A study of erosive phenotypes in lupus arthritis using magnetic resonance imaging and anti-citrullinated protein antibody, anti-RA33 and RF autoantibody status.
OBJECTIVE
The aims of this study were to investigate the extent of MRI-determined joint disease (erosion and synovitis) in SLE and to link this to autoantibody profiles known to be relevant to SLE, including ACPA, RF and anti-RA33 antibodies.


METHODS
Contrast-enhanced MRI of the hand and wrist was performed in 34 symptomatic SLE patients and in 15 RA patients with similar disease duration. Images were scored by two observers using the OMERACT rheumatoid arthritis MRI scoring (RAMRIS) system. Findings were correlated with clinical examination and autoantibody status.


RESULTS
Erosions were present at the wrist in 93% of SLE patients and at the MCP joints in 61% of SLE patients. Despite the high prevalence of MRI-determined erosion, only 8.8% of SLE patients were ACPA positive, although these patients had a higher burden of erosive disease. There was no positive correlation with anti-RA33 titres and erosion scores in the SLE patients, but there was a negative correlation with anti-RA33 titres and total bone oedema scores in the SLE patients. Ninety-three per cent of SLE patients had at least grade 1 synovitis at one or more MCP joints, and wrist joint synovitis was present in all the SLE patients.


CONCLUSIONS
An MRI-determined joint erosive phenotype is common in SLE, even in ACPA-negative cases. The conventional radiographic observation that anti-RA33 is not positively associated with erosion in patients with RA was also found to be the case in SLE patients.
Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK. Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK. elisabethball21@gmail.com.
Elisabeth M A
EM
Ball
Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
Ai Lyn
AL
Tan
Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
Eiji
E
Fukuba
Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
Dennis
D
McGonagle
Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
Arthur
A
Grey
Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
Günter
G
Steiner
Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
Aubrey L
AL
Bell
Centre for Infection and Immunity, School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, Leeds, Department of Radiology, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan, Department of Radiology, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK, Division of Rheumatology Medical University of Vienna, Vienna, Austria and Department of Rheumatology, Musgrave Park Hospital, Belfast, UK.
Madeleine R
MR
Rooney
D000328:Adult; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D050823:Hand Joints / Q000473:pathology; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000276:immunology / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology*; D012217:Rheumatoid Factor / Q000276:immunology*; D014955:Wrist Joint / Q000473:pathology
D001323:Autoantibodies; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide; D012217:Rheumatoid Factor
anti-CCP antibodies; anti-RA33 antibodies; arthritis; autoantibodies; erosive arthritis; magnetic resonance imaging; rheumatoid factor; systemic lupus erythematosus