Early rheumatoid arthritis—do we really know what it means? Consistency and distribution of MRI findings according to different definitions for early rheumatoid arthritis

This study aims to characterize patients with early rheumatoid arthritis (RA) based on different definitions of early RA (disease duration, fulfillment of the American College of Rheumatology (ACR) criteria), and to determine whether these different definitions affect magnetic resonance imaging (MRI) findings of the hand. A cohort of 58 patients with early RA previously described was re-evaluated. There were 43 women and 15 men with a median age of 49 years, a disease duration of less than 2 years, and negative radiographs who were followed up for 6–41 months. MR images of the hand and wrist of these patients were retrospectively evaluated for the presence of synovitis, erosions, and tenosynovitis. The presence and distribution of these MRI findings were analyzed in three groups: fulfillment of 1987-ACR criteria, 6-month disease duration, and 12-month disease duration. Median disease duration was 11 months (range 1–24 months). Thirty patients (52%) fulfilled the ACR criteria. More patients fulfilling ACR criteria had MCP erosions and carpal synovitis compared with those not fulfilling the criteria; however, the difference was not significant. No significant difference was seen in the prevalence of synovitis, tenosynovitis, or erosions between the three groups. Patients with early RA of 2-years duration and negative hand X-ray findings are a homogenous group, regarding their MRI findings.     

Magnetic resonance imaging of pelvic entheses—a systematic comparison between short tau inversion recovery (STIR) and T1-weighted,contrast-enhanced,fat-saturated sequences

Objective

To assess the contribution of contrast material in detecting and evaluating enthesitis of pelvic entheses by MRI.

Materials and methods

Sixty-seven hip or pelvic 1.5-T MRIs (30:37 male:female, mean age: 53 years) were retrospectively evaluated for the presence of hamstring and gluteus medius (GM) enthesitis by two readers (a resident and an experienced radiologist). Short tau inversion recovery (STIR) and T1-weighted pre- and post-contrast (T1+Gd) images were evaluated by each reader at two sessions. A consensus reading of two senior radiologists was regarded as the gold standard. Clinical data was retrieved from patients’ referral form and medical files. Cohen’s kappa was used for intra- and inter-observer agreement calculation. Diagnostic properties were calculated against the gold standard reading.

Results

A total of 228 entheses were evaluated. Gold standard analysis diagnosed 83 (36 %) enthesitis lesions. Intra-reader reliability for the experienced reader was significantly (p?=?0.0001) higher in the T1+Gd images compared to the STIR images (hamstring: k?=?0.84/0.45, GM: k?=?0.84/0.47). Sensitivity and specificity increased from 0.74/0.8 to 0.87/0.9 in the STIR images and T1+Gd sequences. Intra-reader reliability for the inexperienced reader was lower (p?>?0.05).

Conclusions

Evidence showing that contrast material improves the reliability, sensitivity, and specificity of detecting enthesitis supports its use in this setting.     

Approach to a patient with monoarticular disease

PurposeTo reassess the diagnostic approach to a patient with a monoarticular disease in light of the up-to-date medical literature and to examine the practical utility of traditional and newer imaging tools in the setting of monoarthritis.ResultsThe monoarticular disease can represent a medical emergency on the one hand and be a diagnostic conundrum on the other. The management rules of patients with monoarthritis have been established long ago, but various pitfalls still lead physicians off the right diagnosis at times. Septic, pseudoseptic arthritis and hemarthrosis are the most common diagnoses made in patients with an acute presentation, and a decision not to perform a diagnostic arthrocentesis is the most prevalent cause of misdiagnosis in this setting. Many rheumatic and infectious diseases can present with more indolent monoarthritis; careful history and physical examination frequently provide clues to the straightforward diagnosis in some cases, but the extensive investigation is needed in others. Imaging methods become indispensable in individuals with the non-inflammatory monoarticular disease, with magnetic resonance imaging being the gold standard for diagnosing pigmented villonodular synovitis, lipoma arborescence, avascular necrosis, or neuropathic arthropathy.ConclusionsA great variety of medical disorders can present as a monoarticular disease. The disease presentation dictates different diagnostic behavior, while knowing the available imaging methods' diagnostic potential should further shorten the diagnostic process.     

