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Paul Emery - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound erosions in the feet best predict progression to inflammatory arthritis in anti ccp positive at risk individuals without clinical Synovitis
    Annals of the Rheumatic Diseases, 2020
    Co-Authors: Andrea Di Matteo, Richard J Wakefield, Kulveer Mankia, L Duquenne, Edoardo Cipolletta, L Garciamontoya, J Nam, Paul Emery
    Abstract:

    Objectives To investigate, in anti-cyclic citrullinated peptide antibody positive (CCP+) at-risk individuals without clinical Synovitis, the prevalence and distribution of ultrasound (US) bone erosions (BE), their correlation with subclinical Synovitis and their association with the development of inflammatory arthritis (IA). Methods Baseline US scans of 419 CCP+ at-risk individuals were analysed. BE were evaluated in the classical sites for rheumatoid arthritis damage: the second and fifth metacarpophalangeal (MCP2 and MCP5) joints, and the fifth metatarsophalangeal (MTP5) joints. US Synovitis was defined as synovial hypertrophy (SH) ≥2 or SH ≥1+power Doppler signal ≥1. Subjects with ≥1 follow-up visit were included in the progression analysis (n=400). Results BE were found in ≥1 joint in 41/419 subjects (9.8%), and in 55/2514 joints (2.2%). The prevalence of BE was significantly higher in the MTP5 joints than in the MCP joints (p 1 joint 10.6 (95% CI 1.9 to 60.4, p Conclusions In CCP+ at-risk individuals, BE in the feet appear to precede the onset of clinical Synovitis. BE in >1 joint, and BE in combination with US Synovitis in the MTP5 joints, are the most predictive for the development of clinical arthritis.

  • sat0151 imaging and histopathological changes to tocilizumab in patients with moderate to severe ra a single centre randomized double blind placebo controlled study
    Annals of the Rheumatic Diseases, 2016
    Co-Authors: Ahmed S Zayat, Paul Emery, C Wong, Richard Cuthbert, Sarah J Bingham, Maya H Buch
    Abstract:

    Background Tocilizumab (TCZ) is a well-established biologic therapy in the treatment of rheumatoid arthritis (RA). There is limited data on imaging and synovial tissue histology changes. Objectives To evaluate level of response as defined by power Doppler (PD) ultrasound (US) and synovial tissue histology changes. Methods Patients with RA, inefficacy to minimum one DMARD +/− TNFi, with DAS28≥3.2 and knee Synovitis amenable to synovial biopsy were recruited to this open-label 48-week study. Patients randomised to TCZ/methotrexate (MTX) for 48 weeks or placebo (PBO)/MTX for the first 16 weeks followed by TCZ/MTX until week 48. Clinical and US hand, wrist and knee assessments with US-guided knee synovial biopsy at baseline (BL), weeks 12 and 48 (biopsy optional). US was scored accrording to OMERACT 0–3 grey scale and PD Synovitis scoring system. Synovial tissue was assessed for synovial inflammatory infiltrate, stromal cell density, synovial lining on 0–3 scale and overall Synovitis (0–9 scale) determined. Results 15 patients recruited: 12 (80%) females; 9 received TCZ/MTX, 6 PBO/MTX. 2 patients withdrew at each arm, one due to TCZ infusion reaction. Week 16: 33% (3/9) TCZ/MTX achieved DAS28ESR-rem vs 0 PBO+MTX, latter remaining in moderate/high disease activity. Week 48: 92% (12/13) whole group in DAS28ESR-rem. US response: 38% (3/8) TCZ/MTX group who had BL PD Synovitis in hand/wrist had absence of PD Synovitis at week 16 vs none PBO/MTX group. All patients with abnormal BL PD in knees (median (IQR) PD score of 2 (0–9)) had improved week 48 PD score (median (IQR) PD score of 0 (0–1)). 13 patients (8 TCZ/MTX, 5 PBO/MTX) had synovial biopsies obtained weeks 0 & 12; 21/26 samples (80%) samples useable. No difference between pre- and week 12 Synovitis score in both groups. Median (IQR) total Synovitis score at BL and after week 12 respectively of 3 (2.75, 4.25) and 3 (2.5–4) in the TCZ/MTX group vs 6 (4,7) and 6 (4,6) in PBO/MTX group. BL total Synovitis score did not predict early or late response. Conclusions TCZ/MTX was associated with significant clinical and imaging improvement compared to MTX alone. An absence of change in synovial infiltrate with TCZ/MTX at 12 weeks suggests a different mechanism for response compared to other anti-cytokine therapies such as the TNFi. Further histochemistry analysis and investigation may potentially determine mechanism and indicators of response on a tissue level. Disclosure of Interest None declared

  • development and validation of modified disease activity scores in rheumatoid arthritis superior correlation with magnetic resonance imaging detected Synovitis and radiographic progression
    Arthritis & Rheumatism, 2014
    Co-Authors: Joshua F Baker, Philip G Conaghan, Paul Emery, Josef S Smolen, Daniel Aletaha, Justine Shults, Daniel Baker, Mikkel Ostergaard
    Abstract:

