Moderne Bildgebung in der Diagnostik der frühen Arthritis

Zusammenfassung

Neben dem Erreichen der klinischen Remission – durch frühzeitige antirheumatische Therapie induziert – gilt inzwischen auch das Ziel, die radiologische Progression aufzuhalten, um beim Patienten so Funktionalität und Arbeitsunfähigkeit zu erhalten, Lebensqualität zu verbessern und zuletzt kumulative Kosten signifikant zu reduzieren. Sowohl die Anamnese als auch die klinische Untersuchung sind unabdingbare Voraussetzung, können aber subklinische Entzündung vor allem bei Patienten mit schleichendem Beginn, ohne systemische Entzündung und geringer Krankheitsaktivität bei Erstvorstellung übersehen. Moderne bildgebende Verfahren wie die hochauflösende Arthrosonografie, Magnetresonanztomografie sowie Hybrid- und fluoreszenzoptische Verfahren können entzündliche Veränderungen sehr früh und sicher erfassen und so einen Beitrag zur frühzeitigen Diagnose bzw. strukturelle Diagnoseabsicherung leisten. Auf diese Weise können sie helfen, die gewünschte moderne Behandlungsstrategie zu gewährleisten.

Summary

Next to clinical remission, due to early antirheumatic therapy, one of our treatment targets is to stop radiological progression. Functional ability and workability in common with better life quality may be received and at least the costs for the public health system reduced. Careful history taking and clinical examination (CE) are crucial, but may miss subclinical inflammation particularly in subjects with insidious onset, any systemic signs of inflammation and low disease activity at presentation. Modern imaging technologies like arthrosonography, magnetic resonance imaging as well as hybrid technologies and fluorescence optical imaging are able to detect subclinical signs of inflammation early and sensitive. Due to this fact, they could help to assure diagnoses and ensure modern treatment paradigms.

Schlüsselwörter

Frühe Arthritis - Bildgebung - Arthrosonografie - MRT - fluoreszenzoptische Bildgebung

Keywords

Early arthritis - imaging - arthrosonography - MRI - fluorescence optical imaging

