Pernille Bøyesen

Diakonhjemmet Hospital (Norway), Kristiania (historical), Oslo, Norway

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Publications (56)355.75 Total impact

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    ABSTRACT: To evaluate the interreader reliability of change scores and the responsiveness of the OMERACT Hand Osteoarthritis (OA) Magnetic Resonance Image (MRI) Scoring System (HOAMRIS). Paired MRI (baseline and 5-yr followup) from 20 patients with hand OA were scored with known time sequence by 3 readers according to the HOAMRIS: Synovitis, erosive damage, cysts, osteophytes, cartilage space loss, malalignment, and bone marrow lesions (BML; 0-3 scales with 0.5 increments for synovitis, erosive damage, and BML). Interreader reliability for status and change scores were assessed by intraclass correlation coefficients (ICC), percentage exact agreement and percentage close agreement (PEA/PCA), and smallest detectable change (SDC). Responsiveness was assessed by standardized response means (SRM). Cross-sectional interreader ICC were good to very good (≥ 0.74) for all features except synovitis, cysts, and malalignment (ICC 0.50-0.58). The range of change values was small, leading to low ICC for change scores. The SDC values for sum scores (total range 0-24) varied between 1.97-3.05 (except 1.08 for malalignment). For status scores, PEA/PCA on scores in individual joints across the readers were 8.1-50.0 and 43.8-78.1, respectively. Similarly, PEA/PCA for change scores were 20.6-63.8 and 66.3-93.1, respectively. All features except cysts and BML demonstrated good responsiveness with higher SRM for sum scores (range 0.46-1.62) than for scores in individual joints (range 0.24-0.73). Good to very good interreader ICC values were found for cross-sectional readings, whereas the longitudinal reliability was lower because of a smaller range of change scores. All features, except cysts and BML, showed good responsiveness.
    The Journal of Rheumatology 09/2015; DOI:10.3899/jrheum.140983 · 3.19 Impact Factor
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    ABSTRACT: During OMERACT 12, a workshop was held with the aim to endorse a core set of domains for 3 settings: clinical trials of symptom and structure modification and observational studies. Additional goals were to endorse a core set of contextual factors for these settings, and to define preliminary instruments for each core domain. Finally, an agenda for future research in hand osteoarthritis (OA) was to be proposed. Literature reviews of preliminary instruments for each core domain of the proposed core set for hand OA in the settings described above. Literature review of radiographic scoring methods and modern imaging in hand OA were also performed. Proposed contextual factors for a core set were identified through 2 Delphi exercises with participation of hand OA experts, patient partners, and OMERACT participants. Results from Delphi exercises and systematic literature reviews were presented and discussed. It was agreed that a preliminary core domain set for the setting clinical trials of symptom modification should contain at least "pain, physical function, patient global assessment, joint activity and hand strength." The settings clinical trial of structure modification and observational studies would in addition include structural damage. Preliminary instruments for the proposed domains were agreed on. A list of prioritized contextual factors was defined and endorsed for further research. A research agenda was proposed for domain instrument validation according to the OMERACT Filter 2.0. Preliminary core sets for clinical trials of symptom and structure modification and observational studies in hand osteoarthritis, including preliminary instruments and contextual factors, were agreed upon during OMERACT 12.
    The Journal of Rheumatology 07/2015; DOI:10.3899/jrheum.141017 · 3.19 Impact Factor
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    ABSTRACT: Background Previous studies have shown that synovitis is more common in erosive vs. non-erosive hand OA, but it is unknown whether a higher prevalence is explained by more structural damage. If erosive hand OA represents a separate more inflammatory phenotype, inflammation should possibly play a more important role in disease progression in erosive vs. non-erosive hand OA. Objectives First, we explored whether synovitis (irrespective of radiographic damage) and radiographic progression were more common in erosive vs. non-erosive hand OA patients. Secondly, we explored whether synovitis was equally associated with radiographic progression in erosive and non-erosive hand OA patients. Methods In total 26 and 39 patients from the Oslo hand OA cohort (59 women, mean age 68) were classified as non-erosive and erosive based on absence/presence of ≥1 radiographic erosions. The 2nd-5th interphalangeal joints were screened for synovitis at baseline using contrast-enhanced 1.0T MRI of dominant hand and ultrasound-detected grey-scale (GS) synovitis and power-Doppler (PD) activity of both hands (0-3 scales). Bilateral hand radiographs were obtained at baseline