Neue bildgebende Verfahren in der Rheumatologie: From bench to bedside

 

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Zusammenfassung

Moderne bildgebende Verfahren spielen in der Diagnostik und Therapiekontrolle in der Rheumatologie eine zunehmend wichtige Rolle. Gründe hierfür sind die zunehmende Verbesserung, Weiterentwicklung und Evaluation der Verfahren sowie deren Implementierung in Leitlinien und Klassifikationskriterien. Durch neue Therapieoptionen und das Ziel neben der klinischen Remission auch die radiologische Progression der Erkrankungen aufzuhalten ist heute die frühe Diagnosestellung und eine suffiziente Therapiekontrolle unabdingbar. So wird die Sonographie heutzutage bei der Frühdiagnostik von Gelenk- und Gefäßerkrankungen in der Rheumatologie weitestgehend flächendeckend eingesetzt. Die MRT kann als Schnittbildverfahren über die hochsensitive Darstellung von Entzündung hinaus frühzeitig das Knochenmarködem (Osteitis) detektieren, welches Prädiktiv für die Entstehung von Erosionen ist. Aufgrund ihrer Vorteile wird sie bereits zur Diagnostik der frühen Spondyloarthritis (ASAS-Diagnosekriterien) genutzt. Auch die Kapillarmikroskopie wird aufgrund ihrer Vorteile (schnelle Durchführung, fehlende Strahlenbelastung und hohe Sensitivität) zur Frühdiagnostik und Therapiekontrolle von Kollagenosen (z. B. Systemische Sklerose) vielerorts in der Rheumatologie angewendet. Neue und innovative bildgebende Verfahren finden immer mehr Einzug in diagnostische Algorithmen von entzündlich rheumatischen Systemerkrankungen. So kann die DECT sensitiv und vergleichbar wenig belastend (da keine Gelenkpunktion nötig) Gichtkristalle darstellen. Hybride bildgebende Verfahren nutzten die Vorteile der hohen Sensitivität der PET sowie die genaue Ortsauflösung der Schnittbildgebung und sind daher insbesondere bei okkulten Inflammationen ein hervorragendes Hilfsmittel.

Abstract

Modern imaging procedures play an import role in diagnostic and therapy-control in rheumatic diseases. Reasons are the continuous development, the evaluation and the implementation in local / international guidelines and classification criteria. According to new therapeutic goals and the aim of clinical and radiological remission the early diagnosis and sufficient therapy-control is unalterable. The ultrasound is today an inherent tool in the early diagnosis of joint- and vascular diseases and is used comprehensively in rheumatic diseases. Beside the highly sensitive detection of inflammation the MRI might depict bone erosions and bone marrow oedema, which is highly predictive for the development of erosions, clearly earlier than conventional x-rays. Due to its advantages the MRI is used frequently in the early diagnosis of spondyloarthritis (ASAS-guidelines). Moreover the capillary microscopy is – due to the rapid performance, the absence of radiation and the high sensitivity – applied in the early diagnosis and therapy-control of connective tissue diseases (e.g systemic sclerosis). New innovative imaging technics find increasing acceptance in the diagnostic algorithm in rheumatic disease. Hence the DECT can detect monosodium urate (MSU) crystals without the need of a joint puncture. Hybrid imaging technics like PET-CT / PET-MRI combine the high sensitivity of the PET and the accurate solution of the CT / MRI. These advantages lead to increasing importance in diagnostic imaging.