    Objective To develop and validate composite disease activity scores, based on widely available clinical measures, that would demonstrate improved correlation with detection of Synovitis on magnetic resonance imaging (MRI) and radiographic progression, in comparison with conventional measures, in patients with rheumatoid arthritis (RA). Methods This study was conducted as a secondary study of 2 RA clinical trials, GO-BEFORE (development cohort) and GO-FORWARD (validation cohort). Generalized estimating equations were used to evaluate independent cross-sectional associations of component variables (from all time points) with concurrent MRI measures of Synovitis and bone edema in the development cohort. Based on regression coefficients, modified versions of the Disease Activity Score in 28 joints (M-DAS28), Simplified Disease Activity Index (M-SDAI), and Clinical Disease Activity Index (M-CDAI) were generated for each subject in the validation cohort. The M-DAS28, M-SDAI, and M-CDAI scores were compared to conventional scores of disease activity with regard to associations with MRI measures of Synovitis and radiographic progression, assessed using Pearson's and Spearman's correlations, linear/logistic regression, and receiver operating characteristic analysis. Results Four variables were independently associated with MRI-detected Synovitis and bone edema in the development cohort: C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), swollen joint count in 28 joints (SJC28), and evaluator's global assessment of disease activity using a visual analog scale (EvGA score). Modified disease activity scores were generated using the regression coefficients obtained in the Synovitis models for all subjects in the validation cohort; modified scores were calculated as M-DAS28 = 0.49 × ln(CRP) + 0.15 × SJC28 + 0.22 × EvGA + 1 and M-SDAI = CRP + SJC28 + EvGA. Both modified and conventional disease activity scores correlated significantly with MRI measures of Synovitis. Modified scores showed superior correlation with Synovitis, as compared to conventional scores, at all time points (P < 0.05). Furthermore, the M-DAS28 and M-SDAI had superior test characteristics for prediction of radiographic progression at 52 weeks (both P < 0.05). Conclusion Modified disease activity scores demonstrated superior correlation with MRI detection of Synovitis at all time points, and more accurately predicted radiographic progression in patients with RA in a clinical trial setting. Copyright © 2014 by the American College of Rheumatology.

  • a randomized controlled trial of early intervention with intraarticular corticosteroids followed by sulfasalazine versus conservative treatment in early oligoarthritis
    Arthritis Care and Research, 2007
    Co-Authors: Helena Marzoortega, Michael J Green, Richard J Wakefield, Susanna M Proudman, Annemaree Keenan, Paul Emery
    Abstract:

    Objective To determine the outcome after 52 weeks of early intervention with intraarticular corticosteroid injections followed by sulfasalazine versus conservative therapy in patients with recent-onset oligoarthritis in a randomized controlled trial. Methods Patients with ≤4 joints with clinical Synovitis (disease duration ≤12 months) were randomized to early intervention (EI) with intraarticular methylprednisolone into all synovitic joints or to conservative treatment (CT) with nonsteroidal antiinflammatory drugs alone. Sulfasalazine was administered in both groups for persistent disease or disease that evolved into a polyarthritis. Primary outcome was complete response (CR) defined as the absence of Synovitis at 52 weeks. Secondary outcomes included CR at weeks 4 and 12, function (Health Assessment Questionnaire), pain (0–100-mm visual analog scale), and work status. Results Fifty-nine patients (34 men, 25 women; mean age 32.9 years; median early morning stiffness 30 minutes) were randomized. At baseline, two-thirds reported that they were work impaired. At 52 weeks, 81% of patients in the EI group achieved CR compared with 57% in the CT group (χ2 = 3.833, 1 df, P = 0.05). In addition, 45% of patients in the EI group received sulfasalazine as opposed to 14% in the CT group (χ2 = 5.156, 1 df, P = 0.019). There were no differences in physical disability or work impairment between the treatment groups. Conclusion Oligoarthritis has a significant impact on function and work ability. Patients treated with EI using intraarticular corticosteroids followed by sulfasalazine therapy if resistant demonstrated reduced Synovitis 12 months after treatment compared with those initially treated with more conservative therapy.

  • further evidence that a cartilage pannus junction Synovitis predilection is not a specific feature of rheumatoid arthritis
    Annals of the Rheumatic Diseases, 2005
    Co-Authors: Laura A Rhodes, Paul Emery, P G Conaghan, Andrew J Grainger, Aleksandra Radjenovic, Dennis Mcgonagle
    Abstract:

    Objective: To determine if the distribution of Synovitis is the same in osteoarthritis (OA) using sensitive measures of inflammation derived from dynamic, contrast enhanced magnetic resonance imaging (DEMRI). Methods: 20 subjects with established OA of the knee were recruited. Conventional MR images together with the DEMRI measurements were obtained. Areas of Synovitis at the CPJ region and at a distant site in the SPP were calculated; differences in CPJ and SPP Synovitis were determined using DEMRI parameters: the initial rate of contrast enhancement (IRE) and maximal enhancement (ME). Results: The area of Synovitis was significantly greater adjacent to the CPJ than in the SPP. IRE and ME measures were greater at the CPJ than the SPP. Conclusions: The magnitude of Synovitis at the CPJ is not disease-specific and applies across the spectrum of degenerative disease as well as inflammatory diseases.

Philip G Conaghan - One of the best experts on this subject based on the ideXlab platform.

  • a phase ii trial of lutikizumab an anti interleukin 1α β dual variable domain immunoglobulin in knee osteoarthritis patients with Synovitis
    Arthritis & Rheumatism, 2019
    Co-Authors: Roy Fleischmann, Henning Bliddal, Francisco J Blanco, Thomas J Schnitzer, Charles Peterfy, Su Chen, Li Wang, Sheng Feng, Philip G Conaghan, Francis Berenbaum
    Abstract:

    Objective: To assess the efficacy and safety of the anti–interleukin‐1α/β (anti–IL‐1α/β) dual variable domain immunoglobulin lutikizumab (ABT‐981) in patients with knee osteoarthritis (OA) and evidence of Synovitis. Methods: Patients (n = 350; 347 analyzed) with Kellgren/Lawrence grade 2–3 knee OA and Synovitis (determined by magnetic resonance imaging [MRI] or ultrasound) were randomized to receive placebo or lutikizumab 25, 100, or 200 mg subcutaneously every 2 weeks for 50 weeks. The coprimary end points were change from baseline in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score at week 16 and change from baseline in MRI‐assessed Synovitis at week 26. Results: The WOMAC pain score at week 16 had improved significantly versus placebo with lutikizumab 100 mg (P = 0.050) but not with the 25 mg or 200 mg doses. Beyond week 16, the WOMAC pain score was reduced in all groups but was not significantly different between lutikizumab‐treated and placebo‐treated patients. Changes from baseline in MRI‐assessed Synovitis at week 26 and other key symptom‐ and most structure‐related end points at weeks 26 and 52 were not significantly different between the lutikizumab and placebo groups. Injection site reactions, neutropenia, and discontinuations due to neutropenia were more frequent with lutikizumab versus placebo. Reductions in neutrophil and high‐sensitivity C‐reactive protein levels plateaued with lutikizumab 100 mg, with further reductions not observed with the 200 mg dose. Immunogenic response to lutikizumab did not meaningfully affect systemic lutikizumab concentrations. Conclusion: The limited improvement in the WOMAC pain score and the lack of Synovitis improvement with lutikizumab, together with published results from trials of other IL‐1 inhibitors, suggest that IL‐1 inhibition is not an effective analgesic/antiinflammatory therapy in most patients with knee OA and associated Synovitis.

