High-grade MRI bone oedema is common within the surgical field in rheumatoid arthritis patients undergoing joint replacement and is associated with osteitis in subchondral bone

McQueen, Fiona; Gao, Angela; Østergaard, Mikkel; King, Alan R.; Shalley, Gareth; Robinson, Elizabeth; Doyle, Anthony; Clark, Barnaby; Dalbeth, Nicola

doi:10.1136/ard.2007.070326

Cited by 124 publications

(70 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The importance of involvement of subchondral bone in RA became even more evident with the introduction of magnetic resonance imaging (MRI). Bone marrow lesions (BMLs) in RA, described as MRI 'bone edema', were demonstrated to reflect osteitis, as they contain inflammatory cells, replacing adipose bone marrow and bone [Dalbeth et al 2009;Geusens and Lems, 2011;Jimenez-Boj et al 2007;McQueen et al 2007;Schett, 2009]. In postoperative joint specimens of patients with RA, osteoclasts and RANKL expression were also found in these MRI lesions, but not at locations without MRI bone edema [Dalbeth et al 2009].…”

Section: Rankl and Joint Damagementioning

confidence: 99%

The role of RANK ligand/osteoprotegerin in rheumatoid arthritis

Geusens

2012

Therapeutic Advances in Musculoskeletal

119

View full text Add to dashboard Cite

In the complex system of bone remodeling, the receptor activator of nuclear factor κB ligand (RANKL)/osteoprotegerin (OPG) pathway is the coupling factor between bone formation and bone resorption. RANKL binds to the RANK receptor of pre-osteoclasts and mature osteoclasts and stimulates their activation and differentiation. The production of RANKL/OPG by osteoblasts is influenced by hormones, growth factors and cytokines, which each have a different effect on the production of RANKL and OPG. Ultimately, the balance between RANKL and OPG determines the degree of proliferation and activity of the osteoclasts. In rheumatoid arthritis (RA), bone erosions are the result of osteoclastic bone resorption at the sites of synovitis, where RANKL expression is also found. Furthermore, magnetic resonance imaging (MRI) bone edema in RA indicates the presence of active inflammation within bone and the presence of osteitis, which is also associated with the expression of RANKL. Bone loss has been documented in the cortical and trabecular bone in the joints of the hand of RA patients. Both synovitis and periarticular bone involvement (osteitis and bone loss) are essential components of RA: they occur early in the disease and both are predictive for the occurrence and progression of bone damage. RANKL knockout mice and mice treated with OPG did not develop focal bone loss, in spite of persistent joint inflammation. Inhibition of osteoclasts by denosumab, a humanized antibody that selectively binds RANKL, has revealed in patients with RA that the occurrence of erosions and periarticular bone loss can be halted, however without affecting synovial inflammation. This disconnect between inflammation and bone destruction opens new ways to separately focus treatment on inflammation and osteoclastogenesis for preventing and/or minimizing the connection between joints and subchondral bone and bone marrow.

show abstract

Section: Rankl and Joint Damagementioning

confidence: 99%

The role of RANK ligand/osteoprotegerin in rheumatoid arthritis

Geusens

2012

Therapeutic Advances in Musculoskeletal

119

View full text Add to dashboard Cite

show abstract

“…MRI and histopathological signs of synovial inflammation are closely correlated [64][65][66]; in a study of metacarpophalangeal (MCP) joints in patients with early and with established RA, miniarthroscopy confirmed the presence of bone pathology in all joints with MRI bone erosions and histologic and macroscopic synovitis in all joints with MRI synovitis [67]. MRI BME represents inflammatory infiltrates in the bone marrow, i.e., osteitis, as demonstrated by comparison with histological samples obtained at surgery in RA patients [3,4]. Whereas erosions reflect bone damage that has already occurred, BME appears to represent the link between joint inflammation and bone destruction.…”

Section: Mri In Rheumatoid Arthritismentioning

confidence: 89%

“…It is interesting that the uniform appearance of BME in typical subchondral locations displayed by MRI in inflammatory arthritides seems to reflect different histopathological findings. In RA, where the quality of perioperative correlation studies between BME on MRI and histopathology is highest, predominantly active cellular infiltrates with a variety of cytokine signatures have been found [3,4]. Scarce data in SpA from vertebral facet joints removed during spinal extension surgery and from biopsies of the sacroiliac joint (SIJ) showed predominantly mononuclear cell infiltrates with only partial correlation with BME seen on preoperative MRI [5,6].…”