and 5-year follow-up. First, we explored whether erosive hand OA status was associated with synovitis irrespective of radiographic OA using Generalized Estimating Equations. Secondly, we explored whether erosive hand OA status was associated with radiographic progression (increasing osteophytes, joint space narrowing or erosions) independent of baseline synovitis. In the same model, we added an interaction term between erosive hand OA status and synovitis, and we repeated the analyses for erosive and non-erosive hand OA separately. Analyses were adjusted for age and sex. Results Synovitis was most common in erosive hand OA. The median (IQR) sum score of MRI synovitis was 5 (2.5-7) and 7 (4-10) in non-erosive and erosive hand OA patients, respectively (0-24 scale). The difference was even larger for GS synovitis with median (IQR) sum scores of 1 (1, 4) and 6 (3, 10), respectively (0-48 scale). PD activity was infrequently present in erosive hand OA only. Radiographic progression was also significantly more common in erosive hand OA patients. Twice as many joints showed progression in erosive vs. non-erosive hand OA patients (31.5% vs. 15.8%). Radiographic severity, but not erosive hand OA status, was associated with synovitis when both variables were included in same model (Table). Both erosive hand OA status and synovitis at baseline predicted radiographic progression independent of each other (Table). A significant interaction was found between GS synovitis grade 2-3 and erosive hand OA only (OR 12.55, 95% CI 2.39-65.86). In stratified analyses, a clear dose-response association was found between synovitis and progression in erosive hand OA, whereas the pattern was less clear for non-erosive hand OA (data not shown). Conclusions Higher prevalence of synovitis in erosive hand OA is related to more structural damage in these patients. Disease progression is higher in erosive hand OA irrespective of more synovitis. Synovitis seems to be of importance for disease progression in both erosive and non-erosive hand OA, although the associations seem to be somewhat stronger for erosive hand OA. Disclosure of Interest None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):369.1-369. DOI:10.1136/annrheumdis-2015-eular.2223 · 10.38 Impact Factor
  • G. Haugeberg · P. Bøyesen · K. Helgetveit · A. Prøven
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    ABSTRACT: Background The effectiveness of biologic disease modifying anti-rheumatic drugs (DMARDs) on clinical outcome in rheumatoid arthritis (RA) has been studied in several biologic DMARD registries. However, real life long term clinical follow up data and in particular radiographic outcome data are limited (ref.1,2). Objectives To study short- and long term clinical and radiographic outcome in patients with early RA treated according to standard clinical care in the first decade of the biologic treatment era. Methods Early RA patients from an ordinary rheumatology out-patient clinic, all fulfilling the ACR 1987 criteria, were between 1999 and 2001 consecutively enrolled. According to protocol data on demographic, disease activity, health status and treatment was collected at baseline and after 6 months, 2, 5 and 10 years follow up. The radiographs of hands and feet were performed at baseline and after 2, 5 and 10 years and scored according to the van der Heijde modified Sharp score (SHS). Data were presented as percentage for categorical variables and for continuous variables as mean with standard deviation (SD) or median with interquartile range [IQR]. Results Baseline mean age for the 94 (36 men and 58 women) patients was 50.4 years, symptom duration 12.3 months and 68% were rheumatoid factor positive and 70% had erosions on radiographs. The proportion of RA patients in DAS28 remission, low, moderate and high disease activity status was at baseline 4.3%, 1.1%, 35.1% and 59.6%, at 2 years visit 29.0%, 10.8%, 50.5% and 9.7%, at 5 years visit 33.3%, 24.7%, 42,0% and 0% and at 10 years visit 52.1%, 20.5%, 27.4% and 0.0%, respectively. In the table below mean (SD) baseline and data at follow up visits are shown for measures of disease activity, health status and mean and median values for SHS score. The mean (SD) annual change in SHS score for the period 0-2, 2-5 and 5-10 years period was 3.4 (6.3), 1.7 (2.9) and 1.2 (2.7) and for median [IQR] change 0.8 [3.5], 0.3 [2.0] and 0.6 [1.6], respectively. For the 0-2 year period 62.8% had used prednisolone, 91.5% synthetic DMARDs and 18.1% biologic DMARDs and for the 2-10 year period the figures were 50.6%, 89.3% and 62.7% respectively. Conclusions The vast majority of our RA patients achieved a status of clinical remission or low disease activity and had minor deterioration in radiographic joint damage during short and long term follow up. References Disclosure of Interest G. Haugeberg Grant/research support from: Unrestricted grant from Pfizer, P. Bøyesen: None declared, K. Helgetveit: None declared, A. Prøven: None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):432.3-433. DOI:10.1136/annrheumdis-2015-eular.2162 · 10.38 Impact Factor
