Prevalence and distribution of cartilage damage at the metacarpal head level in rheumatoid arthritis and osteoarthritis: an ultrasound study

Hurňáková, Jana; Filippucci, Emilio; Cipolletta, Edoardo; Matteo, Andrea Di; Salaffi, Fausto; Carotti, Marina; Draghessi, Antonella; Donato, Eleonora Di; Carlo, Marco Di; Lato, Valentina; Horváth, Rudolf; Komarc, Martin; Pavelka, Karel; Grassi, Walter

doi:10.1093/rheumatology/key443

Cited by 18 publications

(19 citation statements)

References 25 publications

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“…Compared to the commonly affected DIP, PIP, and thumb base joints, radiographic findings in MCP joints are relatively uncommon in hand OA, as demonstrated in the population-based Framingham study (11). Nevertheless, a recent study applying ultrasound to assess cartilage in a small cohort of RA and hand OA patients found the MCP joints to be commonly affected in hand OA and with similar prevalence as in RA (247).…”

Section: Mrimentioning

confidence: 98%

Associations between fluorescence optical imaging and magnetic resonance imaging and symptoms in hand osteoarthritis

Maugesten

Ohrndorf

Slatkowsky-Christensen

et al. 2021

Rheumatology

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Objectives To investigate whether Fluorescence Optical Imaging (FOI) enhancement and Magnetic Resonance Imaging (MRI)-defined synovitis are associated with pain and physical function in hand osteoarthritis (OA) patients. Methods Bilateral FOI scans and MRI of the dominant hand were available for 221 patients. Finger joints were examined for tenderness on palpation. Pain in individual finger joints during the last 24 h and last 6 weeks and hand pain intensity by the Australian/Canadian hand index and Numeric Rating Scale were self-reported. On joint level, we applied logistic regression with generalized estimating equations to examine whether FOI enhancement and MRI-defined synovitis were associated with pain in the same joint. On subject level, we applied linear regression to assess whether FOI and MRI sum scores were associated with pain intensity and physical function. Results Metacarpophalangeal and thumb base joints were excluded from analyses due to little/no FOI enhancement. Finger joints with FOI enhancement on the composite image had higher odds (95% confidence interval) of pain during the last 6 weeks (grade 1: 1.4 (1.2–1.6), grade 2–3: 2.1 (1.7–2.6)). Similar results were found for joint pain during the last 24 h and joint tenderness in fingers. Numerically stronger associations were found between MRI-defined synovitis and finger joint pain/tenderness. FOI and MRI sum scores demonstrated no/weak associations with hand pain and physical function. Conclusion FOI enhancement and MRI-defined synovitis were associated with pain in the same finger joint. None of the imaging modalities demonstrated consistent associations with pain, stiffness and physical function on subject level.

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Section: Mrimentioning

confidence: 98%

Associations between fluorescence optical imaging and magnetic resonance imaging and symptoms in hand osteoarthritis

Maugesten

Ohrndorf

Slatkowsky-Christensen

et al. 2021

Rheumatology

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“…US examinations were carried out using a MyLab Class C (Esaote SpA, Genoa, Italy), equipped with a very high-frequency broadband linear probe (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). A grayscale standard setting was adopted (B-mode frequency: 22 MHz, master gain: 70%, mechanical index: 0.3, dynamic range: 12, depth 15 mm, focus position at the area of interest).…”

Section: Us Image Acquisition and Interpretationmentioning

confidence: 99%

“…The accuracy of conventional radiography has been questioned in non-weight-bearing joints such as the ones of hands and wrists, which are commonly involved in different rheumatic diseases (3,4). Moreover, in several studies, conventional radiography was found to be less sensitive than ultrasonography (US) in the detection of joint damage (5)(6)(7)(8)(9)(10)(11).…”

Section: Introductionmentioning

confidence: 99%

“…Recently, US has been suggested as a reliable and reproducible tool for the assessment of the hyaline cartilage of the small joints of the hand (4,(11)(12)(13)(14)(15)(16)(17). One of the main drawbacks of US is its subjectivity in the interpretation of US findings and the consequent variable inter-and intraobserver reliability (18)(19)(20).…”