• Literatur

• 1 AWMF. „Evidenzbasierte Leitlinie der Deutschen Gesellschaft für Rheumatologie (DGRh) und der beteiligten medizinisch-wissenschaftlichen Fachgesellschaften und weiterer Organisationen Langfassung zur S3- Leitlinie Axiale Spondyloarthritis inklusive Morbus Bechterew und Frühformen“. 2013. http://www.awmf.org/uploads/tx_szleitlinien/060-003l_S3_Axiale_Spondyloarthritis_Morbus_Bechterew_2013-11.pdf
  Google Scholar
• 2 Backhaus M, Burmester GR, Sandrock D et al. Prospective Two Year Follow up Study Comparing Novel and Conventional Imaging Procedures in Patients with Arthritic Finger Joints. Ann Rheum Dis 2002; 61: 895-904
  CrossrefPubMedGoogle Scholar
• 3 Backhaus M, Ohrndorf S, Kellner H et al. Evaluation of a Novel 7-Joint Ultrasound Score in Daily Rheumatologic Practice: A Pilot Project“. Arthritis Rheum 2009; 61: 1194-1201
  CrossrefPubMedGoogle Scholar
• 4 Backhaus TM, Ohrndorf S, Kellner H et al. The US7 Score Is Sensitive to Change in a Large Cohort of Patients with Rheumatoid Arthritis over 12 Months of Therapy“. Ann Rheum Dis 2013; 72: 1163-1169
  CrossrefPubMedGoogle Scholar
• 5 Baker JF, Ostergaard M, Emery P et al. Early MRI Measures Independently Predict 1-Year and 2-Year Radiographic Progression in Rheumatoid Arthritis: Secondary Analysis from a Large Clinical Trial. Ann Rheum Dis 2013; DOI: 10.1136/annrheumdis-2013-203444.
  PubMedGoogle Scholar
• 6 Black R, Roach D, Rischmueller M et al. The Use of Temporal Artery Ultrasound in the Diagnosis of Giant Cell Arteritis in Routine Practice“. Int J Rheumc Dis 2013; 16: 352-357
  PubMedGoogle Scholar
• 7 Braun J, Bollow M, Remlinger G. Prevalence of Spondylarthropathies in HLA-B27 Positive and Negative Blood Donors. Arthritis Rheum 1998; 41: 58-67
  CrossrefPubMedGoogle Scholar
• 8 Braun J, van den Berg R, Baraliakos X et al. 2010 Update of the ASAS/EULAR Recommendations for the Management of Ankylosing Spondylitis. Ann Rheum Dis 2011; 70: 896-904
  CrossrefPubMedGoogle Scholar
• 9 Breedveld F. The Value of Early Intervention in RA – a Window of Opportunity. Clin Rheumatol 2011; 30 (Suppl. 01) S33-39
  CrossrefPubMedGoogle Scholar
• 10 Catanoso M, Pipitone N, Salvarani C. Epidemiology of Psoriatic Arthritis. Reumatism 2012; 64: 66-70
  PubMedGoogle Scholar
• 11 Chowalloor PV, Keen HI. A Systematic Review of Ultrasonography in Gout and Asymptomatic Hyperuricaemia. Ann Rheum Dis 2013; 72: 638-645
  CrossrefPubMedGoogle Scholar
• 12 Colebatch AN, Edwards CJ, Østergaard M et al. EULAR Recommendations for the Use of Imaging of the Joints in the Clinical Management of Rheumatoid Arthritis. Ann Rheum Dis 2013; 72: 804-814
  CrossrefPubMedGoogle Scholar
• 13 Dalbeth N, Choi HK. Dual-Energy Computed Tomography for Gout Diagnosis and Management“. Curr Rheumatol Rep 2013; 15: 301
  CrossrefPubMedGoogle Scholar
• 14 Dalbeth N, Doyle A, McQueen FM. Imaging in Gout: Insights into the Pathological Features of Disease“. Current Opin Rheumatol 2012; 24: 132-138
  PubMedGoogle Scholar
• 15 Dalvi SR, Moser DW, Samuels J. Ultrasound and Treatment Algorithms of RA and JIA. Rheum Dis Clin North Am 2013; 39: 669-688
  CrossrefPubMedGoogle Scholar
• 16 Dasgupta B, Cimmino MA, Kremers HM et al. 2012 Provisional Classification Criteria for Polymyalgia Rheumatica: A European League Against Rheumatism/American College of Rheumatology Collaborative Initiative. Arthritis Rheum 2012; 64: 943-954
  CrossrefPubMedGoogle Scholar
• 17 Funck-Brentano T, Gandjbakhch F, Etchepare F et al. Prediction of Radiographic Damage in Early Arthritis by Sonographic Erosions and Power Doppler Signal: A Longitudinal Observational Study. Arthritis Care Res 2013; 65: 896-902
  CrossrefPubMedGoogle Scholar
• 18 Genth E, Krieg T. [Systemic sclerosis – diagnosis and classification]. Z Rheumatol 2006; 65 (04) 268-274
  CrossrefPubMedGoogle Scholar
• 19 Ghazinoor S, Crues JV, Crowley C. Low-Field Musculoskeletal MRI“. J Magn Reson Imaging 2007; 25: 234-244
  CrossrefPubMedGoogle Scholar
• 20 Glaudemans AWJM, de Vries EFJ, Galli F et al. The Use of (18)F-FDG-PET/CT for Diagnosis and Treatment Monitoring of Inflammatory and Infectious Diseases. Clin Dev Immunol 2013; 2013: 623036
  Google Scholar
