Falk Roland Miese MD, Presenter: Nothing to Disclose

Anja Lutz, Abstract Co-Author: Nothing to Disclose

Benedikt Ostendorf, Abstract Co-Author: Nothing to Disclose

Christian Rubbert MD, Abstract Co-Author: Fellowship funded, Koninklijke Philips NV

Gerald Antoch MD, Abstract Co-Author: Speaker, Siemens Medical AG Speaker, Bayer AG Speaker, BTG International Ltd

Christoph Schleich, Abstract Co-Author: Nothing to Disclose

To assess cartilage damage measured by delayed gadolinium-enhanced magnetic resonance (MR) imaging of the cartilage (dGEMRIC) of metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis (RA) in dependence on joint inflammation severity.  

43 patients with rheumatoid arthritis (age 52.9±14.5 years, range:18-77 years; disease duration 2.9±4.9 years, range:<0.5–19 years; DAS28 3.7±1.5) who received 3T MRI scans of metacarpophalangeal joints of second and third finger and fulfilled the ACR/EULAR classification criteria were included in this study. Cartilage alterations were assessed by dGEMRIC of MCP2 and 3. The severity of synovitis was scored according to RAMRIS criteria (range:0-3) by two readers in consensus. C-reactive protein (CRP) levels and Disease Activity Score of 28 joints (DAS28) were recorded at the day of MRI. Spearman correlation of DAS(MCP2/3) and RAMRIS were calculated. Each patient’s MCP2 and 3 were dichotomized into the joint with more severe synovitis versus the joint with less severe synovitis for paired Wilcoxon test of dGEMRIC index.

dGEMRIC index of MCP with more severe synovitis was 369 msec±137, dGEMRIC index of MCP with less severe synovitis was 421msec±129. RAMRIS synovitis score of the joint with more severe synovitis was 2.51 (range:1-3), synovitis score of the joint with less severe synovitis was 1.86 (range:0-3). There was a significant difference of dGEMRIC index between the dichotomized MCPs (p=0.0001). The median of difference was 47.12, CI [16.6; 62.76]. There was a moderate correlation between dGEMRIC index and RAMRIS synovitis grading of the joint with more severe synovitis (r=0.5;p<0.05). The spearman rho showed a weak correlation between dGEMRIC index and RAMRIS synovitis of the joint with less sever synovitis (r= 0.33;p <0.05).

These data concur with the concept that inflammation and synovitis are associated with cartilage damage. In dichotomous analysis there is a different inflammation between MCP 2 and 3 in individual patients. The joint with more severe synovitis demonstrates a significantly lower dGEMRIC index representing a higher degree of cartilage destruction.

The degree of cartilage damage correlates with inflammation severity in the particular joint supporting the concept that next to general inflammation in RA there is a local inflammatory cascade partly independent of systemic inflammation.

Miese, F, Lutz, A, Ostendorf, B, Rubbert, C, Antoch, G, Schleich, C, Biochemical Cartilage Damage in Dependence on Inflammatory Severity in Rheumatoid Arthritis.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14009514.html