  • development and validation of modified disease activity scores in rheumatoid arthritis superior correlation with magnetic resonance imaging detected Synovitis and radiographic progression
    Arthritis & Rheumatism, 2014
    Co-Authors: Joshua F Baker, Philip G Conaghan, Paul Emery, Josef S Smolen, Daniel Aletaha, Justine Shults, Daniel Baker, Mikkel Ostergaard
    Abstract:

    Objective To develop and validate composite disease activity scores, based on widely available clinical measures, that would demonstrate improved correlation with detection of Synovitis on magnetic resonance imaging (MRI) and radiographic progression, in comparison with conventional measures, in patients with rheumatoid arthritis (RA). Methods This study was conducted as a secondary study of 2 RA clinical trials, GO-BEFORE (development cohort) and GO-FORWARD (validation cohort). Generalized estimating equations were used to evaluate independent cross-sectional associations of component variables (from all time points) with concurrent MRI measures of Synovitis and bone edema in the development cohort. Based on regression coefficients, modified versions of the Disease Activity Score in 28 joints (M-DAS28), Simplified Disease Activity Index (M-SDAI), and Clinical Disease Activity Index (M-CDAI) were generated for each subject in the validation cohort. The M-DAS28, M-SDAI, and M-CDAI scores were compared to conventional scores of disease activity with regard to associations with MRI measures of Synovitis and radiographic progression, assessed using Pearson's and Spearman's correlations, linear/logistic regression, and receiver operating characteristic analysis. Results Four variables were independently associated with MRI-detected Synovitis and bone edema in the development cohort: C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), swollen joint count in 28 joints (SJC28), and evaluator's global assessment of disease activity using a visual analog scale (EvGA score). Modified disease activity scores were generated using the regression coefficients obtained in the Synovitis models for all subjects in the validation cohort; modified scores were calculated as M-DAS28 = 0.49 × ln(CRP) + 0.15 × SJC28 + 0.22 × EvGA + 1 and M-SDAI = CRP + SJC28 + EvGA. Both modified and conventional disease activity scores correlated significantly with MRI measures of Synovitis. Modified scores showed superior correlation with Synovitis, as compared to conventional scores, at all time points (P < 0.05). Furthermore, the M-DAS28 and M-SDAI had superior test characteristics for prediction of radiographic progression at 52 weeks (both P < 0.05). Conclusion Modified disease activity scores demonstrated superior correlation with MRI detection of Synovitis at all time points, and more accurately predicted radiographic progression in patients with RA in a clinical trial setting. Copyright © 2014 by the American College of Rheumatology.

  • determining a magnetic resonance imaging inflammatory activity acceptable state without subsequent radiographic progression in rheumatoid arthritis results from a followup mri study of 254 patients in clinical remission or low disease activity
    The Journal of Rheumatology, 2014
    Co-Authors: Frederique Gandjbakhch, Philip G Conaghan, B O Ejbjerg, Andrew K Brown, Espen A Haavardsholm, Violaine Foltz, Uffe Moller Dohn, Marissa Lassere, Jane E Freeston, I C Olsen
    Abstract:

    Objective. To assess the predictive value of magnetic resonance imaging (MRI)-detected subclinical inflammation for subsequent radiographic progression in a longitudinal study of patients with rheumatoid arthritis (RA) in clinical remission or low disease activity (LDA), and to determine cutoffs for an MRI inflammatory activity acceptable state in RA in which radiographic progression rarely occurs. Methods. Patients with RA in clinical remission [28-joint Disease Activity Score-C-reactive protein (DAS28-CRP) < 2.6, n = 185] or LDA state (2.6 ≤ DAS28-CRP < 3.2, n = 69) with longitudinal MRI and radiographic data were included from 5 cohorts (4 international centers). MRI were assessed according to the Outcome Measures in Rheumatology (OMERACT) RA MRI scoring system (RAMRIS). Statistical analyses included an underlying conditional logistic regression model stratified per cohort, with radiographic progression as dependent variable. Results. A total of 254 patients were included in the multivariate analyses. At baseline, Synovitis was observed in 95% and osteitis in 49% of patients. Radiographic progression was observed in 60 patients (24%). RAMRIS Synovitis was the only independent predictive factor in multivariate analysis. ROC analysis identified a cutoff value for baseline RAMRIS Synovitis score of 5 (maximum possible score 21). Rheumatoid factor (RF) status yielded a significant interaction with Synovitis (p value = 0.044). RF-positive patients with a RAMRIS Synovitis score of > 5 vs ≤ 5, had an OR of 4.4 (95% CI 1.72–11.4) for radiographic progression. Conclusion. High MRI Synovitis score predicts radiographic progression in patients in clinical remission/LDA. A cutoff point for determining an MRI inflammatory activity acceptable state based on the RAMRIS Synovitis score was established. Incorporating MRI in future remission criteria should be considered.

  • The ability of Synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound
    Annals of the rheumatic diseases, 2012
    Co-Authors: Maxime Dougados, Valérie Devauchelle-pensec, Jean François Ferlet, Sandrine Jousse-joulin, M.a. D'agostino, Marina Backhaus, Jacques Bentin, Gérard Chalès, Isabelle Chary-valckenaere, Philip G Conaghan
    Abstract:

    Objectives To evaluate Synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA). Methods Patients with RA. Study design Prospective, 2-year follow-up. Data collected Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2. Analysis Measures of association (OR) were tested between structural deterioration and the presence of baseline Synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis. Results Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline Synovitis increased the risk of structural progression: OR=2.01 (1.36–2.98) p Conclusions This study confirms the validity of Synovitis for predicting subsequent structural deterioration irrespective of the modality of examination of joints, but also suggests that both clinical and ultrasonographic examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration.

