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Abstract Number: 1307

Anatomical Patterns Suggest the Involvement of Biomechanical Stress in the Pathogenesis of Erosions in Rheumatoid Arthritis

Matthew A. Jessome1, Michael A. Tomizza1, Karen A. Beattie2, William G. Bensen2, Raja S. Bobba2, Alfred Cividino2, Patrick D. Emond2, Chris Gordon2, Lawrence Hart2, Maggie Larche2, Arthur Lau3, Ruben Tavares2, Stephen Tytus2 and Jonathan D. Adachi2, 1Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada, 2St Joseph's Healthcare Hamilton, Hamilton, ON, Canada, 350 Charlton Avenue East, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Biomechanics, Bone, joint damage and pathogenesis, MRI

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Session Information

Date: Monday, November 14, 2016

Title: Imaging of Rheumatic Diseases - Poster II: XR/CT/PET/MRI

Session Type: ACR Poster Session B

Session Time: 9:00AM-11:00AM

Background/Purpose: There is limited data outlining the anatomic characteristics of bone erosions of the small joints in rheumatoid arthritis (RA). In particular, there is minimal utilization of 3-dimensional imaging modalities, such as magnetic resonance imaging (MRI) for the purpose of describing erosion patterns in the metacarpophalangeal (MCP) joints. This is of particular interest for understanding the role of biomechanical forces exerted by the adjacent anatomy in contributing to erosion initiation and progression. Our objective was to describe the anatomical features of erosions in the MCP joints to explore the importance of biomechanical stress in erosion pathogenesis.

Methods: MR images of the 2nd through 5th MCP joints were acquired bilaterally from 22 patients who met early referral criterial for RA. Maximum depth and width of erosions were determined using the semi-automated segmentation software Early Erosions in Rheumatoid Arthritis (EERA). Anatomical features were recorded, including: affected hand and MCP joint, metacarpal head vs. phalangeal base involvement, radial- vs. ulnar-sided cortical breakage, and palmar vs. dorsal cortical breakage. One-way ANOVA was used to compare means across groups. Bivariate correlation between maximum erosion depth and width was calculated as an estimate of erosion geometric sphericity.

Results: Patients were 91% female with mean (SD) age of 55.9 (9.3) years, symptom duration of 4.8 (5.3) years, and disease activity score of 4.8 (1.5). Thirty right-handed and 19 left-handed erosions were identified; all involved the metacarpal head, with none involving the phalangeal base. Erosion frequencies across MCP joints 2 through 5 were: 15, 22, 7 and 5 erosions, respectively. Radial-sided cortical breakage was observed in 42 (86%) erosions, and ulnar-sided breakage was observed in 4 (8%) erosions, 3 of which were on the 5th metacarpal. Palmar cortical breakage was observed in 3 (6%) erosions, and dorsal breakage was observed in 1 (2%) erosion. Mean (SD) maximum erosion depth and width were 4.3 (1.5) mm and 4.6 (2.1) mm, respectively. Maximum depth and width correlated moderately, Pearson’s r = 0.51 (p < 0.05), and with the exclusion of one large erosion outlier, only correlated weakly, r = 0.36 (p < 0.05). Neither erosion depth nor width were significantly associated with MCP joint number, or location of cortical break (p > 0.05 for all comparisons).

Conclusion: Predominance of erosions on the right (mostly dominant) hand, 2nd and 3rd MCP joints (higher stresses compared to 4th and 5th MCP), and the radial side of metacarpal heads (higher stabilizing stress from the adjacent radial collateral ligament) except on the 5th metacarpal, all support the hypothesis that anatomical areas subjected to greater biomechanical stress are more susceptible to erosive damage. The weak to moderate correlation between maximum depth and width reflects the geometric asymmetries and irregularities of erosions of the MCP joints. Application of MRI to characterizing other small joints in RA may provide insight to the unique ways in which biomechanical stresses influence bone erosion pathogenesis and progression.


Disclosure: M. A. Jessome, None; M. A. Tomizza, None; K. A. Beattie, None; W. G. Bensen, None; R. S. Bobba, None; A. Cividino, None; P. D. Emond, None; C. Gordon, None; L. Hart, None; M. Larche, None; A. Lau, None; R. Tavares, None; S. Tytus, None; J. D. Adachi, None.

To cite this abstract in AMA style:

Jessome MA, Tomizza MA, Beattie KA, Bensen WG, Bobba RS, Cividino A, Emond PD, Gordon C, Hart L, Larche M, Lau A, Tavares R, Tytus S, Adachi JD. Anatomical Patterns Suggest the Involvement of Biomechanical Stress in the Pathogenesis of Erosions in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/anatomical-patterns-suggest-the-involvement-of-biomechanical-stress-in-the-pathogenesis-of-erosions-in-rheumatoid-arthritis/. Accessed .
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