Rheumatoid Arthritis: Boutry N

Boutry N, Morel M, Flipo RM, Demondion X, Cotten A. · Department of Musculoskeletal Radiology, Centre Hospitalier Universitaire de Lille and Hôpital Roger Salengro, CHRU de Lille, Blvd. du Pr. J Leclercq, 59037 Lille, France. · AJR Am J Roentgenol. · Pubmed #18029892 links to  free full text

Abstract: OBJECTIVE: The introduction of anti-tumor necrosis factor alpha agents has opened new prospects in therapeutic management of patients with early rheumatoid arthritis, thereby creating new demands on radiologists to identify patients with aggressive disease at an early stage. As a result, imaging techniques such as MRI and sonography have developed during the past few years. CONCLUSION: This article illustrates the imaging findings that may be encountered with these techniques in patients with early rheumatoid arthritis.

Boutry N, Hachulla E, Zanetti-Musielak C, Morel M, Demondion X, Cotten A. · Department of Musculoskeletal Radiology, Hôpital Roger Salengro, CHRU de Lille, Boulevard du Pr. J Leclercq, 59037, Lille Cedex, France. · Eur Radiol. · Pubmed #17021702 No free full text.

Abstract: This article describes the radiographic, sonographic and magnetic resonance (MR) features of musculoskeletal involvement in patients with systemic sclerosis (SSc). Conventional radiography is the traditional method of detecting digital calcifications, but ultrasonography (US) is also able to detect such calcifications before they appear on radiographs. MR imaging can be used to diagnose overlapping conditions (i.e., SSc and myositis or SSc and rheumatoid arthritis), and less frequently, to reveal neurologic complications of SSc. In patients with vascular ulcers, MR angiography is able to depict decreased flow within collateral digital arteries.

Boutry N, Lardé A, Demondion X, Flipo RM, van Holsbeeck M, Cotten A. · Département de Radiologie Ostéo-Articulaire, Hôpital Roger Salengro, CHRU de Lille, Boulevard du Pr. J Leclercq, 59037 Lille Cedex. · J Radiol. · Pubmed #12910171 links to  free full text

Abstract: Technological advances in the field of ultrasound imaging may have, especially in metacarpophalangeal joints, an impact on decision making in patients with early rheumatoid arthritis. First, the normal anatomy of the metacarpophalangeal joints is briefly reviewed. Then, the authors describe the main ultrasound imaging findings of early RA. The role of ultrasound imaging in the assessment of therapeutic response as well as the benefit of microbubble ultrasound contrast agents are considered.

Cotten A, Demondion X, Boutry N, Chastanet P, Delfaut E. · Service de Radiologie Ostéo-Articulaire, Hôpital R. Salengro, Bd du professeur J Leclerc, 59037 Lille Cedex. · J Radiol. · Pubmed #10930881 links to  free full text

Abstract: The purpose of this paper is to present the contribution of imaging in the assessment of synovial diseases, especially in the differentiation between infectious synovitis and rheumatoid arthritis, and in the diagnosis of tumoral and pseudotumoral synovial lesions (idiopathic (osteo)chondromatosis, pigmented villonodular synovitis, synovial hemangioma, lipoma arborescens...).

Boutry N, Lardé A, Lapègue F, Solau-Gervais E, Flipo RM, Cotten A. · Department of Musculoskeletal Radiology, Hopital Roger Salengro, Lille, France. · J Rheumatol. · Pubmed #12672183 No free full text.

