Low-Frequency Magnetic Resonance Imaging Identifies Hand Joint Subclinical Inflammation in Systemic Sclerosis
Objectives: The aim of this work was to determine hand joint inflammation in systemic sclerosis (SSc); patients with rheumatoid arthritis (RA) with hand joint involvement were used as controls. Our investigation also aimed at examining the relationship between these subclinical inflammatory changes...
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| Format: | Article |
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MDPI AG
2022-09-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/9/2165 |
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| author | Bojana Stamenkovic Sonja Stojanovic Valentina Zivkovic Dragan Djordjevic Mila Bojanovic Aleksandra Stankovic Natasa Rancic Nemanja Damjanov Marco Matucci Cerinic |
| author_facet | Bojana Stamenkovic Sonja Stojanovic Valentina Zivkovic Dragan Djordjevic Mila Bojanovic Aleksandra Stankovic Natasa Rancic Nemanja Damjanov Marco Matucci Cerinic |
| author_sort | Bojana Stamenkovic |
| collection | DOAJ |
| description | Objectives: The aim of this work was to determine hand joint inflammation in systemic sclerosis (SSc); patients with rheumatoid arthritis (RA) with hand joint involvement were used as controls. Our investigation also aimed at examining the relationship between these subclinical inflammatory changes in the hands, verified by low-frequency MRI, and clinical (especially cardiopulmonary) manifestations, disease activity, and functional capacity in patients with diffuse cutaneous (dcSSc) and limited cutaneous SSc (lcSSc). Methods: Out of 250 SSc patients, the selection included 82 patients with signs and symptoms of joint involvement, and 35 consecutive RA patients. These patients underwent clinical and laboratory investigations, and hand X-ray and MRI of the dominant hand. Synovitis/tenosynovitis, bone edema, and erosions were investigated, and the bone changes were quantified and scored using the RAMRIS method. HAQ index, modified Rodnan skin score, examination of internal organ involvement, and serological markers for SSc, as well as rheumatoid factor (RF) and cyclic citrullinated peptides antibodies (ACPA), were performed on all experimental group subjects. Results: MRI of the dominant hand showed a significantly higher number of cases with synovitis (78%) than the number of patients with clinically swollen joints (17.1%; <i>p</i> < 0.001); bone edema was found in 62 (75.6%) SSc patients. MRI also showed a higher number of erosions (52; 63.4%) compared to those (22; 27.5%) detected with X-ray (<i>p</i> < 0.001). The average values of the total MRI score of synovitis/edema and erosions in the wrist (<i>p</i> < 0.001) and MCP joints (<i>p</i> < 0.001) were statistically higher in RA than in SSc patients (<i>p</i> < 0.001). The probability of the MRI-detected inflammatory changes was considerably higher in SSc patients who had vascular complications (digital ulceration, OR = 4.68; 95% IP: 1.002–22.25; <i>p</i> < 0.05), in patients with more severe functional impairment (OR = 8.22; 95% IP: 1.74–38.89; <i>p</i> < 0.01), and in patients with active disease (OR = 3.132; 95% IP: 1.027–9.551; <i>p</i> < 0.05). In our investigation, patients with a limited form of the disease and with inflammatory changes on MR more often had higher functional impairment compared to the other group without MRI inflammation. Conclusions: Our data show that in SSc MRI can detect a significant subclinical joint inflammation. RAMRIS confirmed the high degree of joint inflammation in RA, but also revealed a great deal of joint inflammation in SSc. That inflammation is associated with systemic inflammation (disease activity), vascular complications, and more severe forms of the disease, as synovitis cannot be precisely diagnosed by the clinical examination of joints. These results suggest that a careful joint investigation is necessary in SSc, and that in symptomatic patients, MRI may identify joint inflammation. In clinical practice, this evidence might drive to an early targeted therapy, thus preventing joint erosions. |
| first_indexed | 2024-03-10T00:17:27Z |
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| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-10T00:17:27Z |
