Abstract
Background: Emerging research on the mechanisms of disease chronicity in experimental arthritis has included a new focus on the draining lymph node (LN). Here, we combined clinical-serological analyses and power Doppler ultrasound (PDUS) imaging to delineate noninvasively the reciprocal relationship in vivo between the joint and the draining LN in patients with rheumatoid arthritis (RA). Methods: Forty consecutive patients refractory to conventional synthetic disease-modifying anti-rheumatic drugs were examined through parallel PDUS of the hand-wrist joints and axillary LNs and compared with 20 healthy subjects. A semiquantitative score for LN gray-scale (GS) parameters (nodal hypertrophy and cortical structure) and LN PD signal was developed. A 6-month follow-up study with serial sonographic assessments was then performed on initiation of tumor necrosis factor (TNF) inhibitors. Results: PDUS analysis of RA axillary LNs revealed the existence of marked inter-individual heterogeneity and of quantitative differences compared with healthy individuals in both GS and PD characteristics. RA LN changes were plastic, responsive to anti-TNF treatment, and displayed a degree of concordance with synovitis activity in peripheral joints. However, low LN PD signal at baseline despite active arthritis was strongly associated with a poor clinical response to TNF blockade. Conclusions: PDUS analysis of the draining LN in RA allows capture of measurable inter-individual differences and dynamic changes linked to the underlying pathologic process. LN and joint sonographic assessments are nonredundant approaches that may provide independent perspectives on peripheral disease and its evolution over time.
| Original language | English |
|---|---|
| Article number | 242 |
| Journal | Arthritis Research and Therapy |
| Volume | 18 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Oct 22 2016 |
Fingerprint
Keywords
- Lymph node
- Rheumatoid arthritis
- Ultrasonography
ASJC Scopus subject areas
- Immunology and Allergy
- Rheumatology
- Immunology
Cite this
Power Doppler ultrasonographic assessment of the joint-draining lymph node complex in rheumatoid arthritis : A prospective, proof-of-concept study on treatment with tumor necrosis factor inhibitors. / Manzo, Antonio; Benaglio, Francesca; Vitolo, Barbara; Bortolotto, Chandra; Zibera, Francesca; Todoerti, Monica; Alpini, Claudia; Bugatti, Serena; Caporali, Roberto; Calliada, Fabrizio; Montecucco, Carlomaurizio.
In: Arthritis Research and Therapy, Vol. 18, No. 1, 242, 22.10.2016.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Power Doppler ultrasonographic assessment of the joint-draining lymph node complex in rheumatoid arthritis
T2 - A prospective, proof-of-concept study on treatment with tumor necrosis factor inhibitors
AU - Manzo, Antonio
AU - Benaglio, Francesca
AU - Vitolo, Barbara
AU - Bortolotto, Chandra
AU - Zibera, Francesca
AU - Todoerti, Monica
AU - Alpini, Claudia
AU - Bugatti, Serena
AU - Caporali, Roberto
AU - Calliada, Fabrizio
AU - Montecucco, Carlomaurizio
PY - 2016/10/22
Y1 - 2016/10/22
N2 - Background: Emerging research on the mechanisms of disease chronicity in experimental arthritis has included a new focus on the draining lymph node (LN). Here, we combined clinical-serological analyses and power Doppler ultrasound (PDUS) imaging to delineate noninvasively the reciprocal relationship in vivo between the joint and the draining LN in patients with rheumatoid arthritis (RA). Methods: Forty consecutive patients refractory to conventional synthetic disease-modifying anti-rheumatic drugs were examined through parallel PDUS of the hand-wrist joints and axillary LNs and compared with 20 healthy subjects. A semiquantitative score for LN gray-scale (GS) parameters (nodal hypertrophy and cortical structure) and LN PD signal was developed. A 6-month follow-up study with serial sonographic assessments was then performed on initiation of tumor necrosis factor (TNF) inhibitors. Results: PDUS analysis of RA axillary LNs revealed the existence of marked inter-individual heterogeneity and of quantitative differences compared with healthy individuals in both GS and PD characteristics. RA LN changes were plastic, responsive to anti-TNF treatment, and displayed a degree of concordance with synovitis activity in peripheral joints. However, low LN PD signal at baseline despite active arthritis was strongly associated with a poor clinical response to TNF blockade. Conclusions: PDUS analysis of the draining LN in RA allows capture of measurable inter-individual differences and dynamic changes linked to the underlying pathologic process. LN and joint sonographic assessments are nonredundant approaches that may provide independent perspectives on peripheral disease and its evolution over time.
AB - Background: Emerging research on the mechanisms of disease chronicity in experimental arthritis has included a new focus on the draining lymph node (LN). Here, we combined clinical-serological analyses and power Doppler ultrasound (PDUS) imaging to delineate noninvasively the reciprocal relationship in vivo between the joint and the draining LN in patients with rheumatoid arthritis (RA). Methods: Forty consecutive patients refractory to conventional synthetic disease-modifying anti-rheumatic drugs were examined through parallel PDUS of the hand-wrist joints and axillary LNs and compared with 20 healthy subjects. A semiquantitative score for LN gray-scale (GS) parameters (nodal hypertrophy and cortical structure) and LN PD signal was developed. A 6-month follow-up study with serial sonographic assessments was then performed on initiation of tumor necrosis factor (TNF) inhibitors. Results: PDUS analysis of RA axillary LNs revealed the existence of marked inter-individual heterogeneity and of quantitative differences compared with healthy individuals in both GS and PD characteristics. RA LN changes were plastic, responsive to anti-TNF treatment, and displayed a degree of concordance with synovitis activity in peripheral joints. However, low LN PD signal at baseline despite active arthritis was strongly associated with a poor clinical response to TNF blockade. Conclusions: PDUS analysis of the draining LN in RA allows capture of measurable inter-individual differences and dynamic changes linked to the underlying pathologic process. LN and joint sonographic assessments are nonredundant approaches that may provide independent perspectives on peripheral disease and its evolution over time.
KW - Lymph node
KW - Rheumatoid arthritis
KW - Ultrasonography
UR - http://www.scopus.com/inward/record.url?scp=84992207330&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84992207330&partnerID=8YFLogxK
U2 - 10.1186/s13075-016-1142-7
DO - 10.1186/s13075-016-1142-7
M3 - Article
VL - 18
JO - Arthritis Research and Therapy
JF - Arthritis Research and Therapy
SN - 1478-6354
IS - 1
M1 - 242
ER -