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Enhanced MRI in early undifferentiated oligoarthritis of the knee joints: Improvements already visible after 2 months of DMARDs treatment

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Abstract

To describe (1) the findings with MRI in a series of patients with early undifferentiated oligoarthritis of the knee joint(s) and (2) the early effect after 2 months of treatment with only methotrexate (MTX) and hydroxychloroquine (HCQ) as disease-modifying antirheumatic drugs (DMARDs), 15 consecutive patients with undifferentiated oligoarthritis of the knee joint(s) were recruited. The mean age was 31.7 years (SD = 8.1 years), and the mean disease duration was 15.3 months (SD = 12.2 months). In all patients, synovial fluid analysis, RF, anti-CCP2 antibodies, ANA, CRP, ESR, and routine laboratory investigations were performed. Enhanced MRI was done at initial evaluation and after 2 months treatment. Four of the 15 patients had positive RF and 6 had positive anti-CCP2. After treatment with DMARDs, a regression was seen regarding effusion and synovitis in all patients; in one of three patients, the bone edema had regressed. Synovial thickening as measured by enhanced MRI decreased significantly (p < 0.01) and correlated significantly with the improved ESR and CRP (p < 0.01). After 2 months treatment with MTX and HCQ, the MRI improved considerably especially regarding synovial thickening.

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References

  1. Hulsemann JL, Zeidler H (1995) Undifferentiated arthritis in an early synovitis out-patient clinic. Clin Exp Rheumatol 13:37–43

    PubMed  CAS  Google Scholar 

  2. Harrison BJ, Symmons DP, Brennan P, Bankhead CR, Barrett EM, Scott DG, Silman AJ (1996) Inflammatory polyarthritis in the community is not a benign disease: predicting functional disability one year after presentation. J Rheumatol 23:1326–1331

    PubMed  CAS  Google Scholar 

  3. Linn-Rasker SP, Allaart DF, Kloppenburg FC, Breedveld FC, Huizinga TWJ (2004) Sustained remission in a cohort of patients with rheumatoid arthritis: an association with absence of IGM rheumatoid factor and absence of anti-CCP antibodies. Advances in Rheumatology 2(4):4–6

    Google Scholar 

  4. van Gaalen FA, Linn-Rasker SP, van Venrooij WJ, de Jong BA, Breedveld FC, Verweij CL, Toes RE, Huizinga TW (2004) Autoantibodies to cyclic citrullinated peptides predict progression to rheumatoid arthritis in patients with undifferentiated arthritis. Arthritis Rheum 50:709–715

    Article  PubMed  CAS  Google Scholar 

  5. Combe B, Landewe R, Lukas C, Bolosiu HD, Breedveld F, Dougados M, Emery P, Ferraccioli G, Hazes JM, Klareskog L, Machold K, Martin-Mola E, Nielsen H, Silman A, Smolen J, Yazici H (2007) 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 66:34–35

    Article  PubMed  CAS  Google Scholar 

  6. Linn-Rasker SP, van der Helm-van Mil AH, Breedveld FC, Huizinga TW (2007) Arthritis of the large joints in particular, the knee at first presentation is predictive for a high level of radiological destruction of the small joints in rheumatoid arthritis. Ann Rheum Dis 66:646–650

    Article  PubMed  CAS  Google Scholar 

  7. Goupille P, Roulot B, Akoka S, Avimadje AM, Garaud P, Naccache L, Le Pape A, Valat JP (2001) Magnetic resonance imaging: a valuable method for the detection of synovial inflammation in rheumatoid arthritis. J Rheumatol 28:35–40

    PubMed  CAS  Google Scholar 

  8. Østergaard M, McQueen F, Bird P, Peterfy C, Haavardsholm E, Ejbjerg B, Lassere M, O’Connor P, Emery P, Edmonds J, Genant H, Conaghan PG (2007) The OMERACT Magnetic Resonance Imaging Inflammatory Arthritis Group—advances and priorities. J Rheumatol 34:852–853

    PubMed  Google Scholar 

  9. El-Gabalawy HS, Goldbach-Mansky R, Smith D 2nd, Arayssi T, Bale S, Gulko P, Yarboro C, Wilder RL, Klippel JH, Schumacher HR Jr (1999) Association of HLA alleles and clinical features in patients with synovitis of recent onset. Arthritis Rheum 42:1696–1705

    Article  PubMed  CAS  Google Scholar 

  10. Wolfe F, Ross K, Hawley DJ, Roberts FK, Cathey MA (1993) The prognosis of rheumatoid arthritis and undifferentiated polyarthritis syndrome in the clinic: a study of 1141 patients. J Rheumatol 20:2005–2009

    PubMed  CAS  Google Scholar 

  11. Inaoui R, Pierre-Marie Preux PB, Trèves R (2004) Outcome of patients with undifferentiated chronic monoarthritis: retrospective study of 46 cases. Jt Bone Spine 71:209–213

