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Objective: To evaluate the reproducibility of T2 relaxation time measurements of the sacroiliac joints at 1.5T. Materials and methods: Healthy volunteers underwent an oblique axial multislice multiecho spin-echo sequence of the sacroiliac joints at 1.5T. Regions of interest were manually drawn using a dedicated software by two musculoskeletal radiologists to include the cartilaginous part of the sacroiliac joints. A senior radiologist performed the measurement twice, while a resident measured once. Intra- and inter-observer reproducibility was tested using the Bland-Altman method. Association between sex and T2 relaxation times was tested using the Mann-Whitney U test. Correlation between T2 relaxation times and body mass index (BMI) was tested using the Spearman’s rho. Results: Eighty sacroiliac joints of 40 subjects (mean age: 28 ± 4.8years, range: 20–43; mean BMI: 23.3 ± 3.1, range: 18.9–30) were imaged. The mean T2 values obtained by the senior radiologist in the first series of measurements were 42 ± 4.4ms, whereas in the second series were 40.7 ± 4.5ms. The mean T2 values obtained by the radiology resident were 41.1 ± 4.2ms. Intra-observer reproducibility was 88% (coefficient of repeatability = 3.8; bias = 1.28; p

Purpose: To test whether T2 mapping of the sacro-iliac joints (SIJs) might help identifying patients with spondyloarthritis. Method: This study included 20 biologic-naive patients with axial spondyloarthritis (10 females; mean age: 38 ± 9years; range, 19–47) and 27 controls (16 males; mean age = 39 ± 13years; range = 28–71) who prospectively underwent SIJs MRI at 1.5 T, including a multislice multiecho spin-echo sequence. Standard MRIs were reviewed to assess the SIJs according to the Assessment of SpondyloArthritis International Society (ASAS) criteria and SPondyloArthritis Research Consortium of Canada (SPARCC) MRI index. T2 maps obtained from multiecho sequences were used to draw regions of interests in the cartilaginous part of the SIJs. Disease activity was assessed using BASDAI questionnaire. Bland-Altman method, ROC curve analysis, Chi square, Mann-Whitney U, Pearson's and Spearman's correlation coefficient were used for data analysis. Results: According to ASAS criteria, MRI was positive for sacroiliitis in 5/20 patients (25 %). Inter-observer reproducibility of T2 values was 87 % (coefficient of repeatability = 7.0; bias = 0.49; p < .001). Mean T2 values of patients (58.5 ± 4.4 ms, range: 52.6–68.2 ms) were significantly higher (p < .001) than those of controls (44.1 ± 6.6 ms, range: 33.6–67.2 ms). A T2 value of 52.51 ms yielded 100 % sensitivity and 91.7 % specificity to differentiate patients from controls. No statistically significant association/correlation was found between T2 values and BASDAI (r=˗.026, p = .827), disease duration (r = .024, p = .871), SPARCC (r=-.004, p = .981), ASAS criteria (p = .476), HLA-B27-positivity (p = .139), age (r=-.2.53, p = .891), and gender (p = .404). Conclusions: T2 relaxation times of the SIJs were significantly higher in patients than in healthy controls, making this tool potentially helpful to early identify patients with spondyloarthritis.

To date, diffusion weighted imaging (DWI) is included in routine magnetic resonance imaging (MRI) protocols for several cancers. The real additive role of DWI lies in the “functional” information obtained by probing the free diffusivity of water molecules into intra and inter-cellular spaces that in tumors mainly depend on cellularity. Although DWI has not gained much space in some oncologic scenarios, this non-invasive tool is routinely used in clinical practice and still remains a hot research topic: it has been tested in almost all cancers to differentiate malignant from benign lesions, to distinguish different malignant histotypes or tumor grades, to predict and/or assess treatment responses, and to identify residual or recurrent tumors in follow-up examinations. In this review, we provide an up-to-date overview on the application of DWI in oncology.

Objective To investigate the expression and tissue distribution of Th9-related cytokines in patients with psoriatic arthritis (PsA). Methods Quantitative gene expression analysis of Th1, Th17, and Th9 cytokines was performed in intestinal biopsy samples obtained from patients with PsA, HLA-B27-positive patients with ankylosing spondylitis (AS), patients with Crohn's disease (CD), and healthy controls. Expression and tissue distribution of interleukin-23 (IL-23), IL-17, IL-22, IL-9, and IL-9 receptor (IL-9R) were evaluated by immunohistochemistry and confocal microscopy. Flow cytometry was used to study the frequency of Th9 cells among peripheral blood, lamina propria, and synovial fluid mononuclear cells. The functional relevance of IL-9R expression on epithelial cells was assessed in functional in vitro studies. