands of patients with rheumatologic disorders: diagnostic performance of optical imaging in comparison with magnetic resonance imaging. Arthritis Rheum 2012;64:2489–98. 10.1002/art.34467
    1. Aletaha D, Neogi T, Silman AJ, et al. . 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010;69:1580–8. 10.1136/ard.2010.138461
    1. Altman R, Alarcon G, Appelrouth D, et al. . The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum 1990;33:1601–10. 10.1002/art.1780331101
    1. Prevoo ML, van't Hof MA, Kuper HH, et al. . Modified disease activity scores that include twenty-eight-joint counts. Development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum 1995;38:44–8. 10.1002/art.1780380107
    1. Backhaus M, Burmester GR, Gerber T, et al. . Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001;60:641–9.
    1. Scheel AK, Hermann KG, Kahler E, et al. . A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis. Arthritis Rheum 2005;52:733–43. 10.1002/art.20939
    1. Kennedy A, Ng CT, Biniecka M, et al. . Angiogenesis and blood vessel stability in inflammatory arthritis. Arthritis Rheum 2010;62:711–21. 10.1002/art.27287
    1. Andersson SE, Johansson A, Lexmuller K, et al. . Physiological characterization of mBSA antigen induced arthritis in the rat. II. Joint blood flow, glucose metabolism, and cell proliferation. J Rheumatol 1998;25:1778–84.
    1. Mordon S, Devoisselle JM, Soulie-Begu S, et al. . Indocyanine green: physicochemical factors affecting its fluorescence in vivo. Microvasc Res 1998;55:146–52. 10.1006/mvre.1998.2068
    1. Mathiessen A, Slatkowsky-Christensen B, Kvien TK, et al. . Ultrasound-detected inflammation predicts radiographic progression in hand osteoarthritis after 5 years. Ann Rheum Dis 2015. Published Online First: 1 Apr 2015. 10.1136/annrheumdis-2015-207241 10.1136/annrheumdis-2015-207241

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe