PMID- 30630515
OWN - NLM
STAT- In-Data-Review
LR  - 20190116
IS  - 1478-6362 (Electronic)
IS  - 1478-6354 (Linking)
VI  - 21
IP  - 1
DP  - 2019 Jan 10
TI  - Significant association between joint ultrasonographic parameters and synovial
      inflammatory factors in rheumatoid arthritis.
PG  - 14
LID - 10.1186/s13075-018-1802-x [doi]
AB  - BACKGROUND: Ultrasonography (US) can directly demonstrate joint inflammation,
      including grayscale (GS) signs of synovial hypertrophy and power Doppler (PD)
      techniques to demonstrate increased blood flow and vascularization. Recently,
      echogenicity, especially hypoechoic synovium, has also been associated with local
      inflammatory activity. However, only a few studies have demonstrated correlation 
      between histopathologic and immunopathologic evaluation and US findings. The aim 
      of this study was to clarify whether joint US findings including synovial
      hypertrophy, vascularity, and echogenicity can accurately characterize synovial
      pathophysiology in patients with active rheumatoid arthritis (RA). METHODS: A
      total of 44 patients with RA were included, both treated (n = 25) and untreated
      (n = 19) and scheduled for US examination of the knee joint with synovial fluid
      (SF) aspiration and two treated patients also underwent synovial biopsy. US
      images were quantitatively analyzed using grayscale assessment of synovial
      hypertrophy and PD for vascularity and echogenicity. Levels of nine SF cytokines 
      and growth factors were also measured. RESULTS: Both US synovial hypertrophy and 
      PD vascularity significantly correlated with SF inflammatory cytokine levels such
      as IL-6, IL-8, IL-1beta and IL-10 in untreated patients. Angiogenic factors,
      including vascular endothelial growth factor (VEGF), only correlated with PD
      vascularity. In the treated patients, the associations between synovial
      hypertrophy and any cytokines were diminished, although synovial vascularity and 
      echogenicity correlated with IL-6 and VEGF (p < 0.05). Histopathologic analysis
      revealed that hypoechogenicity of the synovium correlated with marked
      infiltration of lymphocytes and hypervascularity. CONCLUSIONS: We demonstrated
      the pathophysiological origins of US findings in the joint. The degree of US
      vascularity of the synovium correlated with local inflammatory cytokine levels
      and angiogenetic factors in patients with active RA. Synovial echogenicity, and
      not hypertrophy, correlated with inflammation, especially in treated patients
      with RA.
FAU - Kondo, Yasushi
AU  - Kondo Y
AD  - Division of Rheumatology, Department of Internal Medicine, Keio University School
      of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
FAU - Suzuki, Katsuya
AU  - Suzuki K
AD  - Division of Rheumatology, Department of Internal Medicine, Keio University School
      of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
FAU - Inoue, Yumiko
AU  - Inoue Y
AD  - Division of Rheumatology, Department of Internal Medicine, Keio University School
      of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
FAU - Sakata, Koumei
AU  - Sakata K
AD  - Division of Rheumatology, Department of Internal Medicine, Keio University School
      of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
FAU - Takahashi, Chihiro
AU  - Takahashi C
AD  - Division of Rheumatology, Department of Internal Medicine, Keio University School
      of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
FAU - Takeshita, Masaru
AU  - Takeshita M
AD  - Division of Rheumatology, Department of Internal Medicine, Keio University School
      of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
FAU - Kassai, Yoshiaki
AU  - Kassai Y
AD  - Immunology Unit, Research, Takeda Pharmaceutical Company Limited, Fujisawa,
      Kanagawa, Japan.
FAU - Miyazaki, Takahiro
AU  - Miyazaki T
AD  - Immunology Unit, Research, Takeda Pharmaceutical Company Limited, Fujisawa,
      Kanagawa, Japan.
AD  - Nektar Therapeutics, San Francisco, CA, USA.
FAU - Morita, Rimpei
AU  - Morita R
AD  - Department of Microbiology and Immunology, Keio University School of Medicine,
      Tokyo, Japan.
FAU - Niki, Yasuo
AU  - Niki Y
AD  - Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo,
      Japan.
FAU - Kaneko, Yuko
AU  - Kaneko Y
AD  - Division of Rheumatology, Department of Internal Medicine, Keio University School
      of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
FAU - Yasuoka, Hidekata
AU  - Yasuoka H
AD  - Division of Rheumatology, Department of Internal Medicine, Keio University School
      of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
FAU - Yamaoka, Kunihiro
AU  - Yamaoka K
AD  - Division of Rheumatology, Department of Internal Medicine, Keio University School
      of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan.
FAU - Yoshimura, Akihiko
AU  - Yoshimura A
AD  - Department of Microbiology and Immunology, Keio University School of Medicine,
      Tokyo, Japan.
FAU - Takeuchi, Tsutomu
AU  - Takeuchi T
AD  - Division of Rheumatology, Department of Internal Medicine, Keio University School
      of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan. tsutake@z5.keio.jp.
LA  - eng
GR  - 25461484/Scientific Research from the Ministry of Education, Culture, Sports,
      Science and Technology of Japan
PT  - Journal Article
DEP - 20190110
PL  - England
TA  - Arthritis Res Ther
JT  - Arthritis research & therapy
JID - 101154438
PMC - PMC6327469
OTO - NOTNLM
OT  - Cytokines
OT  - Diagnostic imaging
OT  - Inflammation
OT  - Rheumatoid arthritis/DG
OT  - Ultrasonography
EDAT- 2019/01/12 06:00
MHDA- 2019/01/12 06:00
CRDT- 2019/01/12 06:00
PHST- 2018/09/04 00:00 [received]
PHST- 2018/12/20 00:00 [accepted]
PHST- 2019/01/12 06:00 [entrez]
PHST- 2019/01/12 06:00 [pubmed]
PHST- 2019/01/12 06:00 [medline]
AID - 10.1186/s13075-018-1802-x [doi]
AID - 10.1186/s13075-018-1802-x [pii]
PST - epublish
SO  - Arthritis Res Ther. 2019 Jan 10;21(1):14. doi: 10.1186/s13075-018-1802-x.