Rheumatoid Arthritis: Freeston JE

Freeston JE, Bird P, Conaghan PG. · Chapel Allerton Hospital, University of Leeds, UK. · Curr Opin Rheumatol. · Pubmed #19339918 No free full text.

Abstract: PURPOSE OF REVIEW: This review describes the important role of MRI in rheumatoid arthritis (RA), exploring recent reliability and validity work, as well as the current use of MRI in clinical trials and practice. RECENT FINDINGS: Both bone oedema and erosions on MRI have been confirmed as representing osteitis and cortical bone defects, respectively, adding to what was already known about the validity of contrast enhanced synovium representing synovitis. An increasing number of studies have used MRI as an outcome measure with interest moving from disease-modifying antirheumatic drugs (DMARDs) to biological therapies and a more technical focus on dynamic imaging. In addition, low-field extremity MRI has been developed as a well tolerated, comfortable and convenient method for imaging assessment in clinical practice. SUMMARY: This review has highlighted both recent research advances as well as the future potential for MRI in RA, with the aim that MRI will become part of standard measures for RA clinical trials. With respect to extremity imaging, further work is required to provide useful clinical algorithms.

Wakefield RJ, Freeston JE, Hensor EM, Bryer D, Quinn MA, Emery P. · Chapel Allerton Hospital, Leeds, UK. · Arthritis Rheum. · Pubmed #18050231 links to  free full text

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Olech E, Freeston JE, Conaghan PG, Hensor EM, Emery P, Yocum D. · University of Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma 73104, USA. · J Rheumatol. · Pubmed #18322995 No free full text.

Abstract: OBJECTIVE: To identify the optimal combination for detecting erosions in early rheumatoid arthritis using extremity magnetic resonance imaging (eMRI). METHODS: In 44 patients, eMRI of 1 hand identified 77% who were erosive, 2 hands 89%, and 2 hands and feet 91%. RESULTS: eMRI identified 4 times as many erosions as radiography. At 6 months, eMRI of 1 hand identified an increase in erosions in 50% subjects, 2 hands in 55%, and 2 hands and feet in 55%. When only subjects with a change in erosion score above the smallest detectable difference were considered, these numbers were 30%, 25%, and 20%, respectively. CONCLUSION: eMRI provides superior erosion identification compared to radiography. Imaging 2 hands can be used as a screening tool and 1 hand to monitor erosions over time.

Wakefield RJ, Freeston JE, O'Connor P, Reay N, Budgen A, Hensor EM, Helliwell PS, Emery P, Woodburn J. · Academic Unit of Musculoskeletal Disease, Chapel Allerton Hospital, Chapeltown Road, Leeds, LS7 4SA, UK. · Ann Rheum Dis. · Pubmed #18258710 No free full text.

Abstract: OBJECTIVES: The aim of this pilot study was to compare clinical examination (CE) and ultrasound (US) with high field MRI (as the reference standard) for the detection of rearfoot and midtarsal joint synovitis and secondly tenosynovitis of the ankle tendons in patients with established rheumatoid arthritis (RA). METHODS: Patients with RA (as determined by the modified American College of Rheumatology (ACR) criteria) with symptoms of midfoot and rearfoot disease were recruited. Demographic data were collected. All underwent CE, US and high field MRI (with intravenous gadolinium contrast) of their right foot. Percentage exact agreement (PEA), sensitivity and specificity were calculated for CE and US when compared to MRI. Inter-reader reliability for CE and US was also assessed. RESULTS: Compared to the gold standard of MRI, for CE (joint synovitis) the ranges for sensitivity, specificity and PEA were 55-83%, 23-46% and 46-60%, and for US were 64-89%, 60-80% and 64-78%, respectively. Compared to the gold standard of MRI, for CE (tenosynovitis) the ranges for sensitivity, specificity and PEA were 0-100%, 20-91% and 55-91%, and for US were 0-67%, 86-100% and 59-86%, respectively. CONCLUSION: CE was sensitive but US more specific in identifying hindfoot pathology in RA when compared to the reference standard of MRI. There was poor interobserver variability between ultrasonographers suggesting a need for standardisation of acquisition and interpretation of US images of the hindfoot.

Freeston JE, Conaghan PG, Dass S, Vital E, Hensor EM, Stewart SP, Emery P. · Academic Unit of Musculoskeletal Disease, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK. · Ann Rheum Dis. · Pubmed #17666445 No free full text.

Abstract: BACKGROUND: Long-standing rheumatoid arthritis produces unique challenges when assessing damage due to joint deformity. The use of extremity magnetic resonance imaging (eMRI) offers the possibility of improved disease assessment because of greater patient tolerability. OBJECTIVES: The aim of this cross-sectional study was to compare the identification of wrist erosions in a severe rheumatoid arthritis cohort by eMRI with a restricted field of view (eMRI-RV) to radiography and high field MRI, using the latter as the reference. METHODS: Fifteen patients (87% female, median age 56 years) with active rheumatoid arthritis (median DAS28 7.01 and disease duration 11 years) on leflunomide were enrolled. Radiography of hands, eMRI-RV (0.2 T MagneVu MV 1000) and high field MRI of unilateral wrist joints were performed. RESULTS: Of 86 comparable wrist joint areas, high field MRI identified 70 erosions, eMRI-RV 32 and radiography 4. With high field MRI considered the reference, the sensitivity, specificity and accuracy of eMRI-RV for erosions were 46%, 94% and 55%, and the corresponding values for x ray were 6%, 100% and 23%, respectively. CONCLUSIONS: In severely damaged rheumatoid arthritis joints, sensitivity of erosion detection was markedly higher for eMRI-RV than radiography, using high field MRI as the reference. eMRI-RV was, however, less sensitive than high field MRI.

Freeston JE, Olech E, Yocum D, Hensor EM, Emery P, Conaghan PG. · Academic Unit of Musculoskeletal Disease, Chapel Allerton Hospital, Chapeltown Road, Leeds LS7 4SA, UK. · Ann Rheum Dis. · Pubmed #17616555 No free full text.

Abstract: OBJECTIVES: To develop and test the reliability of a modified version of the OMERACT rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for erosions using extremity MRI (eMRI) with reduced field of view (RAMRIS-RV). METHODS: Using a MagneVu 0.2 T machine, the preliminary RAMRIS-RV assessed erosions in metacarpophalangeal (MCP) joints 2-3, bases of metacarpal (MC) 2-5, and all wrist bones excluding base MC 1, pisiform and trapezium. T1 weighted images of >/=500 MCP and wrist bony sites from a mixed severity RA and control cohort were evaluated. An inter-reader reliability study evaluating 300 wrist and 160 MCP bony sites was then performed. RESULTS: Mean per cent exact (and close) agreement results were as follows: MCP proximal sites 83.5 (96.2), MCP distal 54.4 (77.2), bases MC 2-4 85.2 (96.7), carpal bones 79.0 (92.1), distal radius/ulna 66.4 (87.8). The base of MCP 5 was visualised in </=50% cases (13/25) and was removed from the final RAMRIS-RV. CONCLUSIONS: The RAMRIS-RV is a practical tool that can be used with eMRI with a reduced field of view. This study shows excellent inter-reader reliability for erosion assessment, albeit in a reduced number of bony sites.

Freeston JE, Brown AK, Hensor EM, Emery P, Conaghan PG. · No affiliation provided · Ann Rheum Dis. · Pubmed #18697780 No free full text.

This publication has no abstract.