Effect of alendronate on bone mineral density in adult patients with Laron syndrome (primary growth hormone insensitivity).

Severe short stature resulting from a deficiency in insulin-like growth factor-I (IGF-I) is a prominent feature of Laron syndrome (LS). Whether patients with LS are osteopenic or not, and whether they need treatment with bisphosphonates, remains uncertain. The aim of this study was to investigate the action of alendronate on the IGF-I-deficient bones of adult patients with LS and osteoporosis, as determined by dual X-ray absorptiometry . Seven patients (5 women and 2 men) of mean age 40.8+/-7.6 years and mean bone mass density (BMD) 0.843+/-0.06 g/cm2 (T score -2.9+/-0.5) at the lumbar spine and 0.734+/-0.11 g/cm2 (T score -2.2+/-0.9) at the femoral neck were treated with alendronate 70 mg once/weekly over a 12-month period. Treatment led to an increase of 5.3% in BMD (p=0.038) at the femoral neck. There was a similar trend at the lumbar spine, but the difference was not statistically significant (2.3%, p=0.34). Mean total alkaline phosphatase decreased by 14% from normal range at baseline (p=0.007). Urinary deoxypyridinoline levels, which were elevated at baseline (10+/-2.3 nM/mMcre), showed a nonsignificant change during treatment. Our study suggests that treatment with alendronate may have positive effects in patients with LS and low BMD on dual X-ray absorptiometry.     

MRI of enthesitis of the appendicular skeleton in spondyloarthritis

Entheses are sites where tendons, ligaments, joint capsules or fascia attach to bone. Inflammation of the entheses (enthesitis) is a well-known hallmark of spondyloarthritis (SpA). As entheses are associated with adjacent, functionally related structures, the concepts of an enthesis organ and functional entheses have been proposed. This is important in interpreting imaging findings in entheseal-related diseases. Conventional radiographs and CT are able to depict the chronic changes associated with enthesitis but are of very limited use in early disease. In contrast, MRI is sensitive for detecting early signs of enthesitis and can evaluate both soft-tissue changes and intraosseous abnormalities of active enthesitis. It is therefore useful for the early diagnosis of enthesitis-related arthropathies and monitoring therapy. Current knowledge and typical MRI features of the most commonly involved entheses of the appendicular skeleton in patients with SpA are reviewed. The MRI appearances of inflammatory and degenerative enthesopathy are described. New options for imaging enthesitis, including whole-body MRI and high-resolution microscopy MRI, are briefly discussed.     

The flowering hormone florigen functions as a general systemic regulator of growth and termination

The florigen paradigm implies a universal flowering-inducing hormone that is common to all flowering plants. Recent work identified FT orthologues as originators of florigen and their polypeptides as the likely systemic agent. However, the developmental processes targeted by florigen remained unknown. Here we identify local balances between SINGLE FLOWER TRUSS (SFT), the tomato precursor of florigen, and SELF-PRUNING (SP), a potent SFT-dependent SFT inhibitor as prime targets of mobile florigen. The graft-transmissible impacts of florigen on organ-specific traits in perennial tomato show that in addition to import by shoot apical meristems, florigen is imported by organs in which SFT is already expressed. By modulating local SFT/SP balances, florigen confers differential flowering responses of primary and secondary apical meristems, regulates the reiterative growth and termination cycles typical of perennial plants, accelerates leaf maturation, and influences the complexity of compound leaves, the growth of stems and the formation of abscission zones. Florigen is thus established as a plant protein functioning as a general growth hormone. Developmental interactions and a phylogenetic analysis suggest that the SFT/SP regulatory hierarchy is a recent evolutionary innovation unique to flowering plants.     

Plasma ferritin and type 2 diabetes mellitus: a critical review.

Multiple factors appear to be involved in the pathogenesis of type 2 (non insulin dependent) diabetes mellitus (DM). One of these factors may be iron overload. This critical review summarizes the major studies on the link between type 2 DM, insulin resistance, glycemic control, diabetic complications and hyperferritinemia. Although some studies suggested that plasma ferritin concentration is positively correlated with insulin resistance and with the risk of acquiring type 2 DM, substantial iron overload is not a typical feature of DM. There is no correlation between plasma ferritin level and glycemic control or diabetic microangiopathic complications.