| publishDate | 2022-09-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-ed01ec8668724386a679db7e89a284792023-11-23T15:49:49ZengMDPI AGDiagnostics2075-44182022-09-01129216510.3390/diagnostics12092165Low-Frequency Magnetic Resonance Imaging Identifies Hand Joint Subclinical Inflammation in Systemic SclerosisBojana Stamenkovic0Sonja Stojanovic1Valentina Zivkovic2Dragan Djordjevic3Mila Bojanovic4Aleksandra Stankovic5Natasa Rancic6Nemanja Damjanov7Marco Matucci Cerinic8Institute for Treatment and Rehabilitation Niška Banja, 18205 Niška Banja, SerbiaInstitute for Treatment and Rehabilitation Niška Banja, 18205 Niška Banja, SerbiaInstitute for Treatment and Rehabilitation Niška Banja, 18205 Niška Banja, SerbiaInstitute for Treatment and Rehabilitation Niška Banja, 18205 Niška Banja, SerbiaFaculty of Medicine, University of Niš, 18000 Niš, SerbiaFaculty of Medicine, University of Niš, 18000 Niš, SerbiaFaculty of Medicine, University of Niš, 18000 Niš, SerbiaMedical Faculty, University of Belgrade, 11000 Belgrade, SerbiaDepartment of Experimental and Clinical Medicine, University of Florence, 50121 Florence, ItalyObjectives: The aim of this work was to determine hand joint inflammation in systemic sclerosis (SSc); patients with rheumatoid arthritis (RA) with hand joint involvement were used as controls. Our investigation also aimed at examining the relationship between these subclinical inflammatory changes in the hands, verified by low-frequency MRI, and clinical (especially cardiopulmonary) manifestations, disease activity, and functional capacity in patients with diffuse cutaneous (dcSSc) and limited cutaneous SSc (lcSSc). Methods: Out of 250 SSc patients, the selection included 82 patients with signs and symptoms of joint involvement, and 35 consecutive RA patients. These patients underwent clinical and laboratory investigations, and hand X-ray and MRI of the dominant hand. Synovitis/tenosynovitis, bone edema, and erosions were investigated, and the bone changes were quantified and scored using the RAMRIS method. HAQ index, modified Rodnan skin score, examination of internal organ involvement, and serological markers for SSc, as well as rheumatoid factor (RF) and cyclic citrullinated peptides antibodies (ACPA), were performed on all experimental group subjects. Results: MRI of the dominant hand showed a significantly higher number of cases with synovitis (78%) than the number of patients with clinically swollen joints (17.1%; <i>p</i> < 0.001); bone edema was found in 62 (75.6%) SSc patients. MRI also showed a higher number of erosions (52; 63.4%) compared to those (22; 27.5%) detected with X-ray (<i>p</i> < 0.001). The average values of the total MRI score of synovitis/edema and erosions in the wrist (<i>p</i> < 0.001) and MCP joints (<i>p</i> < 0.001) were statistically higher in RA than in SSc patients (<i>p</i> < 0.001). The probability of the MRI-detected inflammatory changes was considerably higher in SSc patients who had vascular complications (digital ulceration, OR = 4.68; 95% IP: 1.002–22.25; <i>p</i> < 0.05), in patients with more severe functional impairment (OR = 8.22; 95% IP: 1.74–38.89; <i>p</i> < 0.01), and in patients with active disease (OR = 3.132; 95% IP: 1.027–9.551; <i>p</i> < 0.05). In our investigation, patients with a limited form of the disease and with inflammatory changes on MR more often had higher functional impairment compared to the other group without MRI inflammation. Conclusions: Our data show that in SSc MRI can detect a significant subclinical joint inflammation. RAMRIS confirmed the high degree of joint inflammation in RA, but also revealed a great deal of joint inflammation in SSc. That inflammation is associated with systemic inflammation (disease activity), vascular complications, and more severe forms of the disease, as synovitis cannot be precisely diagnosed by the clinical examination of joints. These results suggest that a careful joint investigation is necessary in SSc, and that in symptomatic patients, MRI may identify joint inflammation. In clinical practice, this evidence might drive to an early targeted therapy, thus preventing joint erosions.https://www.mdpi.com/2075-4418/12/9/2165systemic sclerosismagnetic resonance imaginghand inflammation |
| spellingShingle | Bojana Stamenkovic Sonja Stojanovic Valentina Zivkovic Dragan Djordjevic Mila Bojanovic Aleksandra Stankovic Natasa Rancic Nemanja Damjanov Marco Matucci Cerinic Low-Frequency Magnetic Resonance Imaging Identifies Hand Joint Subclinical Inflammation in Systemic Sclerosis Diagnostics systemic sclerosis magnetic resonance imaging hand inflammation |
| title | Low-Frequency Magnetic Resonance Imaging Identifies Hand Joint Subclinical Inflammation in Systemic Sclerosis |
| title_full | Low-Frequency Magnetic Resonance Imaging Identifies Hand Joint Subclinical Inflammation in Systemic Sclerosis |
| title_fullStr | Low-Frequency Magnetic Resonance Imaging Identifies Hand Joint Subclinical Inflammation in Systemic Sclerosis |
| title_full_unstemmed | Low-Frequency Magnetic Resonance Imaging Identifies Hand Joint Subclinical Inflammation in Systemic Sclerosis |
| title_short | Low-Frequency Magnetic Resonance Imaging Identifies Hand Joint Subclinical Inflammation in Systemic Sclerosis |
| title_sort | low frequency magnetic resonance imaging identifies hand joint subclinical inflammation in systemic sclerosis |
| topic | systemic sclerosis magnetic resonance imaging hand inflammation |
| url | https://www.mdpi.com/2075-4418/12/9/2165 |
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