  • a systematic literature review analysis of ultrasound joint count and scoring systems to assess Synovitis in rheumatoid arthritis according to the omeract filter
    The Journal of Rheumatology, 2011
    Co-Authors: Peter Mandl, Philip G Conaghan, Esperanza Naredo, Richard J Wakefield, Maria Antonietta Dagostino, Omeract Ultrasound Task Force
    Abstract:

    Objective. The OMERACT Ultrasound Task Force is currently developing a global Synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and to analyze the metric properties of proposed global (i.e., patient level) ultrasound (US) scoring systems of Synovitis in RA, a systematic analysis of the literature was performed. Methods. A systematic literature search of Pubmed and Embase was performed (January 1, 1984, to March 31, 2010). Original research reports written in English including RA, ultrasound, Doppler, and scoring systems were included. The design, subjects, methods, imaging protocols, and performance characteristics studied were analyzed, as well as the ultrasound definition of Synovitis. Results. Of 3004 reports identified, 14 articles were included in the review. We found a lack of clear definition of Synovitis as well as varying validity data with respect to the proposed scores. Scoring systems included a wide range and number of joints. All analyzed studies assessed construct validity and responsiveness by using clinical examination, laboratory findings, and other imaging modalities as comparators. Both construct validity and responsiveness varied according to the number and size of joints examined and according to the component of Synovitis measured [i.e., gray-scale (GS) or power Doppler (PD) alone or in combination]. With regard to feasibility, time of evaluation varied from 15 to 60 min and increased with the number of joints involved in the examination. Conclusions. Ultrasound can be regarded as a valuable tool for globally examining the extent of Synovitis in RA. However, it is presently difficult to determine a minimal number of joints to be included in a global ultrasound score. Further validation of proposed scores is needed.

Richard J Wakefield - One of the best experts on this subject based on the ideXlab platform.

  • ultrasound erosions in the feet best predict progression to inflammatory arthritis in anti ccp positive at risk individuals without clinical Synovitis
    Annals of the Rheumatic Diseases, 2020
    Co-Authors: Andrea Di Matteo, Richard J Wakefield, Kulveer Mankia, L Duquenne, Edoardo Cipolletta, L Garciamontoya, J Nam, Paul Emery
    Abstract:

    Objectives To investigate, in anti-cyclic citrullinated peptide antibody positive (CCP+) at-risk individuals without clinical Synovitis, the prevalence and distribution of ultrasound (US) bone erosions (BE), their correlation with subclinical Synovitis and their association with the development of inflammatory arthritis (IA). Methods Baseline US scans of 419 CCP+ at-risk individuals were analysed. BE were evaluated in the classical sites for rheumatoid arthritis damage: the second and fifth metacarpophalangeal (MCP2 and MCP5) joints, and the fifth metatarsophalangeal (MTP5) joints. US Synovitis was defined as synovial hypertrophy (SH) ≥2 or SH ≥1+power Doppler signal ≥1. Subjects with ≥1 follow-up visit were included in the progression analysis (n=400). Results BE were found in ≥1 joint in 41/419 subjects (9.8%), and in 55/2514 joints (2.2%). The prevalence of BE was significantly higher in the MTP5 joints than in the MCP joints (p 1 joint 10.6 (95% CI 1.9 to 60.4, p Conclusions In CCP+ at-risk individuals, BE in the feet appear to precede the onset of clinical Synovitis. BE in >1 joint, and BE in combination with US Synovitis in the MTP5 joints, are the most predictive for the development of clinical arthritis.

  • a systematic literature review analysis of ultrasound joint count and scoring systems to assess Synovitis in rheumatoid arthritis according to the omeract filter
    The Journal of Rheumatology, 2011
    Co-Authors: Peter Mandl, Philip G Conaghan, Esperanza Naredo, Richard J Wakefield, Maria Antonietta Dagostino, Omeract Ultrasound Task Force
    Abstract:

    Objective. The OMERACT Ultrasound Task Force is currently developing a global Synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and to analyze the metric properties of proposed global (i.e., patient level) ultrasound (US) scoring systems of Synovitis in RA, a systematic analysis of the literature was performed. Methods. A systematic literature search of Pubmed and Embase was performed (January 1, 1984, to March 31, 2010). Original research reports written in English including RA, ultrasound, Doppler, and scoring systems were included. The design, subjects, methods, imaging protocols, and performance characteristics studied were analyzed, as well as the ultrasound definition of Synovitis. Results. Of 3004 reports identified, 14 articles were included in the review. We found a lack of clear definition of Synovitis as well as varying validity data with respect to the proposed scores. Scoring systems included a wide range and number of joints. All analyzed studies assessed construct validity and responsiveness by using clinical examination, laboratory findings, and other imaging modalities as comparators. Both construct validity and responsiveness varied according to the number and size of joints examined and according to the component of Synovitis measured [i.e., gray-scale (GS) or power Doppler (PD) alone or in combination]. With regard to feasibility, time of evaluation varied from 15 to 60 min and increased with the number of joints involved in the examination. Conclusions. Ultrasound can be regarded as a valuable tool for globally examining the extent of Synovitis in RA. However, it is presently difficult to determine a minimal number of joints to be included in a global ultrasound score. Further validation of proposed scores is needed.

