Uszkodzenie chrząstki i kości w reumatoidalnym zapaleniu stawów
Data nadesłania: 21-02-2018
Data ostatniej rewizji: 10-04-2018
Data akceptacji: 17-04-2018
Data publikacji online: 09-05-2018
Data publikacji: 30-04-2018
Reumatologia 2018;56(2):111-120
Rheumatoid arthritis (RA), which is a chronic inflammatory disease with a multifactorial aetiology, leads to partial or permanent disability in the majority of patients. It is characterised by persistent synovitis and formation of pannus, i.e. invasive synovial tissue, which ultimately leads to destruction of the cartilage, subchondral bone, and soft tissues of the affected joint. Moreover, inflammatory infiltrates in the subchondral bone, which can lead to inflammatory cysts and later erosions, play an important role in the pathogenesis of RA. These inflammatory infiltrates can be seen in magnetic resonance imaging (MRI) as bone marrow oedema (BME). BME is observed in 68–75% of patients in early stages of RA and is considered a precursor of rapid disease progression. The clinical significance of synovitis and bone marrow oedema as precursors of erosions is well established in daily practice, and synovitis, BME, cysts, hyaline cartilage defects and bone erosions can be detected by ultrasonography (US) and MRI. A less explored subject is the inflammatory and destructive potential of intra- and extra-articular fat tissue, which can also be evaluated in US and MRI. Finally, according to certain hypotheses, hyaline cartilage damage may trigger synovitis and lead to irreversible joint damage, and MRI may be used for preclinical detection of cartilage biochemical abnormalities.
This review discusses the pathomechanisms that lead to articular cartilage and bone damage in RA, including erosion precursors such as synovitis and osteitis and panniculitis, as well as the role of imaging techniques employed to detect early cartilage damage and bone erosions.
Buchbender C, Ostendorf B, Mattes-György K, et al. Synovitis and bone inflammation in early rheumatoid arthritis: high-resolution multi-pinhole SPECT versus MRI. Diagn Interv Radiol 2013; 19: 20-24.
Sudoł-Szopińska I, Kontny E, Zaniewicz-Kaniewska K, et al. Role of inflammatory factors and adipose tissue in pathogenesis of rheumatoid arthritis and osteoarthritis. Part I: Rheumatoid adipose tissue. J Ultrason 2013; 13: 192-201.
Smolen JS, Aletaha D, Steiner G. Does damage cause inflammation? Revisiting the link between joint damage and inflammation. Ann Rheum Dis 2009; 68: 159-162.
Miese FR, Ostendorf B, Wittsack H-J, et al. Metacarpophalangeal Joints in Rheumatoid Arthritis: Delayed Gadolinium-enhanced MR Imaging of Cartilage – A Feasibility Study. Radiology 2010; 257: 441-447.
Narváez JA, Narváez J, De Lama E, et al. MR imaging of early rheumatoid arthritis. Radiographics 2010; 30: 143-163.
Sudoł-Szopińska I, Kontny E, Maśliński W, et al. The pathogenesis of rheumatoid arthritis in radiological studies. Part I: Formation of inflammatory infiltrates within the synovial membrane. J Ultrason 2012; 12: 202-213.
Hollander AP, Atkinst RM, Eastwoodt DM, et al. Human cartilage is degraded by rheumatoid arthritis synovial fluid but not by recombinant cytokines in vitro. Clin Exp Immunol 1991; 83: 52-57.
Gullick NJ, Evans HG, Church LD, et al. Linking power Doppler ultrasound to the presence of Th17 cells in the rheumatoid arthritis joint. PLoS One 2010; 5: e12516.
Bugatti S, Caporali R, Manzo A, et al. Involvement of subchondral bone marrow in rheumatoid arthritis: lymphoid neogenesis and in situ relationship to subchondral bone marrow osteoclast recruitment. Arthritis Rheum 2005; 52: 3448-3459.
Jimenez-Boy E, Redlich K, Türk B, et al. Interaction between synovial inflammatory tissue and bone marrow in rheumatoid arthritis. J Immunol 2005; 175: 2579-2588.
McQueen FM, Benton N, Perry D, et al. Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis.
Arthritis Rheum 2003; 48: 1814-1827.
Tamai I, Kawakami A, Uetani M, et al. A prediction rule for disease outcome in patients with undifferentiated arthritis using magnetic resonance imaging of the wrists and finger joints and serologic autoantibodies. Arthritis Rheum 2009; 61: 772-778.
Sudoł-Szopińska I, Kontny R, Maśliński W, et al. Significance of bone marrow edema in pathogenesis of rheumatoid arthritis. Pol J Radiol 2013; 78: 57-63.
Manara M, Varenna M. A clinical overview of bone marrow edema. Reumatismo 2014; 66: 184-196.
Ostendorf B, Peters R, Dann P, et al. Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints. Sensitive detection of morphologic changes in rheumatoid arthritis. Arthritis Rheum 2001; 44: 2492-2502.
Ostendorf B, Scherer A, Modder U, et al. Diagnostic value of magnetic resonance imaging of the forefeet in early rheumatoid arthritis when findings on imaging of the metacarpophalageal joints of the hands remain normal. Arthritis Rheum 2004; 50: 2094-2102.
