C h allenge s i n I mag i n g i n P re c l i n i c a l R h e u m a t o i d Arthritis Daniel P. Marcusa,
BA,
Lisa A. Mandl,
MD, MPH*
KEYWORDS Imaging Preclinical Inflammatory arthritis KEY POINTS Imaging can identify evidence of synovitis in patients with autoimmunity without clinical arthritis. Imaging could be used to risk-stratify patients most at risk of progressing to rheumatoid arthritis. More work needs to be done in evaluating and comparing different imaging modalities.
INTRODUCTION
Rheumatoid arthritis (RA) is an autoimmune disease affecting up to 1% of the developed world’s population.1 Because early treatment can limit joint erosion and impede disease progression, it has been important to detect clinical RA at its earliest presentation and to treat with disease-modifying therapy (DMARDs) or biological therapy early, as it has been convincingly shown that delaying therapy in RA patients leads to worse outcomes.2 This aspect has led investigators to hypothesize that there may be an even earlier point in RA pathogenesis, when there is evidence of autoimmunity but not yet any evidence of clinical arthritis, and when treatment may be able to abort overt manifestations of the disease altogether (Fig. 1).3 Imaging, therefore, would play a crucial role in identifying preclinical RA patients from those with noninflammatory arthralgias and myalgias. Does the Preclinical Phase of Rheumatoid Arthritis Exist?
There is clear evidence that preclinical RA exists. Kraan and colleagues4 have studied the synovial tissue from patients with RA and have found that synovial tissue from
The authors declare no financial or other conflict of interests pertaining to the article, and the funding agencies had no influence into the study design, results, or content of the article. Department of Medicine, Hospital for Special Surgery, 535 E70th Street, New York City, NY 10021, USA * Corresponding author. E-mail address: [email protected] Rheum Dis Clin N Am 40 (2014) 727–734 http://dx.doi.org/10.1016/j.rdc.2014.07.014 rheumatic.theclinics.com 0889-857X/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
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Marcusa & Mandl
Fig. 1. Pathogenesis of rheumatoid arthritis (RA). (From van Steenbergen HW, Huizinga TW, van der Helm-van Mil AH. The preclinical phase of rheumatoid arthritis, what is acknowledged and what needs to be assessed? Arthritis Rheum 2013;65:2219–32; with permission.)
clinically uninvolved knee joints shows infiltration with macrophages and expresses macrophage-derived cytokines. In addition, the uninvolved knee had significantly higher CD681 macrophages when compared with tissue biopsies from control patients without RA (P
BA,
Lisa A. Mandl,
MD, MPH*
KEYWORDS Imaging Preclinical Inflammatory arthritis KEY POINTS Imaging can identify evidence of synovitis in patients with autoimmunity without clinical arthritis. Imaging could be used to risk-stratify patients most at risk of progressing to rheumatoid arthritis. More work needs to be done in evaluating and comparing different imaging modalities.
INTRODUCTION
Rheumatoid arthritis (RA) is an autoimmune disease affecting up to 1% of the developed world’s population.1 Because early treatment can limit joint erosion and impede disease progression, it has been important to detect clinical RA at its earliest presentation and to treat with disease-modifying therapy (DMARDs) or biological therapy early, as it has been convincingly shown that delaying therapy in RA patients leads to worse outcomes.2 This aspect has led investigators to hypothesize that there may be an even earlier point in RA pathogenesis, when there is evidence of autoimmunity but not yet any evidence of clinical arthritis, and when treatment may be able to abort overt manifestations of the disease altogether (Fig. 1).3 Imaging, therefore, would play a crucial role in identifying preclinical RA patients from those with noninflammatory arthralgias and myalgias. Does the Preclinical Phase of Rheumatoid Arthritis Exist?
There is clear evidence that preclinical RA exists. Kraan and colleagues4 have studied the synovial tissue from patients with RA and have found that synovial tissue from
The authors declare no financial or other conflict of interests pertaining to the article, and the funding agencies had no influence into the study design, results, or content of the article. Department of Medicine, Hospital for Special Surgery, 535 E70th Street, New York City, NY 10021, USA * Corresponding author. E-mail address: [email protected] Rheum Dis Clin N Am 40 (2014) 727–734 http://dx.doi.org/10.1016/j.rdc.2014.07.014 rheumatic.theclinics.com 0889-857X/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.
728
Marcusa & Mandl
Fig. 1. Pathogenesis of rheumatoid arthritis (RA). (From van Steenbergen HW, Huizinga TW, van der Helm-van Mil AH. The preclinical phase of rheumatoid arthritis, what is acknowledged and what needs to be assessed? Arthritis Rheum 2013;65:2219–32; with permission.)
clinically uninvolved knee joints shows infiltration with macrophages and expresses macrophage-derived cytokines. In addition, the uninvolved knee had significantly higher CD681 macrophages when compared with tissue biopsies from control patients without RA (P
![[Challenges in Older Patients with Rheumatoid Arthritis].](/assets/img/hold.png)