    Article  Google Scholar 

  12. Vander Cruyssen B, Hoffman IE, Peene I, Union A, Mielants H, Meheus L, De Keyser F (2007) Prediction models for rheumatoid arthritis during diagnostic investigation: evaluation of combinations of rheumatoid factor, anti-citrullinated protein/peptide antibodies and the human leucocyte antigen-shared epitope. Ann Rheum Dis 66:364–369

    Article  PubMed  CAS  Google Scholar 

  13. Foley-Nolan D, Stack JP, Ryan M, Redmond U, Barry C, Ennis J, Coughlan RJ (1991) Magnetic resonance imaging in the assessment of rheumatoid arthritis: a comparison with plain film radiographs. Br J Rheumatol 30:101–106

    Article  PubMed  CAS  Google Scholar 

  14. Jorgensen C, Cyteval C, Anaya JM, Baron MP, Lamarque JL, Sany J (1993) Sensitivity of magnetic resonance imaging of the wrist in very early rheumatoid arthritis. Clin Exp Rheumatol 11:163–168

    PubMed  CAS  Google Scholar 

  15. Hodgson RJ, O’Connor P, Moots R (2008) MRI of rheumatoid arthritis image quantitation for the assessment of disease activity, progression and response to therapy. Rheumatology 47:13–21

    Article  PubMed  CAS  Google Scholar 

  16. Østergaard M, Ejbjerg B, Stoltenberg M, Gideon P, Volck B, Skov K, Hjorth Jensen C, Lorenzen I (1999) Magnetic resonance imaging-determined synovial membrane volume as a marker of disease activity and a predictor of progressive joint destruction in the wrists of patients with rheumatoid arthritis. Arthritis Rheum 42:918–929

    Article  PubMed  Google Scholar 

  17. Emad Y, Ragab Y, Shaarawy A (2007) The diagnostic dilemma of undifferentiated inflammatory synovitis of the knee joint/joints: a comprehensive approach. APLAR Journal of Rheumatology 10:182–189

    Article  Google Scholar 

  18. Østergaard M, Duer A, Hørslev-Petersen K (2005) Can magnetic resonance imaging differentiate undifferentiated arthritis? Arthritis Res Ther 7:243–245

    Article  PubMed  Google Scholar 

  19. Benton N, Stewart N, Crabbe J, Robinson E, Yeoman S, McQueen FM (2004) MRI of the wrist in early rheumatoid arthritis can be used to predict functional outcome at 6 years. Ann Rheum Dis 63:555–561

    Article  PubMed  CAS  Google Scholar 

  20. McQueen FM, Stewart N, Crabbe J, Robinson E, Yeoman S, Tan PL, McLean L (1998) Magnetic resonance imaging of the wrist in early rheumatoid arthritis reveals a high prevalence of erosions at four months after symptom onset. Ann Rheum Dis 57:350–356

    Article  PubMed  CAS  Google Scholar 

  21. McQueen FM, Benton N, Perry D, Crabbe J, Robinson E, Yeoman S, McLean L, Stewart N (2003) Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis. Arthritis Rheum 48:1814–1827

    Article  PubMed  Google Scholar 

  22. Østergaard M, Hansen M, Stoltenberg M, Jensen KE, Szkudlarek M, Pedersen-Zbinden B, Lorenzen I (2003) New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier. Arthritis Rheum 48:2128–2131

    Article  PubMed  Google Scholar 

  23. Tamai M, Kawakami A, Uetani M, Takao S, Tanaka F, Fujikawa K, Aramaki T, Nakamura H, Iwanaga N, Izumi Y, Arima K, Aratake K, Kamachi M, Huang M, Origuchi T, Ida H, Aoyagi K, Eguchi K (2007) Bone marrow oedema determined by MRI reflects severe disease status in patients with early-stage rheumatoid arthritis. J Rheumatol 34:2154–2157

    PubMed  CAS  Google Scholar 

  24. Mimori T (2005) Clinical significance of anti-CCP antibodies in rheumatoid arthritis. Intern Med 44:1122–1126

    Article  PubMed  CAS  Google Scholar 

  25. Pruijn GJM, Vossenaar ER, Drijfhout JW, van Venrooij WJ, Zendman AJW (2005) Anti-CCP antibody detection facilitates early diagnosis and prognosis of rheumatoid arthritis. Current Rheumatology Reviews 1:1–7

    Article  CAS  Google Scholar 

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Correspondence to Yasser Emad.

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All the authors responsible for this article have no conflicts of interest of any kind.

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Emad, Y., Ragab, Y., Shaarawy, A. et al. Enhanced MRI in early undifferentiated oligoarthritis of the knee joints: Improvements already visible after 2 months of DMARDs treatment. Clin Rheumatol 27, 1177–1182 (2008). https://doi.org/10.1007/s10067-008-0935-8

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