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Osteitis and synovitis, but not bone erosion, is associated with proteoglycan loss and microstructure damage in the cartilage of patients with rheumatoid arthritis
  1. Barbara Herz1,
  2. Andreas Albrecht1,
  3. Matthias Englbrecht1,
  4. Götz H Welsch2,
  5. Michael Uder3,
  6. Nina Renner2,
  7. Philipp Schlechtweg3,
  8. Dominik Paul4,
  9. Lars Lauer4,
  10. Klaus Engelke5,
  11. Rolf Janka3,
  12. Jürgen Rech1,
  13. Georg Schett1,
  14. Stephanie Finzel1
  1. 1Department of Internal Medicine 3, Rheumatology and Immunology, University of Erlangen-Nuremberg, Erlangen, Germany
  2. 2Department of Traumatic Surgery, University of Erlangen-Nuremberg, Erlangen, Germany
  3. 3Institute of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
  4. 4Siemens Healthcare, Erlangen, Germany
  5. 5Institue of Medical Physics, University of Erlangen-Nuremberg, Erlangen, Germany
  1. Correspondence to Dr Stephanie Finzel, Department of Internal Medicine 3, Rheumatology and Immunology; University of Erlangen-Nuremberg; Krankenhausstrasse 12, Erlangen D-91054; Germany; stephanie.finzel{at}


Objectives To investigate the relation between anatomic changes of the synovium, the bone, the bone marrow and the cartilage to biochemical properties of the cartilage in patients with rheumatoid arthritis (RA).

Methods 33 patients with RA received 3-T MRI scans of the metacarpophalangeal joints. Two independent methods, (A) the delayed gadolinium enhanced MRI of the cartilage (dGEMRIC, T2-mapping), which was used to assess the biochemical properties of the cartilage; (B) synovitis, osteitis and bone erosions were quantified according to the RA MRI scoring (RAMRIS) method and cartilage thickness (CT), interbone joint space (IBJS, distance between proximal and distal bone surface) and intercartilage joint space (ICJS, distance between proximal and distal cartilage surface) were measured.

Results Biochemical changes of the cartilage, corresponding to low dGEMRIC and high T2 values, were more likely to be seen in joints with decreased IBJS and ICJS as well as decreased CT. For instance, dGEMRIC was directly correlated to the IBJS (p=0.001) and ICJS (p=0.001), whereas T2 mapping was inversely correlated to IBJS and ICJS (both p=0.017). Moreover, the degree of osteitis, and to some extent synovitis, was correlated to biochemical cartilage changes as measured by dGEMRIC (p=0.003) or the T2 mapping (p=0.013). By contrast, bone erosions did not correlate to the degree of biochemical cartilage changes.

Discussion These data support the concept that synovitis and osteitis may be two main triggers for cartilage damage. Thus, the actual inflammatory state of a joint, but not so much the degree of bone erosion, appears to influence cartilage properties in RA.

  • Rheumatoid Arthritis
  • Magnetic Resonance Imaging
  • Synovitis
  • Inflammation
  • Outcomes research

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