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    ABSTRACT: Background Rheumatoid arthritis (RA) is characterised by progressive joint destruction and loss of periarticular bone mass. Hand bone loss (HBL) is measured by Digital X-ray Radiogrammetry (DXR) which has been proposed as an outcome measure for treatment effect in RA. A definition of increased HBL adjusted for age- and gender-related bone loss is lacking. Furthermore, it is unknown to which extent HBL is normalised in RA patients during treatment with tumour necrosis factor alpha inhibitors (TNF-I). Objectives To establish a reference material for HBL and to investigate whether HBL normalises in RA patients during TNF-I treatment in clinical practice. Methods Hand bone mass (DXR-BMD) was measured with DXR, a computerised method of estimating cortical bone mineral density in the diaphysis of the 2nd – 4th metacarpal bone in a reference population and a patient cohort. The reference population consisted of 1,533 men and 2618 women randomly selected from the urban county of Østerbro in Denmark who had hand x-rays performed in the cross-sectional Copenhagen Osteoarthritis Study. Linear regression analyses were used to calculate normal HBL (defined as the 95% Confidence Interval (95%CI) for the age-related mean changes in DXR-BMD between subsequent age-groups). The patient cohort was 135 patients from the DANBIO registry with hand x-rays obtained ∼2 years before start of TNF-I (pre-baseline, all patients treated with conventional synthethic Disease-Modifying Anti-Rheumatic Drugs (csDMARD)), at start of TNF-I (baseline) and ∼ 2 years after start of TNF-I (follow-up). Annual HBL during csDMARD and TNF-I treatment were calculated in individual patients and compared with the lower 95%CI of mean DXR-BMD change in the gender- and age-matched reference group to assess if increased HBL was present. Results Table 1 presents the HBL reference material. The 135 RA patients (85% women, 71% IgM-RF positive, median age 55 (range 23-84) years; median disease duration 5 (range 1-53) years) had a pre-baseline median DAS28 of 4.3 (range 1.6-6.9) and a baseline DAS28 of 5.3 (1.4-8.2). TNF-I treatment was infliximab (74%), etanercept (13%) or adalimumab (13%). At follow-up (DAS28 3.1 (1.4-7.7) 59% received the initial TNF-I, 27% had switched to another biological drug and 14% had withdrawn. Compared to the reference population, 84 (62%) patients had increased HBL during csDMARD treatment and 60 (44%) had during TNF-I treatment (p=0.10,Chi-Sq). In 42 patients who had elevated HBL during csDMARD treatment HBL was normalised during TNF-I. Eighteen patients had normal HBL during csDMARD treatment but increased HBL during treatment with TNF-I. Conclusions We have established a reference material for HBL in the general population and found significant age-related decreases in DXR-BMD in both men and women. Increased HBL was present in the majority of RA patients initiating TNF-I treatment in clinical practice and was normalised in only a minority of patients during treatment. Disclosure of Interest None declared
    Annals of the Rheumatic Diseases 06/2015; 74(Suppl 2):677.1-677. DOI:10.1136/annrheumdis-2015-eular.1789 · 10.38 Impact Factor
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    ABSTRACT: To investigate criterion validity and intraobserver reliability of magnetic resonance imaging (MRI) in hand osteoarthritis (HOA). In 16 patients with HOA (median age 57 yrs, 62% women, 13 with erosive OA), 3 Tesla MRI scans with gadolinium-chelate administration of right second to fifth distal interphalangeal/proximal interphalangeal joints were scored according to the Oslo HOA scoring method for synovial thickening, bone marrow lesions (BML), osteophytes, joint space narrowing (JSN), and erosions (grade 0-3). Ultrasound (US) was scored for synovial thickening and osteophytes, radiographs for osteophytes and JSN (Osteoarthritis Research Society International score), and anatomical phases (Verbruggen-Veys score). Pain was assessed during physical examination. Correlations of MRI with US and radiographic features were assessed with generalizability theory. With generalized estimating equations analyses, MRI features were associated with pain, adjusting for confounding. Forty-three percent, 27%, 77%, and 61% of joints had synovial thickening (moderate/severe), BML, osteophytes, and erosions on MRI, respectively. Intraobserver reliability, assessed in 6 patients, was good (ICC 0.77-1.00). Correlations between osteophytes, JSN, and erosions on radiographs and MRI were moderate, substantial, and fair (ICC 0.53, 0.68, and 0.32, respectively); MRI showed more lesions than radiography. Correlation between synovial thickening and osteophytes on MRI and US was moderate (ICC 0.43 and 0.49, respectively). MRI was more sensitive for synovial thickening, US for osteophytes. Pain was associated with moderate/severe synovial thickening (adjusted OR 2.4, 95% CI 1.06-5.5), collateral ligaments (4.2, 2.2-8.3), BML (3.5, 1.6-7.7), erosions (4.5, 1.7-12.2), and osteophytes (2.4, 1.1-5.2). MRI is a reliable and valid method to assess inflammatory and structural features in HOA. It gives additional information over radiographs and US.