Section: Introductionmentioning

confidence: 99%

The impact of MRI on the clinical management of inflammatory arthritides

et al. 2011

View full text Add to dashboard Cite

In the past two decades, MRI has gained a major role in research and clinical management of patients with inflammatory arthritides, particularly in spondyloarthritis (SpA), rheumatoid arthritis (RA), and osteoarthritis (OA). MRI is regarded as the most sensitive imaging modality for detecting early SpA in young patients with inflammatory back pain and normal radiographs of the sacroiliac joints. The recently published Assessment of SpondyloArthritis International Society classification criteria for axial SpA include for the first time a positive MRI demonstrating sacroiliitis as an imaging criterion indicative of SpA together with at least one clinical feature of SpA. Recent data show that systematic assessment of sacroiliitis displayed on MRI has much greater diagnostic utility than previously reported and highlight the diagnostic relevance of structural lesions. In RA, MRI has predictive value for the development of disease in new onset undifferentiated arthritis, and MR pathology at disease onset is a highly significant predictor of radiographic erosions. Consequently MRI has been credited with an important role in the new ACR/EULAR 2010 classification criteria for RA. In OA, bone marrow edema (BME) and synovitis may serve as biomarkers in interventional trials. Treatment interventions targeting BME and synovitis observed on MRI in inflammatory arthritides may have a disease-modifying effect as these lesions are potentially reversible and have been shown to be associated with structural progression. Research should focus on the prognostic significance of MRI lesions in larger cohorts and whether adding MRI to routine care improves clinical and radiographic outcome in patients with inflammatory arthritides.

show abstract

“…Our own imaging/histopathological studies indicated a significant ‘floor effect’ for T2W bone oedema so that mild degrees of osteitis from resected periarticular bone were not detectable on matching MRI scans. However, more intense osteitis appeared as regions of bone oedema, with increasing grades matching each other above a threshold level 57. T2W images may also be relatively insensitive to minor changes in osteitis as the relative enhancement ratio of bone marrow in the study by Hodgson and colleagues fell significantly after 2 weeks of anti-TNFα treatment, while no effect was seen on the RAMRIS bone oedema score 56.…”

Section: How Are Synovitis and Osteitis Related?mentioning

confidence: 96%

MRI in rheumatoid arthritis: a useful tool for the clinician?

McQueen¹

2014

Postgraduate Medical Journal

View full text Add to dashboard Cite

Over the last two decades, MRI has emerged as an important clinical tool to assist in the diagnosis and management of rheumatic disease. In rheumatoid arthritis (RA), MRI has improved our understanding of the pathological basis of disease and has provided new information about imaging features that reflect joint inflammation and damage. Using MRI, we can now directly observe inflammation involving the synovial membrane and tenosynovium, plus joint damage including bone erosion and cartilage thinning. Inflammation of bone beneath the joint (osteitis) appears as bone oedema which is a feature unique to MRI and yields important diagnostic and prognostic information in patients with inflammatory arthritis. With the introduction of biologics to rheumatology clinical practice, sensitive tools are required to monitor disease activity and progression, so that the disease suppressing effect of these new agents can be measured. MRI fits the bill for this role as it can inform the clinician about the development of bone erosions well before plain radiography, and its ability to reveal cartilage damage is emerging. The use of MRI as a marker of outcome in clinical trials is being paralleled by its increasing role in the clinic. Both extremity and high field MRI have clinical applications in RA and need to be considered along with other advanced imaging techniques as useful tools to add to the clinician’s armamentarium. This review will summarise recent advances in this field and will apply current knowledge to specific clinical scenarios relevant to modern rheumatology practice.

show abstract

High-grade MRI bone oedema is common within the surgical field in rheumatoid arthritis patients undergoing joint replacement and is associated with osteitis in subchondral bone

Cited by 124 publications

References 21 publications

The role of RANK ligand/osteoprotegerin in rheumatoid arthritis

The role of RANK ligand/osteoprotegerin in rheumatoid arthritis

The impact of MRI on the clinical management of inflammatory arthritides

MRI in rheumatoid arthritis: a useful tool for the clinician?

Contact Info

Product

Resources

About