  • the detection of subclinical Synovitis by ultrasound in oligoarticular juvenile idiopathic arthritis a pilot study
    Rheumatology, 2010
    Co-Authors: Kirsty Haslam, Liza J Mccann, Susan Wyatt, Richard J Wakefield
    Abstract:

    Objectives. Adult studies have demonstrated that ultrasonography (US) is more sensitive at detecting Synovitis than clinical examination. The detection of subclinical disease has implications for deciding which patients receive more aggressive therapy from the outset. This study aimed to determine whether children with clinically diagnosed oligoarticular juvenile idiopathic arthritis (JIA) had US-detectable subclinical Synovitis. Methods. This was a cross-sectional pilot study conducted in a tertiary paediatric rheumatology clinic. Seventeen children with a median age of 10 years (range 3–13 years) and with oligoarticular disease of duration <12 months (median 5 months) were recruited. All subjects were DMARD and oral/i.v. corticosteroid nao¨ve. A core set of 40 joints was clinically examined for Synovitis and then scanned by a rheumatologist trained in joint US and blinded to all clinical data, at the same appointment. Results. In total, 680 joints were examined both clinically and by US. Twenty-three joints were found to have clinical Synovitis, and of these only 17 had Synovitis confirmed by US. A further 15 joints were found to have Synovitis on US examination alone. Overall, subclinical Synovitis was detected in 6/17 children, mostly in the hands and feet. One child was reclassified as having polyarticular disease.

  • a randomized controlled trial of early intervention with intraarticular corticosteroids followed by sulfasalazine versus conservative treatment in early oligoarthritis
    Arthritis Care and Research, 2007
    Co-Authors: Helena Marzoortega, Michael J Green, Richard J Wakefield, Susanna M Proudman, Annemaree Keenan, Paul Emery
    Abstract:

    Objective To determine the outcome after 52 weeks of early intervention with intraarticular corticosteroid injections followed by sulfasalazine versus conservative therapy in patients with recent-onset oligoarthritis in a randomized controlled trial. Methods Patients with ≤4 joints with clinical Synovitis (disease duration ≤12 months) were randomized to early intervention (EI) with intraarticular methylprednisolone into all synovitic joints or to conservative treatment (CT) with nonsteroidal antiinflammatory drugs alone. Sulfasalazine was administered in both groups for persistent disease or disease that evolved into a polyarthritis. Primary outcome was complete response (CR) defined as the absence of Synovitis at 52 weeks. Secondary outcomes included CR at weeks 4 and 12, function (Health Assessment Questionnaire), pain (0–100-mm visual analog scale), and work status. Results Fifty-nine patients (34 men, 25 women; mean age 32.9 years; median early morning stiffness 30 minutes) were randomized. At baseline, two-thirds reported that they were work impaired. At 52 weeks, 81% of patients in the EI group achieved CR compared with 57% in the CT group (χ2 = 3.833, 1 df, P = 0.05). In addition, 45% of patients in the EI group received sulfasalazine as opposed to 14% in the CT group (χ2 = 5.156, 1 df, P = 0.019). There were no differences in physical disability or work impairment between the treatment groups. Conclusion Oligoarthritis has a significant impact on function and work ability. Patients treated with EI using intraarticular corticosteroids followed by sulfasalazine therapy if resistant demonstrated reduced Synovitis 12 months after treatment compared with those initially treated with more conservative therapy.

  • should oligoarthritis be reclassified ultrasound reveals a high prevalence of subclinical disease
    Annals of the Rheumatic Diseases, 2004
    Co-Authors: Richard J Wakefield, Michael J Green, Helena Marzoortega, Susanna M Proudman, Dennis Mcgonagle, P G Conaghan, Wayne Gibbon, Paul Emery
    Abstract:

    Objective: To determine the prevalence of subclinical Synovitis using ultrasound (US) imaging of both painful and asymptomatic joints, in patients with early ( Methods: Eighty patients underwent a detailed clinical assessment by two physicians. All painful joints were identified, which were immediately scanned by a sonographer. In the last 40 patients, an additional standard group of joints was scanned to establish the prevalence of Synovitis in asymptomatic joints. Results: In 80 patients, 644 painful joints (with and without clinical Synovitis) were identified and each underwent a US assessment. Of these joints, 185 had clinical Synovitis, of which, US detected Synovitis in only 79% (147/185). In the other 38 joints US demonstrated tenoSynovitis instead of Synovitis in 12 joints and possible, but not definite, Synovitis in 11 joints. Fifteen joints were, however, normal on US. In 459 joints that were not clinically synovitic, US detected Synovitis in 33% (150/459). In 64% (51/80) of patients, US detected Synovitis in more joints than clinical examination and in 36% (29/80) of patients, US detected a polyarthritis (>6 joints). Of the 826 asymptomatic (non-painful) joints scanned, 13% (107/826) had US detected Synovitis. Conclusion: Sonography detected more Synovitis than clinical examination in patients with oligoarthritis. In almost two thirds of patients there was evidence of subclinical disease while one third could be reclassified as polyarticular. These findings suggest that a definition of oligoarthritis based purely on clinical findings may be inappropriate, which may have important implications for disease management.

Dennis Mcgonagle - One of the best experts on this subject based on the ideXlab platform.

  • further evidence that a cartilage pannus junction Synovitis predilection is not a specific feature of rheumatoid arthritis
    Annals of the Rheumatic Diseases, 2005
    Co-Authors: Laura A Rhodes, Paul Emery, P G Conaghan, Andrew J Grainger, Aleksandra Radjenovic, Dennis Mcgonagle
    Abstract:

    Objective: To determine if the distribution of Synovitis is the same in osteoarthritis (OA) using sensitive measures of inflammation derived from dynamic, contrast enhanced magnetic resonance imaging (DEMRI). Methods: 20 subjects with established OA of the knee were recruited. Conventional MR images together with the DEMRI measurements were obtained. Areas of Synovitis at the CPJ region and at a distant site in the SPP were calculated; differences in CPJ and SPP Synovitis were determined using DEMRI parameters: the initial rate of contrast enhancement (IRE) and maximal enhancement (ME). Results: The area of Synovitis was significantly greater adjacent to the CPJ than in the SPP. IRE and ME measures were greater at the CPJ than the SPP. Conclusions: The magnitude of Synovitis at the CPJ is not disease-specific and applies across the spectrum of degenerative disease as well as inflammatory diseases.