    The Journal of Rheumatology 05/2015; 42(7). DOI:10.3899/jrheum.140338 · 3.19 Impact Factor
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    ABSTRACT: To explore whether changes of MRI-defined synovitis and bone marrow lesions (BMLs) are related to changes in joint tenderness in a 5-year longitudinal study of the Oslo hand osteoarthritis (OA) cohort. We included 70 patients (63 women, mean (SD) age 67.9 (5.5) years). BMLs and contrast-enhanced synovitis in the distal and proximal interphalangeal joints were evaluated on 0-3 scales in n=69 and n=48 patients, respectively. Among joints without tenderness at baseline, we explored whether increasing/incident synovitis and BMLs were associated with incident joint tenderness using generalised estimating equations. Among joints with tenderness at baseline, we explored whether decreasing or resolution of synovitis and BMLs were associated with loss of joint tenderness. We adjusted for age, sex, body mass index, follow-up time and changes in radiographic OA. Among joints without tenderness at baseline, increasing/incident synovitis and BMLs were seen in 45 of 220 (20.5%) and 47 of 312 (15.1%) joints, respectively. Statistically significant associations to incident joint tenderness were found for increasing/incident synovitis (OR=2.66, 95% CI 1.38 to 5.11) and BMLs (OR=2.85, 95% CI 1.23 to 6.58) independent of structural progression. We found a trend that resolution of synovitis (OR=1.72, 95% CI 0.80 to 3.68) and moderate/large decreases of BMLs (OR=1.90, 95% CI 0.57 to 6.33) were associated with loss of joint tenderness, but these associations were non-significant. The Oslo hand OA cohort is the first study with longitudinal hand MRIs. Increasing synovitis and BMLs were significantly associated with incident joint tenderness, whereas no significant associations were found for decreasing or loss of synovitis and BMLs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to
    Annals of the Rheumatic Diseases 03/2015; DOI:10.1136/annrheumdis-2014-206829 · 10.38 Impact Factor
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    ABSTRACT: Objective: To assess the intrareader and interreader agreement and sensitivity to change of the Outcome Measures in Rheumatology (OMERACT) Rheumatoid Arthritis Magnetic Resonance Imaging Joint Space Narrowing (RAMRIS-JSN) score in the rheumatoid arthritis (RA) wrist in a longitudinal multireader exercise. Methods: Coronal T1-weighted MR image sets of 1 wrist from 20 patients with early RA were assessed twice for JSN at 17 sites at baseline and after 36 or 60 months by 4 readers blinded to patient data but not time order. The joints were scored 0-4 according to the OMERACT RAMRIS-JSN score. Intraclass correlation coefficients (ICC), smallest detectable change (SDC), percentage exact/close agreement (PEA/PCA), and standardized response mean (SRM) were calculated. Results: Median baseline and change score was 10.3 and 1.9, respectively. Intrareader ICC for baseline and change scores was good (≥ 0.50) to very good (≥ 0.80) for all and 3 of 4 readers, respectively. Interreader ICC was very good for change (0.93), while poor for baseline score if all 4 readers were included (0.36), but very good if 1 reader was excluded (0.87). Intrareader and interreader SDC was low (2.34-3.18), except for the intrareader SDC for 1 reader (6.75). The mean PEA/PCA was high for baseline and change scores both within and between the readers (51.5-99.2), except for interreader baseline PEA (14.4). SRM was moderate for all readers (0.55-0.77). Conclusion: The OMERACT RAMRIS-JSN score showed high overall intrareader and interreader reliability, and moderate sensitivity to change, supporting inclusion of the measure as part of the OMERACT RAMRIS system.
    The Journal of Rheumatology 02/2015; DOI:10.3899/jrheum.141009 · 3.19 Impact Factor
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    ABSTRACT: Objective: To provide an update on the status and future research priorities of the Outcome Measures in Rheumatology (OMERACT) magnetic resonance imaging (MRI) in arthritis working group. Methods: A summary is provided of the activities of the group within rheumatoid arthritis (RA), psoriatic arthritis (PsA), and osteoarthritis (OA), and its research priorities. Results: The OMERACT RA MRI score (RAMRIS) evaluating bone erosion, bone edema (osteitis), and synovitis is now the standard method of quantifying articular pathology in RA trials. Cartilage loss is another important part of joint damage, and at the OMERACT 12 conference, we provided longitudinal data demonstrating reliability and sensitivity to change of the RAMRIS JSN component score, supporting its use in future clinical trials. The MRI group has previously developed a PsA MRI score (PsAMRIS). At OMERACT 12, PsAMRIS was evaluated in a randomized placebo-controlled trial of patients with PsA, demonstrating the responsiveness and discriminatory ability of applying the PsAMRIS to hands and feet. A hand OA MRI score (HOAMRIS) was introduced at OMERACT 11, and has subsequently been further validated. At OMERACT 12, good cross-sectional interreader reliability, but variable reliability of change scores, were reported. Potential future research areas were identified at the MRI session at OMERACT 12 including assessment of tenosynovitis in RA and enthesitis in PsA and focusing on alternative MRI techniques. Conclusion: MRI has been further developed and validated as an outcome measure in RA, PsA, and OA. The group will continue its efforts to optimize the value of MRI as a robust biomarker in rheumatology clinical trials.
