Development and Validation of an OMERACT MRI Whole-Body Score for Inflammation in Peripheral Joints and Entheses in Inflammatory Arthritis (MRI-WIPE)

Krabbe, Simon; Eshed, Iris; Gandjbakhch, Frédérique; Pedersen, Susanne Juhl; Bird, Paul; Mathew, Ashish Jacob; Lambert, Robert G.; Maksymowych, Walter P.; Glinatsi, Daniel; Stoenoiu, Maria; Poggenborg, René Panduro; Jans, Lennart; Jaremko, Jacob L.; Herregods, Nele; Foltz, Violaine; Conaghan, Philip G.; Althoff, Christian E.; Paschke, Joel; Peterfy, Charles; Hermann, Kay-Geert A.; Østergaard, Mikkel

doi:10.3899/jrheum.181084

Cited by 41 publications

(26 citation statements)

References 15 publications

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“…WBMRI may, in the future clinical practice aid in diagnosis of early forms of SpA, enabling evaluation of both axial and peripheral entheses and joints. (40)(41)(42) Readability and reproducibility of WBMRI were high in spine and SI joints, but lower in the peripheral joints in earlier studies (43). However, a more recent study has found good reliability in peripheral entheses too (41).…”

Section: Utility Of Mri In the Diagnosis Of Enthesitis In Spamentioning

confidence: 89%

“…For MRI assessment of enthesitis in clinical trials, it is recommended to apply validated assessment methods, such as the OMERACT MRI scoring systems (27,41). More studies are needed to validate and optimize the existing MRI outcome measures.…”

Section: How Have Clinical Trials Applied Mri For Assessing Enthesitis?mentioning

confidence: 99%

“…Limitations with WBMRI include the examination time, low resolution of images and attainable spatial resolution compared to conventional MRI (74,75). The total scan time for WBMRI, including peripheral and axial joints, and entheses is generally around 60 min (41,43). Patients with active arthritis may find it challenging to remain stationary in the same position for long periods of time, which may result in motion artifacts.…”

Section: Limitations Of Imaging Enthesitis In Spa and Psa Using Mrimentioning

confidence: 99%

“…Experience of the reader also plays a pivotal role with WBMRI. Reliability among experienced readers has been shown to be good, while poorer among less experienced ones (41).…”

Section: Limitations Of Imaging Enthesitis In Spa and Psa Using Mrimentioning

confidence: 99%

“…( 40 – 42 ) Readability and reproducibility of WBMRI were high in spine and SI joints, but lower in the peripheral joints in earlier studies ( 43 ). However, a more recent study has found good reliability in peripheral entheses too ( 41 ). Poggenborg et al investigated the ability of WBMRI to assess axial and peripheral enthesitis in patients with PsA and axial SpA, and observed moderate agreement between clinical examination and WBMRI.…”

Section: Utility Of Mri In the Diagnosis Of Enthesitis In Spamentioning

confidence: 99%

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Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

Mathew

Østergaard

2020

Front. Med.

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Enthesitis, inflammation at the attachment sites of tendons, ligaments, fascia, and joint capsules to bones plays a critical role in the pathogenesis of spondyloarthritis (SpA), including psoriatic arthritis (PsA). Magnetic resonance imaging (MRI) has aided in a better understanding of pathophysiology, early diagnosis, prognostication, therapeutic outcomes, and follow up of enthesitis. The concept of enthesitis as a focal insertional pathology has transformed over the past decade, with the help of MRI, to a more widespread entity involving both bone and surrounding soft tissues. The utility of MRI in the differential diagnosis of suspected enthesitis has recently been explored. With the emergence of the treat-to-target concept, and a domain-based approach in the management of SpA, objective and sensitive monitoring of response to targeted therapy becomes prudent. Properties like high sensitivity, ability to image intra-osseous pathology along with surrounding structures exemplify the utility of MRI technology. Considering the lack of a comprehensive, validated MRI score the Outcome Measures in Rheumatology (OMERACT) MRI in Arthritis Working Group, informed by a systematic literature review, developed the first international, consensus-based MRI-scoring system, combined with MRI definitions of pathologies for enthesitis in patients with spondyloarthritis (SpA) and PsA. An atlas with representative images of each grade of the scoring system was subsequently developed by the group to aid readers interested in using the heel enthesitis MRI scoring system (HEMRIS). The HEMRIS can find utility in clinical trials targeting enthesitis as the primary outcome. MRI also finds value for global assessment of the total burden of enthesitis. The concept of whole-body MRI (WBMRI), enabling visualization of entheses throughout the body using a single image is relatively new. The MRI whole-body score for inflammation in peripheral joints and entheses (MRI-WIPE) is a promising scoring system, which is undergoing further testing in clinical trials and longitudinal cohorts evaluating global measures of inflammation at entheses. This review discusses the role of MRI in diagnosis and monitoring of enthesitis in SpA and PsA, along with recent advances in the field, based on published literature.

