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Objective To investigate whether methotrexate (MTX) use is associated with bone mineral density (BMD) in patients with polymyalgia rheumatica (PMR) and various forms of vasculitis. Methods Rh-GIOP is a cohort study designed to evaluate bone health in patients with inflammatory rheumatic diseases. This cross-sectional analysis assessed the baseline visits of all patients with PMR or any kind of vasculitis. Following univariable analysis, multivariable linear regression analysis was performed. The lowest T-score of either the lumbar spine or the femur was chosen as the dependent variable to examine the relationship between MTX use and BMD. These analyses were adjusted for a variety of potential confounders, including age, sex, and glucocorticoid (GC) intake. Results Of 198 patients with PMR or vasculitis, 10 patients were excluded for very high GC dose (n = 6) or short disease duration (n = 4). The remaining 188 patients had the following diseases: PMR 37.2%, giant cell arteritis 25.0%, granulomatosis with polyangiitis 16.5%, followed by rarer diseases. The mean age was 68.0 ± 11.1 years, mean disease duration was 5.58 ± 6.39 years, and 19.7% had osteoporosis by dual x-ray absorptiometry (T-score ≤ −2.5). 23.4% were taking MTX at baseline with a mean dose of 13.2 mg/week (median: 15 mg/week). 38.6% of those used a subcutaneous preparation. MTX users had similar BMD compared to non-users (minimum T-scores −1.70 (± 0.86) versus −1.75 (± 0.91), respectively; p = 0.75). There was no statistically significant dose–response relationship: neither current nor cumulative dose were associated with BMD in unadjusted or adjusted models (current dose: slope −0.02; −0.14 to 0.09; p = 0.69; cumulative dose: slope −0.12; −0.28 to 0.05; p = 0.15). Conclusion In the Rh-GIOP cohort, MTX is used in about a quarter of patients with PMR or vasculitis. It is not associated with BMD levels.

X-ray is the fundamental imaging technique in both diagnosis and follow-up of rheumatic diseases. As patients often require sequential X-rays over many years, dose reduction is of great importance. New advanced noise reduction algorithms allow for a dose reduction of up to 50%. The aim of this study was to evaluate whether quality of low-dose images is non-inferior to standard-dose images and, therefore, application of this technique is possible in the context of imaging of rheumatic diseases. A total of 298 patients with known or suspected rheumatic disease were enrolled prospectively into this study, separated into three consecutive groups: 80%, 64% and 50% tube charge reduction. All patients received imaging of one hand (laterality randomly assigned) with low-dose technique and imaging of the contralateral hand with standard-dose protocol. Images were evaluated by two independent readers who scored (on a scale of 1–5) the visualization of bony cortex, trabeculae and joint spaces of fingers and wrist separately. Additionally, soft tissue and overall contrast were evaluated on the same scale. Overall image quality (expressed by mean sum score out of 40) of the 50% low-dose images was 31.52 (SD 1.94) vs. 31.66 (SD 1.82) for standard images (p = 0.068). Bony contours as well as trabeculae were equally well visualized in both image sets. Median scores for soft tissue visualization was slightly lower for low dose compared to standard images [4 (IQR 3.5–4) vs. 4 (IQR 3.88–4); p = 0.001]. Overall image quality of low-dose images was not inferior to standard-dose images. Therefore, the application of low-dose technology based on advanced noise estimation algorithms in the context of imaging of rheumatic diseases is possible.

To evaluate the ability of dual-energy computed tomography (DECT) to improve diagnostic discrimination between gout and other crystal arthropathies such as calcium pyrophosphate deposition disease (CPPD) of the wrist in a clinical patient population. This retrospective case-control study included 29 patients with either gout (case group; n = 9) or CPPD (control group; n = 20) who underwent DECT of the wrist for clinically suspected crystal arthropathy. Color-coded urate and enhanced calcium as well as virtual 120 kVe blended images were reconstructed from the DECT datasets. Two independent and blinded readers evaluated each reconstructed dataset for the presence of depositions in 17 predefined regions. Additionally, a global diagnosis was made first for 120 kVe images only, based solely on morphologic criteria, and subsequently for all reconstructed images. Sensitivity for the global diagnosis of gout was 1.0 (95% CI 0.63–1) for both DECT and 120 kVe images with specificities of 0.70 (95% CI 0.46–0.87) for DECT and 0.80 (95% CI 0.56–0.93) for 120 kVe images. Color-coded DECT images did not detect more depositions than monochrome standard CT images. Discrimination of crystal arthropathies of the wrist is limited using DECT and primarily relying on color-coded images. Evaluation of morphologic criteria on standard CT images is essential for accurate diagnosis.

A Correction to this paper has been published: 10.1007/s00256-021-03833-5

Dual-energy computed tomography detects tophi in patients with chronic gout. However, other information that can be obtained from the same scan is not the focus of the current research, e.g., the detection of bone marrow edema (BME) using virtual bone marrow imaging (VBMI). The aim of this study was to evaluate if BME in patients with acute arthritis can be detected with VBMI using magnetic resonance imaging (MRI) as the standard of reference.This retrospective study included 11 patients who underwent both MRI and dual-energy computed tomography (mean interval of 40 days). BME in MRI (standard of reference) and VBMI was judged independently by two different blinded readers. φ-correlation coefficient and Cohen's κ were performed for statistical analysis. Approval was waived by the IRB.Two patients with a final diagnosis of RA and one with septic arthritis showed osteitis on MRI and VBMI. However, in each case, there were individual bones identified with osteitis on MRI but not VBMI. Three additional patients with the final diagnosis of RA were identified correctly as negative for BME. There was a good correlation between both modalities (φ = 0.8; κ = 0.8). Inter-rater reliability was excellent for both modalities (κ = 0.9).We have shown that detecting osteitis using VBMI is feasible in patients with inflammatory arthritis. Further studies are needed on larger, more-targeted populations to better define the indications, accuracy, and added value of this technique.