    The Journal of Rheumatology 02/2015; DOI:10.3899/jrheum.141248 · 3.19 Impact Factor
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    ABSTRACT: To explore if the reliability of synovitis assessment by unenhanced MRI is influenced by different MRI field-strengths, coil types and image resolutions in RA patients. Forty-one RA patients and 12 healthy controls underwent hand MRI (wrist and 2(nd)--5(th) metacarpophalangeal joints) at 4 different field-strengths (0.23 T/0.6 T/1.5 T/3.0 T) on the same day. Seven protocols using a STIR sequence with different field-strengths, coils (flex coils/dedicated phased-array extremity coils) and resolution were applied and scored blindly for synovitis (OMERACT-RAMRIS method). A 1.5 T post-contrast T1-weighted sequence was used as gold standard reference. Fair-good agreement (ICC=0.38--0.72) between the standard reference and the different STIR protocols (best agreement with extremity coil and small voxel size at 1.5 T). The accuracy for presence/absence of synovitis was very high per person (0.80--1.0), and moderate-high per joint (0.63--0.85), whereas exact agreements on scores were moderate (0.50--0.66). The intrareader agreement (15 patients and 3 controls) on presence/absence of synovitis was very high (0.87--1.0). Unenhanced MRI using STIR sequence is only moderately reliable for assessing hand synovitis in RA, when contrast-enhanced MRI is considered the gold standard reference. Contrast injection, field strength and coil type influence synovitis assessment, and should be considered before performing MRI in clinical trials and practice. • STIR is only moderately reliable for synovitis assessment, compared with post-contrast-T1-w. • Contrast injection, field strength, and coil type influence synovitis assessment. • Contrast injection is recommended for reliable and reproducible hand synovitis assessment.
    European Radiology 12/2014; 25(4). DOI:10.1007/s00330-014-3470-9 · 4.01 Impact Factor
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    ABSTRACT: Objective: To investigate baseline characteristics associated with radiographic progression and the effect of disease activity, drug, switching, and withdrawal on radiographic progression in tumor necrosis factor (TNF) inhibitor-naive patients with rheumatoid arthritis (RA) followed for about 2 years after anti-TNF initiation in clinical practice. Methods: DANBIO-registered patients with RA who had available radiographs (anti-TNF initiation and ∼2 yrs followup) were included. Radiographs were scored, blinded to chronology with the Sharp/van der Heijde method and linked with DANBIO data. Baseline characteristics were investigated with univariate regression and significant variables included in a multivariable logistic regression analysis with ± radiographic progression [Δ total Sharp score (TSS) > 0] as dependent variable. Effect of time-averaged C-reactive protein (CRP), 28-joint Disease Activity Score with CRP (DAS28-CRP), and treatment status at followup were investigated with univariate regression analysis. Results: The study included 930 patients. They were 75% women, 79% positive for IgM-rheumatoid factor (IgM-RF), median age was 57 yrs (range 19-88), disease duration 9 yrs (1-59), DAS28-CRP 5.0 (1.4-7.8), TSS median 15 [3-45 interquartile range (IQR)] and mean 31 (SD 40). Patients started treatment with infliximab (59%), etanercept (18%), or adalimumab (23%). At followup (median 526 days, IQR 392-735), 61% were treated with the initial anti-TNF, 29% had switched TNF inhibitor, and 10% had withdrawn. Twenty-seven percent of patients had progressed radiographically. ΔTSS was median 0.0 [0.0-0.5 IQR/mean 0.6 (SD 2.4)] units/year. Higher TSS, older age, positive IgM-RF, and concomitant prednisolone at baseline were associated with radiographic progression. Time-averaged DAS28-CRP and time-averaged CRP, but not type of TNF inhibitor, were associated with radiographic progression. Patients who stopped/switched during followup progressed more than patients who continued treatment. Conclusion: High TSS, older age, IgM-RF positivity, and concomitant prednisolone were associated with radiographic progression during 2 years of followup of 930 anti-TNF-treated patients with RA in clinical practice. High disease activity and switching/stopping anti-TNF treatment were associated with radiographic progression.
    The Journal of Rheumatology 10/2014; 41(12). DOI:10.3899/jrheum.131299 · 3.19 Impact Factor
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    ABSTRACT: Objective: This systematic literature review aimed to evaluate the use of conventional radiography (CR) in hand osteoarthritis (OA) and to assess the metric properties of the different radiographic scoring methods. Design: Medical literature databases up to November 2013 were systematically reviewed for studies reporting on radiographic scoring of structural damage in hand OA. The use and metric properties of the scoring methods, including discrimination (reliability, sensitivity to change), feasibility and validity, were evaluated. Results: Of the 48 included studies, 10 provided data on reliability, 11 on sensitivity to change, four on feasibility and 36 on validity of radiographic scoring methods. Thirteen different scoring methods have been used in studies evaluating radiographic hand OA. The number of examined joints differed extensively and the obtained scores were analyzed in various ways. The reliability of the assessed radiographic scoring methods was good for all evaluated scoring methods, for both cross-sectional and longitudinal radiographic scoring. The responsiveness to change was similar for all evaluated scoring methods. There were no major differences in feasibility between the evaluated scoring methods, although the evidence was limited. There was limited knowledge about the validity of radiographic OA findings compared with clinical nodules and deformities, whereas there was better evidence for an association between radiographic findings and symptoms and hand function. Conclusions: Several radiographic scoring methods are used in hand OA literature. To enhance comparability across studies in hand OA, consensus has to be reached on a preferred scoring method, the examined joints and the used presentation of data.