  • regional variation and differential response to therapy for knee Synovitis adjacent to the cartilage pannus junction and suprapatellar pouch in inflammatory arthritis implications for pathogenesis and treatment
    Arthritis & Rheumatism, 2004
    Co-Authors: Laura A Rhodes, Paul Emery, Ai Lyn Tan, Steven F Tanner, Aleksandra Radjenovic, Elizabeth M A Hensor, Richard Reece, Philip Oconnor, Dennis Mcgonagle
    Abstract:

    Objective To use magnetic resonance imaging (MRI) to investigate the importance of knee joint Synovitis at the cartilage–pannus junction (CPJ) in rheumatoid arthritis (RA) as compared with Synovitis at a distant site in the suprapatellar pouch (SPP) and as compared with CPJ Synovitis in the spondylarthropathies (SpA), and to assess the relative response of knee joint Synovitis to therapy at the CPJ and SPP sites. Methods Dynamic contrast-enhanced MRI (DEMRI) of actively involved knee joints in 24 patients (13 with RA and 11 with SpA) was undertaken. The area of Synovitis was calculated at the CPJ and SPP regions of interest in patients with RA and in patients with SpA. Differences in CPJ and SPP Synovitis were determined using calculated DEMRI parameters which included the initial rate of contrast enhancement (IRE) and the maximal enhancement (ME). Changes in the synovial area at the CPJ and SPP were also measured in 10 patients with early RA, following treatment with disease-modifying antirheumatic drugs (DMARDs) (either methotrexate or leflunomide). Results In patients with RA or SpA, the area of Synovitis was significantly larger immediately adjacent to the CPJ compared with a distant site at the SPP (in RA, mean Synovitis area 162 mm2 at the CPJ versus 114 mm2 at the SPP [P = 0.010]; in SpA, mean Synovitis area 214 mm2 at the CPJ versus 143 mm2 at the SPP [P = 0.002]), but the differences in the areas of Synovitis at these sites were not significant between the RA and SpA patients. The IRE and ME values were also higher at the CPJ compared with the SPP, both in the RA patients (IRE P = 0.054, ME P = 0.018) and in the SpA patients (IRE P = 0.002, ME P = 0.001). A larger reduction in the area of Synovitis was seen at the SPP compared with the CPJ following DMARD therapy in the RA patients (mean reduction 35% at the SPP [P = 0.023] and 12% at the CPJ [P not significant]). Conclusion The non–disease-specific variations in Synovitis and the differential responses to therapy in RA patients have implications for improving our understanding of CPJ Synovitis. The results suggest that the pathophysiologic events at the CPJ reflect common anatomic, immune system, or biomechanical factors that play a role in modulating the severity of arthritis, and these events are not specific to RA since the same process was observed in other arthritides.

  • should oligoarthritis be reclassified ultrasound reveals a high prevalence of subclinical disease
    Annals of the Rheumatic Diseases, 2004
    Co-Authors: Richard J Wakefield, Michael J Green, Helena Marzoortega, Susanna M Proudman, Dennis Mcgonagle, P G Conaghan, Wayne Gibbon, Paul Emery
    Abstract:

    Objective: To determine the prevalence of subclinical Synovitis using ultrasound (US) imaging of both painful and asymptomatic joints, in patients with early ( Methods: Eighty patients underwent a detailed clinical assessment by two physicians. All painful joints were identified, which were immediately scanned by a sonographer. In the last 40 patients, an additional standard group of joints was scanned to establish the prevalence of Synovitis in asymptomatic joints. Results: In 80 patients, 644 painful joints (with and without clinical Synovitis) were identified and each underwent a US assessment. Of these joints, 185 had clinical Synovitis, of which, US detected Synovitis in only 79% (147/185). In the other 38 joints US demonstrated tenoSynovitis instead of Synovitis in 12 joints and possible, but not definite, Synovitis in 11 joints. Fifteen joints were, however, normal on US. In 459 joints that were not clinically synovitic, US detected Synovitis in 33% (150/459). In 64% (51/80) of patients, US detected Synovitis in more joints than clinical examination and in 36% (29/80) of patients, US detected a polyarthritis (>6 joints). Of the 826 asymptomatic (non-painful) joints scanned, 13% (107/826) had US detected Synovitis. Conclusion: Sonography detected more Synovitis than clinical examination in patients with oligoarthritis. In almost two thirds of patients there was evidence of subclinical disease while one third could be reclassified as polyarticular. These findings suggest that a definition of oligoarthritis based purely on clinical findings may be inappropriate, which may have important implications for disease management.

  • elucidation of the relationship between Synovitis and bone damage a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis
    Arthritis & Rheumatism, 2003
    Co-Authors: Philip G Conaghan, Michael J Green, Richard J Wakefield, Paul Astin, Dennis Mcgonagle, Wayne Gibbon, Philip Oconnor, Mark A Quinn, Zunaid Karim, Susanna M Proudman
    Abstract:

    Objective To simultaneously image bone and synovium in the individual joints characteristically involved in early rheumatoid arthritis (RA). Methods Forty patients with early, untreated RA underwent gadolinium-enhanced magnetic resonance imaging (MRI) of the second through fifth metacarpophalangeal joints of the dominant hand at presentation, 3 months, and 12 months. In the first phase (0–3 months), patients were randomized to receive either methotrexate alone (MTX) or MTX and intraarticular corticosteroids (MTX + IAST) into all joints with clinically active RA. The MTX-alone group received no further corticosteroids until the second phase (3–12 months), when both groups received standard therapy. Results In the first phase, MTX + IAST reduced Synovitis scores more than MTX alone. There were significantly fewer joints with new erosions on MRI in the former group compared with the latter. During the second phase, the Synovitis scores were equivalent and a similar number of joints in each group showed new erosions on MRI. In both phases, there was a close correlation between the degree of Synovitis and the number of new erosions, with the area under the curve for MRI Synovitis the only significant predictor of bone damage progression. In individual joints, there was a threshold effect on new bone damage related to the level of Synovitis; no erosions occurred in joints without Synovitis. Conclusion In early RA, Synovitis appears to be the primary abnormality, and bone damage occurs in proportion to the level of Synovitis but not in its absence. In the treatment of patients with RA, outcome measures and therapies should focus on Synovitis.