McQueen FM, Ostendorf B. What is MRI bone oedema in rheumatoid arthritis and why does it matter? Arthritis Res Ther 2006; 8: 222-225.
Sudoł-Szopińska I, Zaniewicz-Kaniewska K, Warczyńska A, et al. Pathogenesis of rheumatoid arthritis in radiological studies. Part II: Imaging studies in rheumatoid arthritis. J Ultrason 2012; 12: 319-328.
Walsch DA. Angiogenesis and arthritis. Rheumatology 1999; 38: 103-112.
Clockaerts S, Bastiaansen-Jenniskens YM, Runhaar J, et al. The infrapatellar fat pad should be considered as an active osteoarthritic joint tissue: a narrative review. Osteoarthritis Cartilage 2010; 18: 876-882.
Ushiyama T, Chano T, Inoue K, et al. Cytokine production in the infrapatellar fat pad: another source of cytokines in knee synovial fluids. Ann Rheum Dis 2003; 62: 108-112.
Ostergaard M, Peterfy C, Conaghan P, et al. OMERACT rheumatoid arthritis magnetic resonance imaging studies: core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA MRI scoring system. J Rheumatol 2003; 30: 1385-1386.
Oei EHG, Tiel J, Robinson WH, et al. Quantitative radiologic imaging techniques for articular cartilage composition: toward early diagnosis and development of disease-modifying therapeutics for osteoarthritis. Arthritis Care Res (Hoboken) 2014; 66: 1129-1141.
Jungius K-P, Schmid MR, Zanetti M, et al. Cartilaginous defects of the femorotibial joint: accuracy of coronal short inversion time inversion-recovery MR sequence. Radiology 2006; 240: 482-488.
Gagliardi JA, Chung EM, Chandnani VP, et al. Detection and staging of chondromalacia patellae: relative efficacies of conventional MR imaging, MR arthrography, and CT arthrography. Am J Roentgenol 1994; 163: 629-636.
Matzat SJ, van Tiel J, Gold GE, et al. Quantitative MRI techniques of cartilage composition. Quant Imaging Med Surg 2013; 3: 162-174.
Bittersohl B, Miese FR, Hosalkar HS, et al. T2* mapping of hip joint cartilage in various histological grades of degeneration. Osteoarthritis Cartilage 2012; 20: 653-660.
Bittersohl B, Hosalkar HS, Sondern M, et al. Spectrum of T2* values in knee joint cartilage at 3 T: a cross-sectional analysis in asymptomatic young adult volunteers. Skeletal Radiol 2014; 43: 443-452.
Tiel J, Kotek G, Reijman M, et al. Is T1r Mapping an Alternative to Delayed Gadolinium-enhanced MR Imaging of Cartilage in the Assessment of Sulphated Glycosaminoglycan Content in Human Osteoarthritic Knees? An in Vivo Validation Study. Radiology 2016; 279: 523-531.
Schleich C, Müller-Lutz A, Sewerin P, et al. Intra-individual assessment of inflammatory severity and cartilage composition of finger joints in rheumatoid arthritis. Skeletal Radiol 2015; 44: 513-518.
Buchbender C, Scherer A, Kröpil P, et al. Cartilage quality in rheumatoid arthritis: comparison of T2* mapping, native T1 mapping, dGEMRIC, R1 and value of pre-contrast imaging. Skeletal Radiol 2012; 41: 685-692.
Bittersohl B, Hosalkar HS, Miese FR et al. Zonal T2* and T1Gd assessment of knee joint cartilage in various histological grades of cartilage degeneration: an observational in vitro study. BMJ Open 2015; 5: e006895.
Zilkens C, Miese FR, Crumbiegel C, et al. Magnetic resonance imaging and histology of ovine hip joint cartilage in two age populations: a sheep model with assumed healthy cartilage. Skeletal Radiol 2013; 42: 699-705.
Tiderius CJ, Sandin J, Svensson J, et al. Knee cartilage quality assessed with dGEMRIC in rheumatoid arthritis patients before and after treatment with a TNF inhibitor. Acta Radiol 2010; 51: 1034-1037.
Müller-Lutz A, Schleich C, Sewerin P, et al. Comparison of Quantitative and Semiquantitative Dynamic Contrast-Enhanced MRI With Respect to Their Correlation to Delayed Gadolinium-Enhanced MRI of the Cartilage in Patients With Early Rheumatoid Arthritis. J Comput Assist Tomogr 2015; 39: 64-69.
Miese F, Buchbender C, Scherer A, et al. Molecular Imaging of Cartilage Damage of Finger Joints in Early Rheumatoid Arthritis With Delayed Gadolinium-Enhanced Magnetic Resonance Imaging. Arthritis Rheum 2012; 64: 394-399.
Buchbender C, Sewerin P, Mattes-György K, et al. Utility of combined high-resolution bone SPECT and MRI for the identification of rheumatoid arthritis patients with high-risk for erosive progression. Eur J Radiol 2013; 82: 374-379.
Copyright: © Narodowy Instytut Geriatrii, Reumatologii i Rehabilitacji w Warszawie. This is an Open Access journal, all articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License (https://creativecommons.org/licenses/by-nc-sa/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.
Journals System - logo
Scroll to top