    Osteoarthritis and Cartilage 10/2014; 22(10):1710-23. DOI:10.1016/j.joca.2014.05.026 · 4.17 Impact Factor
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    ABSTRACT: Objectives To examine whether MRI features predict radiographic progression including erosive evolution in patients from the Oslo hand osteoarthritis (OA) cohort, which is the first longitudinal hand OA study with available MRI. Methods We included 74 patients (91% female, mean (SD) age of 67.9 (5.3) years) with MRI of the dominant hand and conventional radiographs taken at baseline and 5-year follow-up. Baseline MRIs were read according to the Oslo hand OA MRI score. We used three definitions of radiographic progression: Progression of joint space narrowing (JSN, grades 0–3), increased Kellgren–Lawrence score (grades 0–4) or incident erosions (absent/present). For each definition, we examined whether MRI features predicted radiographic progression in the same joint using Generalised Estimating Equations. We adjusted for age, sex, Body Mass Index, follow-up time and other erosive joints (the latter for analyses on incident erosions only). Results MRI-defined moderate/severe synovitis (OR=3.52, 95% CI 1.29 to 9.59), bone marrow lesions (BML) (OR=2.73, 95% CI 1.29 to 5.78) and JSN (severe JSN: OR=11.05, 95% CI 3.22 to 37.90) at baseline predicted progression of radiographic JSN. Similar results were found for increasing Kellgren–Lawrence score, except for weaker association for JSN. Baseline synovitis, BMLs, JSN, bone damage, osteophytes and malalignment were significantly associated with development of radiographic erosions, of which malalignment showed the strongest association (OR=10.18, 95% CI 2.01 to 51.64). Conclusions BMLs, synovitis and JSN were the strongest predictors for radiographic progression. Malalignment was associated with incident erosions only. Future studies should explore whether reducing BMLs and inflammation can decrease the risk of structural progression.
    Annals of the Rheumatic Diseases 09/2014; DOI:10.1136/annrheumdis-2014-205949 · 10.38 Impact Factor
  • The Journal of Rheumatology 05/2014; 41(5). · 3.19 Impact Factor
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    ABSTRACT: Objective: The aim of this study was to examine the influence of different MRI unit field strengths, coil types and image resolutions on the OMERACT RA MRI scoring system (RAMRIS) of bone marrow oedema (BME) and image quality. Methods: Forty-one patients and 12 healthy controls participated in this cross-sectional study. Coronal short tau inversion recovery (STIR) and T1-weighted sequences were obtained at 0.23, 0.6, 1.5 and 3T using flex coils (Flex). Additional STIR sequences were obtained with phased array extremity coils (Extr) (at 0.6 and 1.5T) and higher resolution (at 1.5T). In otal, 338 STIR image sets were anonymized and scored according to RAMRIS and parameters of image quality were measured. Results: The BME sum scores were similar overall when comparing the different MRI units, coil types and voxel sizes, yet significantly higher at the higher resolution of 1.5T Extr compared with 0.23T Flex (P = 0.004), 0.6T Flex (P = 0.03), 1.5T Flex (P = 0.05) and 3T Flex (P = 0.001). Mean differences were relatively minor (0-3.5). Intrareader reliability of BME scores was high [intraclass correlation coefficient ≥ 0.90 for all except 0.23T (0.81) and percentage exact agreement 81-88%]. The smallest detectable difference was better at 0.6, 1.5 and 3T (9-29% of maximum value) than at 0.23T (40%). Image quality was lowest at 0.23T. Conclusion: No major, consistent differences were found between BME scores using STIR sequences obtained at different field strengths, coil types and image resolutions, suggesting that these are equally suited for assessment of BME in RA. However, parameters of image quality and intrareader reliability (favouring 0.6, 1.5 and 3T) should be considered when selecting the MRI acquisition strategy.