Section: Introductionmentioning

confidence: 99%

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Artificial Intelligence for Ultrasound Informative Image Selection of Metacarpal Head Cartilage. A Pilot Study

et al. 2021

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Objectives: This study aims to develop an automatic deep-learning algorithm, which is based on Convolutional Neural Networks (CNNs), for ultrasound informative-image selection of hyaline cartilage at metacarpal head level. The algorithm performance and that of three beginner sonographers were compared with an expert assessment, which was considered the gold standard.Methods: The study was divided into two steps. In the first one, an automatic deep-learning algorithm for image selection was developed using 1,600 ultrasound (US) images of the metacarpal head cartilage (MHC) acquired in 40 healthy subjects using a very high-frequency probe (up to 22 MHz). The algorithm task was to identify US images defined informative as they show enough information to fulfill the Outcome Measure in Rheumatology US definition of healthy hyaline cartilage. The algorithm relied on VGG16 CNN, which was fine-tuned to classify US images in informative and non-informative ones. A repeated leave-four-subject out cross-validation was performed using the expert sonographer assessment as gold-standard. In the second step, the expert assessed the algorithm and the beginner sonographers' ability to obtain US informative images of the MHC.Results: The VGG16 CNN showed excellent performance in the first step, with a mean area (AUC) under the receiver operating characteristic curve, computed among the 10 models obtained from cross-validation, of 0.99 ± 0.01. The model that reached the best AUC on the testing set, which we named “MHC identifier 1,” was then evaluated by the expert sonographer. The agreement between the algorithm, and the expert sonographer was almost perfect [Cohen's kappa: 0.84 (95% confidence interval: 0.71–0.98)], whereas the agreement between the expert and the beginner sonographers using conventional assessment was moderate [Cohen's kappa: 0.63 (95% confidence interval: 0.49–0.76)]. The conventional obtainment of US images by beginner sonographers required 6.0 ± 1.0 min, whereas US videoclip acquisition by a beginner sonographer lasted only 2.0 ± 0.8 min.Conclusion: This study paves the way for the automatic identification of informative US images for assessing MHC. This may redefine the US reliability in the evaluation of MHC integrity, especially in terms of intrareader reliability and may support beginner sonographers during US training.

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“…However, this minimally invasive surgical method has the risk of potentially damaging the articular cartilage. Studies have indicated that the destruction of the articular cartilage of finger joints has the inevitable sequelae of pain and stiffness as well as arthritis in finger joints [28,29].…”

Section: Introductionmentioning

confidence: 99%

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

Chiu

Ting

et al. 2021

BMC Musculoskelet Disord

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Background Metacarpal shaft fracture is a common fracture in hand trauma injuries. Surgical intervention is indicated when fractures are unstable or involve considerable displacement. Current fixation options include Kirschner wire, bone plates, and intramedullary headless screws. Common complications include joint stiffness, tendon irritation, implant loosening, and cartilage damage. Objective We propose a modified fixation approach using headless compression screws to treat transverse or short-oblique metacarpal shaft fracture. Materials and methods We used a saw blade to model transverse metacarpal neck fractures in 28 fresh porcine metacarpals, which were then treated with the following four fixation methods: (1) locked plate with five locked bicortical screws (LP group), (2) regular plate with five bicortical screws (RP group), (3) two Kirschner wires (K group), and (4) a headless compression screw (HC group). In the HC group, we proposed a novel fixation model in which the screw trajectory was oblique to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; thus, the screw did not damage the articular cartilage. The specimens were tested using a modified three-point bending test on a material testing system. The maximum fracture forces and stiffness values of the four fixation types were determined by observing the force–displacement curves. Finally, the Kruskal–Wallis test was adopted to process the data, and the exact Wilcoxon rank sum test with Bonferroni adjustment was performed to conduct paired comparisons among the groups. Results The maximum fracture forces (median ± interquartile range [IQR]) of the LP, RP, HC, and K groups were 173.0 ± 81.0, 156.0 ± 117.9, 60.4 ± 21.0, and 51.8 ± 60.7 N, respectively. In addition, the stiffness values (median ± IQR) of the LP, HC, RP, and K groups were 29.6 ± 3.0, 23.1 ± 5.2, 22.6 ± 2.8, and 14.7 ± 5.6 N/mm, respectively. Conclusion Headless compression screw fixation provides fixation strength similar to locked and regular plates for the fixation of metacarpal shaft fractures. The headless screw was inserted obliquely to the long axis of the metacarpal bone. The entry point of the screw was in the dorsum of the metacarpal neck, and the exit point was in the volar cortex of the supracondylar region; therefore the articular cartilage iatrogenic injury can be avoidable. This modified fixation method may prevent tendon irritation and joint cartilage violation caused by plating and intramedullary headless screw fixation.

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Prevalence and distribution of cartilage damage at the metacarpal head level in rheumatoid arthritis and osteoarthritis: an ultrasound study

Cited by 18 publications

References 25 publications

Associations between fluorescence optical imaging and magnetic resonance imaging and symptoms in hand osteoarthritis

Associations between fluorescence optical imaging and magnetic resonance imaging and symptoms in hand osteoarthritis

Artificial Intelligence for Ultrasound Informative Image Selection of Metacarpal Head Cartilage. A Pilot Study

Effect of oblique headless compression screw fixation for metacarpal shaft fracture: a biomechanical in vitro study

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