  • elucidation of the relationship between Synovitis and bone damage a randomized magnetic resonance imaging study of individual joints in patients with early rheumatoid arthritis
    Arthritis & Rheumatism, 2003
    Co-Authors: Philip G Conaghan, Michael J Green, Richard J Wakefield, Paul Astin, Dennis Mcgonagle, Wayne Gibbon, Philip Oconnor, Zunaid Karim, Mark Quinn, Susanna M Proudman
    Abstract:

    OBJECTIVE: To simultaneously image bone and synovium in the individual joints characteristically involved in early rheumatoid arthritis (RA). METHODS: Forty patients with early, untreated RA underwent gadolinium-enhanced magnetic resonance imaging (MRI) of the second through fifth metacarpophalangeal joints of the dominant hand at presentation, 3 months, and 12 months. In the first phase (0-3 months), patients were randomized to receive either methotrexate alone (MTX) or MTX and intraarticular corticosteroids (MTX + IAST) into all joints with clinically active RA. The MTX-alone group received no further corticosteroids until the second phase (3-12 months), when both groups received standard therapy. RESULTS: In the first phase, MTX + IAST reduced Synovitis scores more than MTX alone. There were significantly fewer joints with new erosions on MRI in the former group compared with the latter. During the second phase, the Synovitis scores were equivalent and a similar number of joints in each group showed new erosions on MRI. In both phases, there was a close correlation between the degree of Synovitis and the number of new erosions, with the area under the curve for MRI Synovitis the only significant predictor of bone damage progression. In individual joints, there was a threshold effect on new bone damage related to the level of Synovitis; no erosions occurred in joints without Synovitis. CONCLUSION: In early RA, Synovitis appears to be the primary abnormality, and bone damage occurs in proportion to the level of Synovitis but not in its absence. In the treatment of patients with RA, outcome measures and therapies should focus on Synovitis.

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  • infrapatellar fat pad volume and hoffa Synovitis after acl reconstruction association with early osteoarthritis features and pain over 5 years
    Journal of Orthopaedic Research, 2021
    Co-Authors: Ali Guermazi, Harvi F Hart, Adam G Culvenor, Brooke E Patterson, Ankit Doshi, Ashish Vora, Trevor B Birmingham, Kay M Crossley
    Abstract:

    Infrapatellar fat pad (IPFP) morphology and Hoffa-Synovitis may be relevant to the development and progression of post-traumatic osteoarthritis (OA). We aimed to compare IPFP volume and Hoffa-Synovitis in participants with anterior cruciate ligament reconstruction (ACLR) and uninjured controls, and to determine their association with prevalent and worsening early knee OA features and pain in participants post-ACLR. We assessed IPFP volume and Hoffa-Synovitis from magnetic resonance imaging (MRI) in 111 participants 1-year post-ACLR and 20 uninjured controls. Patellofemoral and tibiofemoral cartilage and bone marrow lesions (BMLs) were assessed from MRIs at 1 and 5 years post-ACLR, and worsening defined as any longitudinal increase in lesion size/severity. IPFP volume and Hoffa-Synovitis prevalence were compared between groups with analysis of covariance and χ2 tests, respectively. Generalized linear models assessed the relation of IPFP volume and Hoffa-Synovitis to prevalent and worsening features of OA and knee pain (Knee injury and Osteoarthritis Outcome Score-Pain Subscale, Anterior Knee Pain Scale). No significant between-group differences were observed in IPFP volume (ACLR 34.39 ± 7.29cm3 , Control 34.27 ± 7.56cm3 ) and Hoffa-Synovitis (ACLR 61%, Control 80%). Greater IPFP volume at 1-year post-ACLR was associated with greater odds of patellofemoral BMLs at 1-year (odds ratio [OR] [95% confidence intervals]: 1.104 [1.016, 1.200]) and worsening tibiofemoral cartilage lesions at 5-year post-ACLR (OR: 1.234 [1.026, 1.483]). Hoffa-Synovitis at 1-year post-ACLR was associated with greater odds of worsening patellofemoral BMLs at 5-year post-ACLR (OR: 7.465 [1.291, 43.169]). In conclusion, IPFP volume and Hoffa-Synovitis prevalence are similar between individuals 1-year post-ACLR and controls. Greater IPFP volume and Hoffa-Synovitis appear to be associated with the presence and worsening of some early OA features in those post-ACLR, but not pain.

  • relationship between patient reported swelling and magnetic resonance imaging defined effusion Synovitis in patients with meniscus tears and knee osteoarthritis
    Arthritis Care and Research, 2019
    Co-Authors: Lindsey A Macfarlane, Ali Guermazi, Heidi Yang, Jamie E Collins, Lisa A Mandl, Elena Losina, Bruce A Levy, Robert G Marx, Clare E Safrannorton, Jeffrey N Katz
    Abstract:

    Objective Synovitis is a prevalent feature in patients with knee osteoarthritis (OA) and meniscal tear and is associated with pain and cartilage damage. Patient-reported swelling is also prevalent in this population. The aim of this study was to investigate the cross-sectional association between patient-reported swelling and effusion-Synovitis detected by magnetic resonance imaging (MRI) in patients with OA and meniscal tear. Methods We used baseline data from a multicenter, randomized controlled trial, Meniscal Tear in Osteoarthritis Research (METEOR). MRI-identified effusion-Synovitis, a proxy for effusion and Synovitis on noncontrast MRIs, was graded as none/small versus medium/large. Using MRI-identified effusion-Synovitis as the gold standard, we assessed the sensitivity, specificity, and positive predictive value of patient self-reported swelling in the previous week (none, intermittent, constant) to detect effusion and Synovitis. Results We analyzed data from 276 patients. Twenty-five percent of patients reported no swelling, 40% had intermittent swelling, and 36% had constant swelling. Fifty-two percent had MRI-identified medium/large-grade effusion-Synovitis. As compared with MRI-identified effusion-Synovitis, any patient-reported swelling (versus none) had a sensitivity of 84% (95% confidence interval [95% CI] 77-89), a specificity of 34% (95% CI 26-43), and a positive predictive value of 57% (95% CI 54-61). A history of constant swelling (versus none or intermittent) showed a sensitivity of 46% (95% CI 37-54), a specificity of 75% (95% CI 67-82), and a positive predictive value of 66% (95% CI 58-74). Conclusion We found that the sensitivity and specificity of patient-reported swelling were modest when compared with effusion-Synovitis detected by MRI. These data urge caution against using patient-reported swelling as a proxy of inflammation manifesting as effusion-Synovitis.