    Rheumatology (Oxford, England) 03/2014; 53(8). DOI:10.1093/rheumatology/keu029 · 4.48 Impact Factor
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    ABSTRACT: Objectives With contrast-enhanced MRI as the reference method, to explore to which extent synovitis in wrists and metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA) can be reliably assessed by unenhanced MRI. Furthermore, we explored the influence of different MRI field strengths, coil types and image resolutions. Methods 41 RA patients and 12 healthy controls underwent 7 MRI examinations (Coronal short tau inversion recovery (STIR) and T1-weighted (T1w) sequences) on 4 MRI units (0.23 T, 0.6 T, 1.5 T, and 3.0 T, with different coils, see table for details) within 24 hours. Additional post-contrast T1w sequence was performed at the 1.5T unit (gold standard). Images were scored according to OMERACT RA MRI score (RAMRIS) (1) by an experienced reader blinded to participant’s details and MRI field strength. Gold standard images were scored on a different session. Intrareader reliability was evaluated on a subset of 18 patients and controls. Results Fair to good correlation (ICC=0.38-0.72) was seen between different STIR protocols and the gold standard reference (Table 1). The highest correlation was found using the 1.5T unit with the smaller voxel size and extremity coil. Sensitivity for the presence or absence of synovitis was moderate-high in all units (per patient: 0.8-1.0, per joint: 0.63-0.85) whereas the exact agreement on scores was poorer (0.5-0.66). Conclusions Unenhanced MRI, using STIR sequences, is only moderately reliable for assessing synovitis in RA MCP and wrist joints, when contrast-enhanced MRI is considered the gold standard reference. 0.6 T and 1.5 MRI performed best. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):299-299. DOI:10.1136/annrheumdis-2012-eular.2391 · 10.38 Impact Factor
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    ABSTRACT: Background Bone marrow lesions (BMLs) are associated with pain in hand OA (1), but it is currently not known whether they are related to biomechanical or inflammatory processes. Objectives To explore whether radiographic OA features and inflammation are associated with BMLs in a cross-sectional study of hand OA patients. Methods We included 108 patients (98 women, mean (SD) age 68.8 (5.6) years) from the Oslo hand OA cohort with available MRIs (coronal/axial STIR images, 1.0T), radiographs (posteroanterior view) and clinical joint examination of soft tissue swelling of the 2nd-5th distal (DIP) and proximal interphalangeal (PIP) joints of the dominant hand. One reader read the STIR images for presence of BMLs according to the proposed Oslo hand OA MRI scoring system (2). The hand radiographs were scored for presence of radiographic osteophytes, joint space narrowing (JSN), erosions, cysts, sclerosis and malalignment according to the OARSI atlas. We examined whether radiographic hand OA features (markers of structural pathology) and clinical soft tissue swelling of the joints (marker of inflammation) were associated with presence of MRI-defined BMLs using logistic regression with Generalized Estimating Equations. Features that were associated (p<0.25) with BMLs in univariate analyses (adjusted for age and sex) were included in a multivariate model. The multivariate model included features that were associated with BMLs (p<0.10) after backward selection (adjusted for age and sex). Results Patients with hand OA had low prevalence MRI-defined BMLs in the DIP and PIP joints of the dominant hand; the median (interquartile range; IQR) number of joints with BMLs was 1 (0-2). Radiographic JSN (grade 1-3) were present in the majority of joints (median 7, IQR 6-8), and we therefore defined presence of JSN as grade 2-3. All features except sclerosis were associated with presence of BMLs in the adjusted univariate analyses and were included in the multivariate model (table). The final multivariate model included JSN, malalignment, clinical soft tissue swelling and cysts (table), of which the latter was borderline significant. Conclusions Radiographic JSN and malalignment and clinical soft tissue swelling were strongly associated with presence of MRI-defined BMLs in the DIP and PIP joints in this cross-sectional study. Whether BMLs in hand OA are caused by increased loading and bone trauma (as in knee OA) and/or inflammation needs to be proven in future longitudinal studies. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):299-299. DOI:10.1136/annrheumdis-2012-eular.2390 · 10.38 Impact Factor
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    ABSTRACT: Background The OMERACT RA MRI scoring system (RAMRIS) evaluates bone erosions, bone edema, and synovitis. The system is validated and increasingly used as an outcome measure in RA clinical trials. However, joint space narrowing (JSN), reflecting cartilage damage, is an important aspect of the joint damage in RA, and reliable assessment of this could constitute a useful additional outcome measure in RA clinical trials. Objectives The aim of the present OMERACT initiative was to validate the newly proposed MRI scoring system for JSN [1]. Methods Fourteen RA patients’ and one healthy control’s 2nd-5th metacarpophalangeal joints (MCP2-5) and wrist on one hand were assessed for JSN on MRI and CT by three experienced readers. Images were read twice with different identification numbers for blinding. Results Patient demographics: 71% female, age median 61 years (range 31-78), disease duration 5 (1-20), 71% IgM rheumatoid factor positive, Sharp/van der Heijde X-ray scores: Total 75 (3-106), joint space narrowing 40 (1-70), erosion 27 (2-44)). On both MRI and CT, high intrareader (ICCs ≥0.91) and interreader (ICCs ≥0.89) reliability were found for total assessment of JSN (see table). The agreement was generally lower for MCP joints than the wrist, particularly for CT. Conclusions High intra- and interreader reliabilty was obtained by three readers assessing JSN on MRI and CT using the OMERACT JSN MRI scoring system. The score may be a useful outcome measure in RA clinical trials. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):712-712. DOI:10.1136/annrheumdis-2012-eular.1303 · 10.38 Impact Factor
