Rheumatic Disease Clinics of North America RSS feed: Current Issue. Rheumatic Disease Clinics of North America updates you on the latest trends in patient management; keeps you up to date on the newest advances; and provides a sound basis for choosing treatment options. Each issue focuses on a single topic in rheumatology and is presented under the direction of an experienced guest editor.http://www.rheumatic.theclinics.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Rheumatic Disease Clinics of North America0889-857X353August 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.rheumatic.theclinics.com/article/PIIS0889857X09000957/abstract?rss=yesContents10.1016/S0889-857X(09)00095-7Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7viixhttp://www.rheumatic.theclinics.com/article/PIIS0889857X09000969/abstract?rss=yesForthcoming Issues10.1016/S0889-857X(09)00096-9Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7xixihttp://www.rheumatic.theclinics.com/article/PIIS0889857X09000696/abstract?rss=yes Osteoarthritis (OA) is an extraordinarily prevalent disease. Approximately 50 million Americans and 800 million people worldwide have reported having OA and approximately 20 million Americans arthritis-associated activity limitations. OA of the knee, which is the joint most well investigated, affects an estimated 6% of adults and is a leading cause of disability among adults in the United States. The economic burden of arthritis is estimated to be approximately $120 billion, which is equivalent to 1.2% of the gross domestic product. OA, however, remains an enigmatic disease. At the meeting of the Osteoarthritis Research Society International held in Montreal, Canada, September 10–13, 2009, it was reported that 10% of the population has asymptomatic OA, 58% of persons with knee OA have no radiographic findings, and 80% of persons who have had an anterior cruciate ligament develop OA. Today, knowledge of the pathophysiology and natural history of OA is so limited that most of the patients and even physicians believe that there is little we can do to treat or prevent the disease other than trying to alleviate the inflammatory symptoms when they occur. In the meantime, several epidemiologic studies were or are currently under way to help understand the relationship between structure and function and how best to intervene in this disease process. Imaging is playing a major role in these studies and providing insights in understanding of this complex disease. In this issue of Rheumatic Disease Clinics of North America, world-renowned researchers and clinicians report on the latest advances in understanding of the disease using imaging.Preface–Osteoarthritis: From the Simple X-ray to Compositional MRI: What Have We Learned?Ali Guermazi10.1016/j.rdc.2009.09.003Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7xiiixivhttp://www.rheumatic.theclinics.com/article/PIIS0889857X09000593/abstract?rss=yesThis article highlights recent studies, particularly those with an emphasis on magnetic resonance imaging, that are providing unique insights into the relation between structures identified on imaging and the symptoms and genesis of osteoarthritis. These insights are changing the way disease prevalence is viewed and providing new insights into disease genesis. Furthermore, it is becoming increasingly apparent that the subchondral bone, periosteum, periarticular ligaments, periarticular muscle spasm, synovium, and joint capsule are all richly innervated and are the likely source of nociception in osteoarthritis. In addition, it is apparent that local tissue alterations in the bone and meniscus and alignment of the lower extremity are important in terms of disease genesis. The article is consistent with the literature in that much of the focus and understanding is knee-centric with less focus on the hip and hand.Imaging Insights on the Epidemiology and Pathophysiology of OsteoarthritisDavid J. Hunter10.1016/j.rdc.2009.08.001Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7447463http://www.rheumatic.theclinics.com/article/PIIS0889857X0900060X/abstract?rss=yesOsteoarthritis is widely believed to result from local mechanical factors acting within the context of systemic susceptibility. This narrative review delineates current understanding of the etiopathogenesis of osteoarthritis and more specifically examines the critical role of biomechanics in disease pathogenesis. There are several ways the mechanical forces across the joint can be measured, including some that rely heavily on imaging methods. These are described and methods to advance the field are proposed.Imaging the Role of Biomechanics in OsteoarthritisDavid J. Hunter, David R. Wilson10.1016/j.rdc.2009.08.002Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7465483http://www.rheumatic.theclinics.com/article/PIIS0889857X09000635/abstract?rss=yesThe progression of osteoarthritis is traditionally measured using radiographic joint space width (JSW). Numerous knee radiograph protocols have been developed with various levels of complexity and performance as it relates to detecting JSW loss (ie, joint space narrowing). Sensitivity to joint space narrowing is improved