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Section: Utility Of Mri In the Diagnosis Of Enthesitis In Spamentioning

confidence: 89%

Section: How Have Clinical Trials Applied Mri For Assessing Enthesitis?mentioning

confidence: 99%

Section: Limitations Of Imaging Enthesitis In Spa and Psa Using Mrimentioning

confidence: 99%

“…Experience of the reader also plays a pivotal role with WBMRI. Reliability among experienced readers has been shown to be good, while poorer among less experienced ones (41).…”

Section: Limitations Of Imaging Enthesitis In Spa and Psa Using Mrimentioning

confidence: 99%

Section: Utility Of Mri In the Diagnosis Of Enthesitis In Spamentioning

confidence: 99%

See 3 more Smart Citations

Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

Mathew

Østergaard

2020

Front. Med.

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The Value of Magnetic Resonance Imaging for Assessing Disease Extent and Prediction of Relapse in Early Peripheral Spondyloarthritis

Renson

Carron

Craemer

et al. 2021

Arthritis & Rheumatology

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Objective. This study was undertaken to assess the inflammatory burden in peripheral spondyloarthritis (SpA) by magnetic resonance imaging (MRI) of the legs in an early remission-induction strategy study of tumor necrosis factor (TNF) blockade. Furthermore, we sought to determine the value of MRI to predict disease relapse versus sustained remission after treatment discontinuation.Methods. Thirty-two patients with early peripheral SpA with involvement of the legs determined on clinical examination and confirmed by ultrasonography (US) participated in a remission-induction trial of a TNF inhibitor (TNFi). Patients underwent MRI of the joints and entheses of the legs at baseline and at clinical remission, after which TNFi treatment was withdrawn. Images were evaluated for joint effusion, joint osteitis, entheseal soft tissue inflammation, and entheseal osteitis.Results. Joint effusion and enthesitis on clinical examination and US correlated well with MRI abnormalities. In addition, a substantial amount of subclinical involvement was seen on MRI, mainly in the ankle joints and heel entheses. Inflammation scores were markedly lower in the subclinically involved joints and entheses versus those that were clinically involved (P values ranged from 0.01 to <0.001). Inflammatory load on MRI decreased significantly upon TNFi treatment (P < 0.001). Whereas 80% of the joints that were clinically involved at baseline showed no effusion on remission MRI, 2 of 3 entheses involved at baseline showed residual inflammation. In addition, patients who experienced a relapse after treatment discontinuation displayed more entheseal soft tissue inflammation on remission MRI compared to those who maintained drug-free remission (P = 0.028).Conclusion. Our findings delineate a differential response of synovitis and enthesitis, with enthesitis on MRI being less responsive to TNFi treatment. Furthermore, residual entheseal inflammation might be indicative of the need for continuous therapy.

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Society of skeletal radiology member utilization and performance of whole-body MRI in adults

Feldhaus¹,

Garner

Wessell

2020

Skeletal Radiol

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Development and Validation of an OMERACT MRI Whole-Body Score for Inflammation in Peripheral Joints and Entheses in Inflammatory Arthritis (MRI-WIPE)

Cited by 41 publications

References 15 publications

Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

Magnetic Resonance Imaging of Enthesitis in Spondyloarthritis, Including Psoriatic Arthritis—Status and Recent Advances

The Value of Magnetic Resonance Imaging for Assessing Disease Extent and Prediction of Relapse in Early Peripheral Spondyloarthritis

Society of skeletal radiology member utilization and performance of whole-body MRI in adults

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