Increased Cartilage Damage in Metacarpophalangeal Joints of ACPA Positive Rheumatoid Arthritis (RA) Patients Using T2 Mapping in 3 Tesla Magnetresonance Imaging (MRI)

Nina Renner¹, Arnd Kleyer², David Simon², Gerhard Krönke³, Juergen Rech², Georg Schett², Goetz Welsch⁴ and Milena L. Pachowsky¹, ¹Department of Trauma and Orthopedic Surgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany, Erlangen, Germany, ²Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany., Erlangen, Germany, ³Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Department of Internal Medicine 3 – Rheumatology and Immunology, Universitätsklinikum Erlangen, Erlangen, Germany., Erlangen, Austria, ⁴UKE Athleticum, University Hospital Hamburg-Eppendorf, Hamburg, Germany

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: ACPA, arthritis and cartilage, MRI

Session Information

Date: Tuesday, November 7, 2017

Title: Rheumatoid Arthritis – Clinical Aspects Poster III: Comorbidities

Session Type: ACR Poster Session C

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

Background/Purpose:

T2 mapping is a non-invasive MRI approach to measure cartilage quality, reflecting cartilage hydration and collagen integrity without using contrast enhancement. It has been demonstrated to be a sensitive tool to determine cartilage damage and is currently spreading into a broader clinical application.(1)The objective of this study was the qualitative and quantitative analysis of structural and biochemical changes in cartilage of MCP joints of patients with RA using T2 mapping in a 3 Tesla-MRI setting.

Methods:

Thirty RA patients fulfilling the 2010 ACR/EULAR criteria were recruited. ACPA positive patients were compared to ACPA negative patients. Imaging was performed with a 3 T whole body scanner (VERIO; SIEMENS Healthcare) of the 2^nd and 3^rd MCP joint, using two surface coils to perform high-resolution imaging and to enable parallel imaging techniques.(2)T2 maps were obtained using a pixel-wise, mono-exponential, non-negative least-squares-fit analysis. Region-of-interest (ROI) analysis was performed dividing the cartilage into medial, central and lateral phalangeal (med, cent, lat P ) and metacarpal (MC) area. All results are provided as mean±standard deviation (SD). Statistical evaluation was performed by means of univariate ANOVA testing with random factors. A p-value <0.05 was considered statistically significant. The study protocol was approved by the local ethics commission and written informed consent was obtained from all patients.

Results:

Fourteen ACPA positive (3 male/11 female) and 16 ACPA negative patients (6 male/10 female) were included. Mean age, sex distribution and disease duration were comparable (age: 49.0 ± 15.1 years (ACPA+) vs. 56.1 ± 10.9 years (ACPA-), t=1.494, p=0.146; sex distribution: χ2 (1)= 0.918, p=0.338, disease duration: 7.9 ± 7.3 years (ACPA+) vs. 3.9 ± 3.8 years (ACPA-), U=69.0, Z=-1.799, p=0.072).

T2 values were significantly higher in the majority of the ROIs in ACPA-positive RA patients compared to ACPA negative patients with a statistical significance in most of the ROIs. Details are provided in Table 1.

Conclusion:

In our study we were able to demonstrate the feasibility of T2 mapping in MRI as a non-invasive tool for cartilage evaluation in MC joints in RA patients in a clinical setting. Interestingly, ACPA positive RA patients showed significantly increased T2 values compared to ACPA negative patients reflecting a more severe cartilage alteration despite comparable disease duration.

	ACPA pos.	ACPA neg.	p-value
Demographic characteristics
N	14	16
Male/Female N	3/11	6/10	0.338
Age (years)	49.0 ± 15.1	56.1 ± 10.9	0.146
Disease specific characteristics
Disease duration (years)	7.9 ± 7.3	3.9 ± 3.8	0.072
MRI results (T2 values)
Medial metacarpal area	41.3 ± 15.3	29.6 ± 7.4	0.010
Central metacarpal area	43.8 ± 14.6	28.4 ± 10.9	0.001
Lateral metacarpal area	45.6 ± 13.8	32.0 ± 8.6	0.008
Medial phalangeal area	30.3 ± 14.6	25.7 ± 14.0	0.169
Central phalangeal area	29.9 ± 13.0	22.5 ± 10.1	0.014
Lateral phalangeal area	37.0 ± 15.9	28.8 ± 12.6	0.039

1.Welsch, G.H., Apprich, S., Zbyn, S., et al., Biochemical (T2, T2* and magnetisation transfer ratio

MRI of knee cartilage: feasibility at ultra-high field (7T) compared with high field (3T) strength. Eur

Radiol 2011.

2.Renner, N., Kronke, G., Rech, J., et al., Anti-citrullinated protein antibody positivity correlates with cartilage damage and proteoglycan levels in patients with rheumatoid arthritis in the hand joints. Arthritis Rheumatol 2014.

ADDIN EN.REFLIST

Disclosure: N. Renner, None; A. Kleyer, None; D. Simon, None; G. Krönke, None; J. Rech, None; G. Schett, None; G. Welsch, None; M. L. Pachowsky, None.

To cite this abstract in AMA style:

Renner N, Kleyer A, Simon D, Krönke G, Rech J, Schett G, Welsch G, Pachowsky ML. Increased Cartilage Damage in Metacarpophalangeal Joints of ACPA Positive Rheumatoid Arthritis (RA) Patients Using T2 Mapping in 3 Tesla Magnetresonance Imaging (MRI) [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/increased-cartilage-damage-in-metacarpophalangeal-joints-of-acpa-positive-rheumatoid-arthritis-ra-patients-using-t2-mapping-in-3-tesla-magnetresonance-imaging-mri/. Accessed .

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