when radioanatomic alignment of the medial tibial plateau is achieved. Semiautomated software has been developed to improve the accuracy of JSW measurement over manual methods. JSW measurements include minimum JSW, mean JSW or joint space area, and JSW at fixed locations.Radiographic Grading and Measurement of Joint Space Width in OsteoarthritisMarie-Pierre Hellio Le Graverand, Steve Mazzuca, Jeff Duryea, Alan Brett10.1016/j.rdc.2009.08.005Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7485502http://www.rheumatic.theclinics.com/article/PIIS0889857X09000684/abstract?rss=yesUltrasonography is a useful tool in understanding rheumatic conditions and in diagnosis and management. Much of the investigation into the validity of ultrasonography and its clinical use has been undertaken in inflammatory arthritides. Although ultrasonography has been applied to osteoarthritis (OA) in clinical practice, there has been little investigation into the validity of ultrasonography in OA or its utility in clinical trials or routine clinical practice. This review outlines benefits and limitations of imaging OA with ultrasonography.Usefulness of Ultrasound in OsteoarthritisHelen I. Keen, Philip G. Conaghan10.1016/j.rdc.2009.09.002Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7503519http://www.rheumatic.theclinics.com/article/PIIS0889857X09000647/abstract?rss=yesWhole organ magnetic resonance imaging (MRI)-based semiquantitative (SQ) assessment of knee osteoarthritis (OA), based on reliable scoring methods and expert reading, has become a powerful research tool in OA. SQ morphologic scoring has been applied to large observational cross-sectional and longitudinal epidemiologic studies as well as interventional clinical trials. SQ whole organ scoring analyzes all joint structures that are potentially relevant as surrogate outcome measures of OA and potential disease modification, including cartilage, subchondral bone, osteophytes, intra- and periarticular ligaments, menisci, synovial lining, cysts, and bursae. Resources needed for SQ scoring rely on the MRI protocol, image quality, experience of the expert readers, method of documentation, and the individual scoring system that will be applied. The first part of this article discusses the different available OA whole organ scoring systems, focusing on MRI of the knee, and also reviews alternative approaches. Rheumatologists are made aware of artifacts and differential diagnoses when applying any of the SQ scoring systems. The second part focuses on quantitative approaches in OA, particularly measurement of (subregional) cartilage loss. This approach allows one to determine minute changes that occur relatively homogeneously across cartilage structures and that are not apparent to the naked eye. To this end, the cartilage surfaces need to be segmented by trained users using specialized software. Measurements of knee cartilage loss based on water-excitation spoiled gradient recalled echo acquisition in the steady state, fast low-angle shot, or double-echo steady-state imaging sequences reported a 1% to 2% decrease in cartilage thickness annually, and a high degree of spatial heterogeneity of cartilage thickness changes in femorotibial subregions between subjects. Risk factors identified by quantitative measurement technology included a high body mass index, meniscal extrusion and meniscal tears, knee malalignment, advanced radiographic OA grade, bone marrow alterations, and focal cartilage lesions.Magnetic Resonance Imaging-Based Semiquantitative and Quantitative Assessment in OsteoarthritisFrank W. Roemer, Felix Eckstein, Ali Guermazi10.1016/j.rdc.2009.08.006Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7521555http://www.rheumatic.theclinics.com/article/PIIS0889857X09000611/abstract?rss=yesKnee osteoarthritis (OA) has to be considered a whole joint disease. Magnetic resonance imaging (MRI) allows superior assessment of all joint tissues that may be involved in OA, such as the subchondral bone, synovium, ligaments, and periarticular soft tissues. Reliable MRI-based scoring systems are available to assess and quantify these structures and associated pathology. Cross-sectional and longitudinal evaluation has enabled practitioners to understand their relevance in explaining pain and structural progression.Magnetic Resonance Imaging Assessment of Subchondral Bone and Soft Tissues in Knee OsteoarthritisMichel D. Crema, Frank W. Roemer, Monica D. Marra, Ali Guermazi10.1016/j.rdc.2009.08.003Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7557577http://www.rheumatic.theclinics.com/article/PIIS0889857X09000623/abstract?rss=yesThe meniscus is a critical tissue in the healthy knee joint because of its shock absorption and load distribution properties. Meniscal damage is a frequent finding on MRI of the osteoarthritis (OA) knee. The damage appears as horizontal, flap, or complex tears; meniscal maceration; or destruction. Asymptomatic meniscal lesions are common incidental findings on knee MRI of the middle-aged or older person. This challenges the health professional in choosing the best treatment. A meniscal tear can lead to knee OA, but knee OA can also lead to a spontaneous meniscal