Using Advanced Medical Imaging to Study Bone and Joint Changes in Rheumatoid Arthritis
Date
2019-06-18
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Abstract
Inflammatory processes in rheumatoid arthritis (RA) lead to the damage of joints which results in functional decline. Medical imaging plays an important role in evaluating the onset and progression of RA. High resolution peripheral quantitative computed tomography (HR-pQCT) permits 3-dimensional visualization of the bony microarchitecture allowing for improved erosion detection, joint space width, and bone microstructure measurements. The purpose of this research was to use HR-pQCT and other advanced imaging techniques to visualize and quantify bone changes in the metacarpophalangeal (MCP) joints in RA patients. First, the reproducibility of a semi-automated erosion segmentation program was assessed using intra-rater and scan-rescan measurements on a cohort of early RA participants. HR-pQCT was used to assess possible erosion healing in participants’ initiating a new biologic therapy. We observed that the majority of participants maintained stable joints space, bone mineral density, and erosion volume over a 9-month follow-up period, but 17% of the joints showed a significant decrease in total erosion volume suggesting potential erosion healing. Finally, the impact of subclinical inflammation on bone damage progression for patients in clinical remission was assessed using a combination of HR-pQCT and Magnetic Resonance Imaging (MRI). All 9 of the participants assessed in this study had evidence of subclinical inflammation on MRI, but there was no progression of joint damage seen on HR-pQCT. One participant had a significant decrease in erosion volume. An image registration algorithm, applied for the first time for MCP joints, was used to successfully localize areas of inflammation as seen on MRI with bone damage seen on HR-pQCT. It is demonstrated that even with a sensitive measure of bone damage, healing and progression can be difficult to visualize and quantify due to the heterogeneity of the disease. However, applying other imaging modalities that can provide information on inflammation, as displayed in this thesis, could allow us to gain further insight on the individual characteristics that lead to bone change. The imaging findings and techniques described in this thesis will provide a novel insight into the progression of bone damage in RA to help evaluate current treatment targets and improve patient outcomes in future research.
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Keywords
Rheumatoid Arthritis, High Resolution peripheral Quantitative Computed Tomography (HR-pQCT), Magnetic Resonance Imaging (MRI)
Citation
Brunet, S. C. (2019). Using Advanced Medical Imaging to Study Bone and Joint Changes in Rheumatoid Arthritis (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.