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    ABSTRACT: Background Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) has been validated in rheumatoid arthritis for measuring inflammation, but has rarely been studied in psoriatic arthritis (PsA). Objectives To evaluate changes in DCE-MRI parameters of inflammation in patients with PsA in an investigator-initiated trial, during adalimumab therapy. Methods Anti-TNF-naïve patients with PsA according to Moll and Wrights criteria, ≥3 swollen joints, ≥3 tender joints, hand involvement (swelling and/or dactylitis) and clinical indication for anti-TNF therapy were included. Conventional and DCE-MRI (0.6 T) was performed at baseline, and after 6 and 48 weeks. All patients received adalimumab 40 mg eow. The PsA MRI scoring system (PsAMRIS) was used for analyzing conventional MRIs, and Dynamika software (Image Analysis Ltd., Leeds, UK) for DCE-MRIs. Regions of interest (ROIs) were drawn around the 2.-5. MCP joints, excluding large blood vessels. The ROIs were used for computing the number of pixels with plateau and washout pattern (Np+w), the initial rate of enhancement (IRE), and the maximum enhancement. PsAMRIS total was calculated by adding the components of synovitis, flexor tenosynovitis, periarticular inflammation and bone marrow oedema. Results Patient characteristics (n=9) were: 5 males (56%), median (range) age 39 (25-63) years, joint/skin disease duration 7 (2-59)/12 (2-59) years, 76-swollen joint count (SJC) 20 (6-32), 78-tender joint count (TJC) 41 (9-71), HAQ-score 1.3 (1.1-2.1) and dactylitis count 6 (0-13). Five patients discontinued the trial between 3 and 7 month after inclusion due to lack of efficacy (1 patient), adverse events (2 patients), or violation of study protocol (2 patients). Significant reductions in Np+wwere observed between baseline and follow-up in the entire patient group (n=9, see table). DCE-MRI scans were also available for 12 patients who did not have D-MRI performed at inclusion (total 21 patients). For these 21 patients Np+w, IRE and ME*Np+w correlated with PsAMRIS synovitis (Spearman’s rho 0.52, -0.51, 0.53, all P<0.05), and with PsAMRIS total (Spearman’s rho 0.60, -0.57, 0.61, all P<0.05). We found no statistical significant correlation between dynamic parameters and DAS28, SJC or TJC. Conclusions In active PsA patients treated with adalimumab, dynamic MRI parameters decrease significantly as assessed by the Dynamika software, and are associated with findings on conventional MRI. DCE-MRI might be a valuable method for measuring joint inflammation in PsA. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 71(Suppl 3):711-711. DOI:10.1136/annrheumdis-2012-eular.1290 · 10.38 Impact Factor
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    ABSTRACT: Background Joint space narrowing (JSN), reflecting cartilage damage, is an important aspect of joint damage in rheumatoid arthritis (RA). A scoring system of JSN on magnetic resonance imaging (MRI) has been developed as an OMERACT initiative. However, further validation is needed before the system can be implemented in clinical trials and clinical use. Computed tomography (CT) provides optimal depiction of bone surfaces and is well suited as standard reference for assessment of JSN by MRI and X-ray. Objectives To validate the OMERACT MRI JSN scoring system (1) for RA wrist and MCP joints by investigating its agreement with CT and X-ray, and its intrareader and interreader reliability. Methods MRI and CT images of wrist and MCP2-5 from 14 RA patients and 1 healthy control were assessed independently twice for JSN by three readers. X-rays were scored by a single reader by the Sharp-van der Heijde method. Reliability was assessed by intraclass correlation coefficients (ICC). Images came from a clinical trial and represented a broad range of JSN on X-ray. Results The median (range) JSN score of the assessed hand was on MRI: 13 (0-57), CT: 23 (0-58) and X-ray: 14 (0-29). MRI scores of JSN were very highly correlated with CT scores (MCP: 0.94; wrist: 0.92; MCP+wrist: 0.92). X-ray JSN scores correlated with MRI and CT (MCP2-5: 0.49 and 0.56; wrist: 0.55 and 0.43), see table. On MRI and CT, high intraobserver (ICCs≥0.91 and ≥0.75, respectively) and interobserver (ICCs≥0.82 and ≥0.66, respectively) reliability was observed. In general, lower agreement was found in MCP joints compared to the wrist. Conclusions The OMERACT-RAMRIS MRI JSN scoring system showed very high agreement with CT assessment, whereas X-ray scores were moderately correlated. Both MRI and CT scores showed a high intra- and interreader reliability. The MRI JSN score may, after further validation, become a useful tool in RA clinical trials. References Østergaard M, et al.: Development and preliminary validation of a magnetic resonance imaging joint space narrowing score for use in rheumatoid arthritis: potential adjunct to the OMERACT RA MRI scoring system. J Rheumatol. 2011;38:2045-50. Disclosure of Interest None Declared
    Annals of the Rheumatic Diseases 01/2014; 72(Suppl 3):A52-A52. DOI:10.1136/annrheumdis-2013-eular.219 · 10.38 Impact Factor

Publication Stats

681 Citations
355.75 Total Impact Points


  • 2009–2015
    • Diakonhjemmet Hospital (Norway)
      Kristiania (historical), Oslo, Norway
    • Copenhagen University Hospital Hvidovre
      Hvidovre, Capital Region, Denmark
  • 2013
    • University of Copenhagen Herlev Hospital
      Herlev, Capital Region, Denmark
  • 2008–2011
    • University of Oslo
      • Faculty of Medicine
      Kristiania (historical), Oslo, Norway