• 21 Gonzalez-Gay MA, Vazquez-Rodriguez TR, Lopez-Diaz MJ et al. Epidemiology of Giant Cell Arteritis and Polymyalgia Rheumatica. Arthritis Rheum 2009; 61: 1454-1461
  CrossrefPubMedGoogle Scholar
• 22 Grassi W, Gutierrez M. Psoriatic Arthritis: Need for Ultrasound in Everyday Clinical Practice. J Rheumatol Suppl 2012; 89: 39-43
  CrossrefPubMedGoogle Scholar
• 23 Hartung W, Kellner H, Strunk J et al. Development and Evaluation of a Novel Ultrasound Score for Large Joints in Rheumatoid Arthritis: One Year of Experience in Daily Clinical Practice. Arthritis Care Res 2012; 64: 675-682
  CrossrefPubMedGoogle Scholar
• 24 Ma MHY, Scott IC, Kingsley GH et al. Remission in Early Rheumatoid Arthritis. J Rheumatol 2010; 37: 1444-1453
  CrossrefPubMedGoogle Scholar
• 25 McQueen FM, Ostendorf B. What Is MRI Bone Oedema in Rheumatoid Arthritis and Why Does It Matter?. Arthritis Res Ther 2006; 8: 222
  CrossrefPubMedGoogle Scholar
• 26 Miese F, Buchbender C, Scherer A et al. Molecular Imaging of Cartilage Damage of Finger Joints in Early Rheumatoid Arthritis with Delayed Gadolinium-Enhanced Magnetic Resonance Imaging. Arthritis Rheum 2012; 64: 394-399
  CrossrefPubMedGoogle Scholar
• 27 Nam JL, Ramiro S, Gaujoux-Viala C et al. Efficacy of Biological Disease-Modifying Antirheumatic Drugs: A Systematic Literature Review Informing the 2013 Update of the EULAR Recommendations for the Management of Rheumatoid Arthritis. Ann Rheum Dis 2014; 73: 516-528
  PubMedGoogle Scholar
• 28 Nesher G. The Diagnosis and Classification of Giant Cell Arteritis“. J Autoimmun 2014; 48-49: 73-75
  CrossrefPubMedGoogle Scholar
• 29 Peterfy C, Edmonds J, Lassere M et al. OMERACT Rheumatoid Arthritis MRI Studies Module. J Rheumatol 2003; 30: 1364-1365
  PubMedGoogle Scholar
• 30 Prieto-González S, Depetris M, García-Martínez A et al. Positron Emission Tomography Assessment of Large Vessel Inflammation in Patients with Newly Diagnosed, Biopsy-Proven Giant Cell Arteritis: A Prospective, Case-Control Study“. Ann Rheum Dis 2014; 73: 1388-1392
  CrossrefPubMedGoogle Scholar
• 31 Richter J, Iking-Konert C, Schneider M et al. „[Capillaroscopy. An update]“. Z Rheumatol 2013; 72: 145-150
  CrossrefPubMedGoogle Scholar
• 32 Roddy E, Choi HK. Epidemiology of Gout. Rheum Dis Clin North Am 2014; 40: 155-175
  CrossrefPubMedGoogle Scholar
• 33 Schneider M, Lelgemann M, Abholz HH et al. Interdisziplinäre Leitlinie Management der frühen rheumatoiden Arthritis. 3.. Überarbeitete Auflage. Darmstadt: Steinkopf Verlag; 2011
  Google Scholar
• 34 Sewerin P, Buchbender C, Vordenbäumen S et al. Advantages of a Combined Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) for Hand and Feet: Does the RAMRIS of the Hand Alone Underestimate Disease Activity and Progression?. BMC Musculoskeletal Disorders 2014; 15: 104
  CrossrefPubMedGoogle Scholar
• 35 Sieper J, Rudwaleit M, Baraliakos X et al. The Assessment of SpondyloArthritis International Society (ASAS) Handbook: A Guide to Assess Spondyloarthritis“. Ann Rheum Dis 2009; 68 (Suppl. 02) ii1-ii44
  CrossrefPubMedGoogle Scholar
• 36 Van den Broek M, Visser K, Allaart CF et al. Personalized Medicine: Predicting Responses to Therapy in Patients with RA“. Curr Opin Pharmacol 2013; 13: 463-469
  CrossrefPubMedGoogle Scholar
• 37 Van den Hoogen F, Khanna D, Fransen J et al. 2013 Classification Criteria for Systemic Sclerosis: An American College of Rheumatology/European League against Rheumatism Collaborative Initiative. Arthritis Rheum 2013; 65: 2737-2747
  CrossrefPubMedGoogle Scholar
• 38 Werner SG, Langer H-E, Ohrndorf S et al. Inflammation Assessment in Patients with Arthritis Using a Novel in Vivo Fluorescence Optical Imaging Technology. Ann Rheum Dis 2012; 71: 504-510
  CrossrefPubMedGoogle Scholar
• 39 Werner SG, Langer H-E, Schott P et al. Indocyanine Green–Enhanced Fluorescence Optical Imaging in Patients With Early and Very Early Arthritis: A Comparative Study With Magnetic Resonance Imaging. Arthritis Rheum 2013; 65: 3036-3044
  CrossrefPubMedGoogle Scholar
• 40 Young A, Dixey J, Cox N et al. How Does Functional Disability in Early Rheumatoid Arthritis (RA) Affect Patients and Their Lives? Results of 5 Years of Follow-up in 732 Patients from the Early RA Study (ERAS). Rheumatology (Oxford) 2000; 39: 603-611
  CrossrefPubMedGoogle Scholar