tear. A degenerative meniscal lesion often suggests early-stage knee OA. Surgical resection of nonobstructive degenerate lesions may merely remove evidence of the disorder while the OA and associated symptoms proceed.The Meniscus in Knee OsteoarthritisMartin Englund, Ali Guermazi, L. Stefan Lohmander10.1016/j.rdc.2009.08.004Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7579590http://www.rheumatic.theclinics.com/article/PIIS0889857X09000672/abstract?rss=yesOsteoarthritis (OA) of the hip joint stems from a combination of intrinsic factors, such as joint anatomy, and extrinsic factors, such as injuries, diseases, and load. Possible risk factors for OA are instability and impingement. Different surgical techniques, such as osteotomies of the pelvis and femur, surgical dislocation, and hip arthroscopy, are being performed to delay or halt OA. Success of salvage procedures of the hip depends on the existing cartilage and joint damage before surgery. The likelihood of therapy failure rises with advanced OA. For imaging of intra-articular hip pathology, MRI represents the best technique because it enables clinicians to directly visualize cartilage, it provides superior soft tissue contrast, and it offers the prospect of multidimensional imaging. However, opinions differ on the diagnostic efficacy of MRI and on the question of which MRI technique is most appropriate. This article gives an overview of the standard MRI techniques for diagnosis of hip OA and their implications for surgery.Hip MRI and Its Implications for Surgery in Osteoarthritis PatientsTallal C. Mamisch, Christoph Zilkens, Klaus A. Siebenrock, Bernd Bittersohl, Young-Jo Kim, Stefan Werlen10.1016/j.rdc.2009.09.001Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7591604http://www.rheumatic.theclinics.com/article/PIIS0889857X09000659/abstract?rss=yesOsteoarthritis (OA) of the wrist is mainly secondary to traumatic ligamentous or bone injuries. Involvement of the radiocarpal joint occurs early on in the disease, whereas the mediocarpal joint is involved at a later stage. Metabolic diseases may also involve the wrist and affect specific joints such as the scapho-trapezio-trapezoid joint. Although OA of the wrist is routinely diagnosed on plain films, a thorough assessment of cartilage injuries on computed tomographic arthrography, magnetic resonance imaging (MRI), or MR arthrography remains necessary before any surgical procedure. OA of the fingers is frequently encountered in postmenopausal women. Distal interphalangeal joints and trapezio-metacarpal joint are the most frequently involved joints. Whereas the clinical diagnosis of OA of the wrist and hand is straightforward, the therapeutic management of symptomatic forms remains unclear, with no clear guidelines. OA of the spine is related to degenerative changes of the spine involving the disc space, vertebral endplates, the facet joints, or the supportive and surrounding soft tissues. The sequelae of disc degeneration are among the leading causes of functional incapacity in both sexes, and are a common source of chronic disability in the working years. Disc degeneration involves structural disruption and cell-mediated changes in composition. Radiography remains usually the first-line imaging method. MRI is ideally suited for delineating the presence, extent, and complications of degenerative spinal disease. Other imaging modalities such as computed tomography, dynamic radiography, myelography, and discography may provide complementary information in selected cases, especially before an imaging-guided percutaneous treatment or spinal surgery. The presence of degenerative changes on imaging examinations is by no means an indicator of symptoms, and there is a high prevalence of lesions in asymptomatic individuals. This article focuses on imaging of OA of the wrist and hand, as well as lumbar spine OA, with an emphasis on current MRI grading systems available for the assessment of discovertebral lesions.Role of Imaging in Spine, Hand, and Wrist OsteoarthritisAntoine Feydy, Etienne Pluot, Henri Guerini, Jean-Luc Drapé10.1016/j.rdc.2009.08.007Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7605649http://www.rheumatic.theclinics.com/article/PIIS0889857X09000660/abstract?rss=yesAdvances in imaging technology have increased its suitability for diagnosing musculoskeletal disease. Modification of imaging techniques and improved image quality have led to increased use of computed tomography and magnetic resonance imaging in the assessment of postoperative complications. This article discusses the indications, pre- and postoperative imaging findings, and postoperative complications of knee and hip arthroplasty, articular cartilage repair, and high tibial osteotomy.Pre- and Postoperative Assessment in Joint Preserving and Replacing SurgeryAdnan Sheikh, Mark Schweitzer10.1016/j.rdc.2009.08.008Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7651673http://www.rheumatic.theclinics.com/article/PIIS0889857X09000970/abstract?rss=yesIndex10.1016/S0889-857X(09)00097-0Rheumatic Disease Clinics of North America 35, 3 (2009)2009-08-01Rheumatic Disease Clinics of North America2009-08-01353S0889-857X(09)X0003-7675686