• Literatur

• 1 Aletaha D. et al. 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Ann Rheum Dis 2010; 69 (09) 1580-1588.
• 2 Combe B. et al. EULAR recommendations for the management of early arthritis: report of a task force of the European Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis 2007; 66 (01) 34-45.
• 3 Luqmani R. et al. British Society for Rheumatology and british health professionals in Rheumatology guideline for the management of rheumatoid arthritis (the first two years). Rheumatology (Oxford) 2006; 45 (09) 1167-1169.
• 4 Saag KG. et al. American College of Rheumatology 2008 recommendations for the use of nonbiologic and biologic disease-modifying antirheumatic drugs in rheumatoid arthritis. Arthritis Rheum 2008; 59 (06) 762-784.
• 5 Smolen JS. et al. Treating rheumatoid arthritis to target: recommendations of an international task force. Ann Rheum Dis 2010; 69: 631-637.
• 6 Hartung W. et al. Development and Evaluation of a Novel Ultrasound Score for Large Joints in Rheumatoid Arthritis: One Year of Experience in Daily Clinical Practice. Arthritis Care & Research 2012; 64: 675-682.
• 7 Backhaus M. et al. Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis Rheum 2009; 61: 1194-1201.
• 8 Konermann W, Gruber G. Ultraschalldiagnostik der Stütz- und Bewegungsorgane nach den Richtlinien der DEGUM. Stuttgart: Thieme; 2000
• 9 Backhaus M. et al. Guidelines for musculoskeletal ultrasound in rheumatology. Ann Rheum Dis 2001; 60: 641-649.
• 10 Backhaus M. et al. Arthritis of the finger joints: a comprehensive approach comparing conventional radiography, scintigraphy, ultrasound, and contrast-enhanced magnetic resonance imaging. Arthritis Rheum 1999; 42: 1232-1245.
• 11 Backhaus M. et al. Prospective two year follow up study comparing novel and conventional imaging procedures in patients with arthritic finger joints. Ann Rheum Dis 2002; 61: 895-904.
• 12 Scheel AK. et al. Prospective 7 year follow-up imaging study comparing radiography, ultrasonography and magnetic resonance imaging in rheumatoid arthritis finger joints. Ann Rheum Dis 2006; 65 (05) 595-600.
• 13 Alasaarela E. et al. Evaluation of humeral head erosions in rheumatoid arthritis: A comparison of sonography, magnetic resonance imaging, computerised tomography and plain radiography. Br J Rheumatol 1998; 37: 1152-1156.
• 14 Szkudlarek M. et al. Ultrasonography of the ra finger joints is more sensitive than conventional radiography for detection of erosions without loss of specificity, with MRI as a reference method. Ann Rheum Dis 2004; 63 (Suppl. 01) 82-83.
• 15 Wakefield RJ. et al. The value of sonography in detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 2000; 43 (12) 2762-2770.
• 16 Szkudlarek M. et al. Power Doppler ultrasonography for assessment of synovitis in the metacarpophalangeal joints of patients with rheumatoid arthritis: a comparison with dynamic magnetic resonance imaging. Arthritis Rheum 2001; 44: 2018-2023.
• 17 Terslev L. et al. Doppler ultrasound and magnetic resonance imaging of synovial inflammation of the hand in rheumatoid arhtritis: a comparative study. Arthritis Rheum 2003; 48 (09) 2434-2441.
• 18 Backhaus M. et al. Technik und Stellenwert in der Arthrosonographie in der rheumatologischen Diagnostik – Teil 6: Sonographie der Hand- und Fingergelenke. Z Rheumatol 2002; 61: 674-687.
• 19 Ribbens C. et al. Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study. Radiology 2003; 229: 562-569.
• 20 Walther M. et al. Correlation of power Doppler sonography with vascularity of the synovial tissue of the knee joint in patients with osteoarthritis and rheumatoid arthritis. Arthritis Rheum 2001; 44: 331-338.
• 21 McQueen F. et al. Magnetic resonance imaging of the wrist in early rheumatoid arthrits reveals a high prevalence of erosions at four months after symptom onset. Ann Rheum Dis 1998; 57: 350-356.
• 22 Brown AK. et al. An explanation for the apparent dissociation between clinical remission and continued structural deterioration in rheumatoid arthritis. Arthritis Rheum 2008; 58: 2958-2967.
• 23 Gandjbakhch F. et al. Synovitis and osteitis are very frequent in rheumatoid arthritis clinical remission: results from an MRI study of 294 patients in clinical remission or low disease activity state. J Rheumatol 2011; 38: 2039-2044.
• 24 Ostendorf B. et al. Imaging techniques in rheumatology: magnetic resonance imaging in rheumatoid arthritis. Z Rheumatol 2003; 62: 274-286.
• 25 Ostendorf B. et al. Early detection of bony alterations in rheumatoid and erosive arthritis of finger joints with high-resolution single photon emission computed tomography, and differentiation between them. Skeletal Radiol 2010; 39: 55-61.
• 26 Miese F. 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.
• 27 Ostergaard M. 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.
• 28 Dohn UM. et al. Detection of bone erosions in rheumatoid arthritis wrist joints with magnetic resonance imaging, computed tomography and radiography. Arthritis Res Ther 2008; 10: R25.
• 29 Duer-Jensen A. et al. Detection of rheumatoid arthritis bone erosions by two different dedicated extremity MRI units and conventional radiography. Ann Rheum Dis 2008; 67: 998-1003.
