RESEARCH - Bone edema signals severe disease in early rheumatoid arthritis

[Guest guest]

Bone edema signals severe disease in early rheumatoid arthritis

By Reuters Health

January 1, 2008

NEW YORK (Reuters Health), Jan 1 - Bone edema seen on MRI reflects severe

disease in patients with early-stage rheumatoid arthritis (RA), according to

a report in the November issue of the Journal of Rheumatology.

" If physicians see early arthritis patients, we recommend the evaluation

with MRI of the patients, " Dr. Katsumi Eguchi from the Graduate School of

Biomedical Sciences, Nagasaki University, Japan told Reuters Health. " If the

patient has MRI-proven bone change (bone marrow edema and/or bone erosion),

early (aggressive) therapeutic regimes are recommended. "

Dr. Eguchi and colleagues assessed the significance of bone edema in

early-stage RA by evaluating MRI of wrist and finger sites of 80 patients

with early-stage RA.

The number of sites with bone edema correlated with the number of sites with

MRI synovitis and bone erosion, as well as with C-reactive protein, matrix

metalloproteinase (MMP)-3, and interleukin (IL)-6 levels, the authors

report.

Serum anti-CCP (citrullinated peptide) antibody positivity and titer and

Disease Activity Score 28-CRP were significantly higher in patients with MRI

bone edema, the report indicates.

The HLA-DRB1*0405 allele, the most frequently shared epitope in Japanese RA

patients, was more common in the patients with MRI bone edema than in

patients without MRI bone edema, the researchers note, and more patients

with bone edema than without bone edema were anti-CCP antibody positive.

" Our results suggest that bone edema in patients with early-stage RA

develops through an inflammatory synovial microenvironment with specific

HLA-antigen interaction, and our evaluation method for MRI may be an

alternative for the standard methods, " the authors conclude.

" Prediction of early (undifferentiated) arthritis patients is very

important, " Dr. Eguchi pointed out. " Clinical manifestations, as well as

autoantibodies (especially anti-CCP) and MRI features, are important in the

management of early (undifferentiated) arthritis patients. If you see bone

edema and anti-CCP in patients with early (undifferentiated) arthritis, we

recommend early DMARDs (especially methotrexate) therapy to the patients. "

By Will Boggs, MD

Last Updated: 2007-12-31 11:37:46 -0400 (Reuters Health)

J Rheumatol 2007;34:2154-2157.

http://www.auntminnie.com/index.asp?Sec=sup & Sub=mri & Pag=dis & ItemId=79482

Not an MD