  • association of changes in effusion Synovitis with progression of cartilage damage over eighteen months in patients with osteoarthritis and meniscal tear
    Arthritis & Rheumatism, 2019
    Co-Authors: Lindsey A Macfarlane, Ali Guermazi, Heidi Yang, Jamie E Collins, Mohamed Jarraya, Lisa A Mandl, Scot T Martin, John Wright, Elena Losina, Jeffrey N Katz
    Abstract:

    OBJECTIVE Synovitis is a feature of knee osteoarthritis (OA) and meniscal tear and has been associated with articular cartilage damage. This study was undertaken to examine the associations of baseline effusion-Synovitis and changes in effusion-Synovitis with changes in cartilage damage in a cohort with OA and meniscal tear. METHODS We analyzed data from the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial of surgery versus physical therapy for treatment of meniscal tear. We performed semiquantitative grading of effusion-Synovitis and cartilage damage on magnetic resonance imaging, and dichotomized effusion-Synovitis as none/small (minimal) and medium/large (extensive). We assessed the association of baseline effusion-Synovitis and changes in effusion-Synovitis with changes in cartilage damage size and depth over 18 months, using Poisson regression models. Analyses were adjusted for patient demographic characteristics, treatment, and baseline cartilage damage. RESULTS We analyzed 221 participants. Over 18 months, effusion-Synovitis was persistently minimal in 45.3% and persistently extensive in 21.3% of the patients. The remaining 33.5% of the patients had minimal Synovitis on one occasion and extensive Synovitis on the other. In adjusted analyses, patients with extensive effusion-Synovitis at baseline had a relative risk (RR) of progression of cartilage damage depth of 1.7 (95% confidence interval [95% CI] 1.0-2.7). Compared to those with persistently minimal effusion-Synovitis, those with persistently extensive effusion-Synovitis had a significantly increased risk of progression of cartilage damage depth (RR 2.0 [95% CI 1.1-3.4]). CONCLUSION Our findings indicate that the presence of extensive effusion-Synovitis is associated with subsequent progression of cartilage damage over 18 months. The persistence of extensive effusion-Synovitis over time is associated with the greatest risk of concurrent cartilage damage progression.

  • is Synovitis detected on non contrast enhanced magnetic resonance imaging associated with serum biomarkers and clinical signs of effusion data from the osteoarthritis initiative
    Scandinavian Journal of Rheumatology, 2018
    Co-Authors: Leticia A Deveza, Frank W Roemer, Ali Guermazi, Michael C Nevitt, Jamie E Collins, Virginia B Kraus, David J Hunter
    Abstract:

    Objectives: To determine the relationship between Synovitis detected on non-contrast-enhanced (non-CE) magnetic resonance imaging (MRI), biochemical markers of inflammation, and clinical assessment of effusion in people with knee osteoarthritis (OA).Method: We examined data from the OA Biomarkers Consortium within the Osteoarthritis Initiative (n = 600). Non-CE MRIs were semi-quantitatively scored (grades 0–3) for severity of Hoffa Synovitis and effusion Synovitis. Serum (s) matrix metalloproteinase-3 (sMMP-3), hyaluronic acid (sHA), and nitrated epitope of the α-helical region of type II collagen (sColl2-1NO2) were quantified. The bulge and patellar tap clinical tests were performed at baseline and performance characteristics were assessed for the detection of effusion Synovitis on MRI. Multinomial logistic regression adjusted for covariates was used to assess the association between biochemical and imaging markers at baseline and over 12 and 24 months.Results: At baseline, sHA and sMMP-3 were associated...

  • comparison between semiquantitative and quantitative methods for the assessment of knee Synovitis in osteoarthritis using non enhanced and gadolinium enhanced mri
    Osteoarthritis and Cartilage, 2017
    Co-Authors: M D Crema, Frank W Roemer, R C Alexander, Iain Chessell, Amanda Dudley, Rolf Karlsten, L B Rosen, Ali Guermazi
    Abstract:

    Summary Objective To compare different semiquantitative and quantitative methods using both non-enhanced and gadolinium-enhanced MRI techniques for the assessment of Synovitis in knee osteoarthritis (OA). Methods Knees with end-stage clinical OA in patients undergoing total knee replacement surgery were included in this cross-sectional study. MRI was performed on all knees. Standard non-enhanced and gadolinium-enhanced sequences were acquired. Using non-enhanced MRI, we semiquantitatively assessed two features widely used as surrogates for Synovitis: effusion-Synovitis and Hoffa-Synovitis. Using gadolinium-enhanced sequences, we semiquantitatively assessed synovial thickness. We quantitatively evaluated the total synovial volume on the gadolinium-enhanced sequences as well. We assessed the correlations of effusion-Synovitis and Hoffa-Synovitis with synovial thickness and volume, applying Spearman correlation analysis. The diagnostic performance of both Synovitis features on non-enhanced MRI was assessed using synovial thickness on gadolinium-enhanced MRI as the reference. Results A total of 104 subjects (one knee per subject) were included. Correlations of effusion-Synovitis with synovial thickness and volume were r  = 0.41 and r  = 0.43 ( P P Conclusion Using synovial thickness assessed on gadolinium-enhanced sequences as the reference, effusion-Synovitis showed superior correlations and sensitivity. Effusion-Synovitis should be preferred over Hoffa-Synovitis as a surrogate marker for synovial thickening, in studies of knee OA for which gadolinium-enhanced sequences are not available.