• 30 Ostendorf B. et al. Diagnostic Value of Magnetic Resonance Imaging of the Forefeet in Early Rheumatoid Arthritis When Findings on Imaging of Metacarpophalangeal Joints of the Hand Remain Normal. Arthritis Rheum 2004; 50 (07) 2094-2102.
• 31 McQueen FM, Ostendorf B. What is MRI bone oedema in rheumatoid arthritis and why does it matter?. Arthritis Res Ther 2006; 8: 222.
• 32 McQueen FM. et al. 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. Ann Rheum Dis 2007; 66: 1581-1587.
• 33 Jimenez-Boj E. et al. Bone erosions and bone marrow edema as defined by magnetic resonance imaging reflect true bone marrow inflammation in rheumatoid arthritis. Arthritis Rheum 2007; 56: 1118-1124.
• 34 Haavardsholm EA. et al. Magnetic resonance imaging findings in 84 patients with early rheumatoid arthritis: bone marrow oedema predicts erosive progression. Ann Rheum Dis 2008; 67 (06) 794-800.
• 35 Tamai M. et al. The presence of anti-cyclic citrullinated peptide antibody is associated with magnetic resonance imaging detection of bone marrow oedema in early stage rheumatoid arthritis. Ann Rheum Dis 2006; 65: 133-134.
• 36 Miese FR. et al. Metacarpophalangeal joints in rheumatoid arthritis: delayed gadolinium-enhanced MR imaging of cartilage--a feasibility study. Radiology 2010; 257: 441-447.
• 37 Michaely HJ. et al. Nephrogenic systemic fibrosis (NSF) – implications for radiology. Radiologe 2007; 47: 785-793.
• 38 Boss A. et al. Magnetic resonance spin-labeling perfusion imaging of synovitis in inflammatory arthritis at 3.0 T. MAGMA 2009; 22: 175-180.
• 39 Sandrock D. et al. Imaging techniques in rheumatology: scintigraphy in rheumatoid arthritis. Z Rheumatol 2003; 62: 476-480.
• 40 Miese F. et al. Hybrid 18F-FDG PET-MRI of the hand in rheumatoid arthritis: initial results. Clin Rheumatol 2011; 30: 1247-1250.
• 41 Werner SG. et al. Inflammation assessment in patients with arthritis using a novel in vivo fluorescence optical imaging technology. Ann Rheum Dis 2012; 71 (04) 504-510.
• 42 Werner SG. et al. Comparison of Xiralite with Clinical Examination and MRI. Ann Rheum Diss 2011; 70 (Suppl. 03) 555.
• 43 Werner SG. et al. Sensitivity and Specificity of ICGenhanced Optical Imaging (Xiralite) in Comparison to MRI and Ultrasonography. Arthritis Rheum. 2011 63. (Suppl 10).
• 44 Werner SG. et al. Indocyanine Green Enhanced Optical Imaging Using for Monitoring of Treatment Response. Arthritis Rheum. 2011 63. (Suppl 10).
• 45 Werner SG. et al. ICG-Enhanced Fluorescence Optical Imaging in Clinical Remission: Longitudinal Data in RA and PSA Patients with Pre/Post Comparisons. Ann Rheum Dis 2012; 71 (Suppl. 03) 605.
• 46 Werner SG. et al. Semiquantitative Assessment of Inflammation in Arthritis Patients with Indocyanin Green Enhanced Optical Imaging Using for Monitoring of Treatment Response. Ann Rheum Dis 2012; 71 (Suppl. 03) 712.
• 47 Spiecker F. et al. ICG-enhanced Fluorescence Optical Imaging Reveals Subclinical Disease Activity in Rheumatoid and Psoriatic Arthritis Patients who have Achieved Clinical Remission. Ann Rheum Dis 2012; 71 (Suppl. 03) 298.
• 48 Totterman SM. Magnetic resonance imaging of psoriatic arthritis: insight from traditional and three-dimensional analysis. Curr Rheumatol Rep 2004; 6: 317-321.
• 49 Haavardsholm EA. et al. Monitoring anti-TNFalpha treatment in rheumatoid arthritis: responsiveness of magnetic resonance imaging and ultrasonography of the dominant wrist joint compared with conventional measures of disease activity and structural damage. Ann Rheum Dis 2009; 68 (10) 1572-1579.
• 50 Hammer HB, Kvien TK. Comparisons of 7- to 78-joint ultrasonography scores: all different joint combinations show equal response to adalimumab treatment in patients with rheumatoid arthritis. Arthritis Res Ther 2011; 13 (03) R78.
• 51 Hodgson RJ. et al. MRI of rheumatoid arthritis image quantitation for the assessment of disease activity, progression and response to therapy. Rheumatology 2008; 47: 13-21.
• 52 Brown AK. et al. Presence of significant synovitis in rheumatoid arthritis patients with disease-modifying antirheumatic drug-induced clinical remission: evidence from an imaging study may explain structural progression. Arthritis Rheum 2006; 54: 3761-3773.
• 53 www.nice.org/nicemedia/live/11141/31257/31257.pdf [online]
• 54 Haruna M. et al. Blood volume measurement at the bedside using ICG pulse spectrophotometry. Anesthesiology 1998; 89 (06) 1322-1328.
• 55 Østergaard M. 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 (06) 1385-1386.
• 56 Szkudlarek M. et al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003; 48 (04) 955-962.
• 57 Ohrndorf S. et al. Is Musculoskeletal Ultrasonography an Operator-Dependent Method or a Fast and Reliabley Teachalbe Diagnostic Tool? Interreader Agreements of Three Ultrasonographers with Different Training Levels. Int J of Rheumatol 2010; 164518 Epub 2010 Dec 9.
• 58 Lassere M. et al. OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 3: an international multicenter reliability study using the RA-MRI Score. J Rheumatol 2003; 30 (06) 1366-1375.
• 59 Werner SG. et al. Entwicklung einer standardisierten Bildanalyse für das Xiralite-Verfahren und Intrasowie Interreader-Reliabilität. Z Rheumatol 2011; 70 (Suppl. 01) 1-119.
• 60 Werner SG. et al. Interreader-Reliability of Standardized Evaluation of ICG-Enhanced Fluorescence-Optical Imaging. Ann Rheum Dis 2012; 71 (Suppl. 03) 613.