Abstract: OBJECTIVE: To describe the magnetic resonance (MRI) imaging findings of the feet in patients with early rheumatoid arthritis (RA), and to compare MRI appearance of the feet with that of the hands. METHODS: Thirty consecutive patients (18 women, 12 men; age range 19-64 yrs) with early RA underwent MRI of hands and feet. Axial fat suppressed gadolinium enhanced T1 weighted spin-echo and gadolinium enhanced 3-dimensional gradient-echo (FLASH) images were obtained. RESULTS: In the hands, MRI findings suggested active synovitis of the wrist and metacarpophalangeal (MCP) joints in 28 (93%) and 27 (90%) patients, respectively. In the feet, active synovitis was observed in 29 (97%) patients. Bone erosions were seen in the wrist joints in 24 (80%) patients. Observers found as many bony changes in the MCP as in the metatarsophalangeal joints [23 (77%) patients]. MRI detected tenosynovitis in 16 (53%) patients in the hands, and in 18 (60%) patients in the feet. Bursitis located between or beneath the metatarsal heads was a common MRI finding [19 (63%) patients]. CONCLUSION: Additional MRI of the feet may be useful when evaluation of the hands does not help identify early RA.

Boutry N, Flipo RM, Cotten A. · Department of Musculoskeletal Radiology, Hôpital Roger Salengro, CHRU de Lille, Lille Cedex, France. · Semin Musculoskelet Radiol. · Pubmed #16247721 No free full text.

Abstract: Although conventional radiographs remain the initial mainstay for imaging of the foot in patients with rheumatoid arthritis (RA), magnetic resonance (MR) imaging has afforded the ability to detect early signs of the disease (i.e., synovitis, tenosynovitis, bone lesions, and bursitis), especially at the forefoot. In addition, the relatively symmetric distribution of the imaging abnormalities depicted in the metatarsophalangeal joints and the frequent involvement of the retro-calcaneal bursitis are almost specific for RA. In more advanced stages of the disease, MR imaging is well suited to evaluation of the hindfoot joints and tendons as well as the musculoskeletal complications of RA (e.g., tendon disruption, rheumatoid nodules, sinus tarsi syndrome).

Boutry N, Hachulla E, Flipo RM, Cortet B, Cotten A. · Department of Musculoskeletal Radiology, Unité de Recherche de l'Appareil Locomoteur, Hôpital Roger Salengro, Centre Hospitalier Régional Universitaire de Lille, Blvd du Professeur Leclercq, 59037 Lille CEDEX, France. · Radiology. · Pubmed #15972342 links to  free full text

Abstract: PURPOSE: To evaluate prospectively the use of magnetic resonance (MR) imaging for differentiating true rheumatoid arthritis (RA) from systemic lupus erythematosus (SLE) or primary Sjögren syndrome in patients who have inflammatory polyarthralgia of the hands but no radiographic evidence of RA. MATERIALS AND METHODS: This study had institutional review board approval, and patient informed consent was obtained. Twenty-eight patients (16 female and 12 male patients; mean age, 42 years) with early RA and 19 patients (18 female and one male patient; mean age, 46 years) with SLE (n = 14) or primary Sjögren syndrome (n = 5) underwent MR imaging of both hands. All patients had inflammatory polyarthralgia of the hands and no evidence of erosive changes on radiographs. Coronal T2-weighted short inversion time inversion-recovery, transverse T1-weighted spin-echo, transverse fat-suppressed gadolinium-enhanced T1-weighted spin-echo, and transverse gadolinium-enhanced three-dimensional gradient-echo MR images were obtained. The following MR imaging variables were assessed in the wrist and nonthumb metacarpophalangeal joints: synovitis, bone lesions (erosion, defect, and edema), and tenosynovitis. Synovitis and bone lesions were scored with the OMERACT RA-MRI scoring system. Findings in patients with RA and those without RA were compared by means of Mann-Whitney, chi2, and Fisher exact tests. RESULTS: The only significant difference between the two groups in terms of individual scores for synovitis, bone lesions, and tenosynovitis was the more frequent presence of tenosynovitis of the right fourth extensor tendon in patients without RA (P = .04). There were no significant differences between patients with RA and those without RA in terms of global scores for synovitis, bone lesions, and tenosynovitis. However, bone marrow edema in the metacarpophalangeal joints was seen more frequently in patients with RA (P < .001). CONCLUSION: It may be impossible to distinguish between patients with early RA and those without RA (ie, those with SLE or primary Sjögren syndrome) by means of MR imaging.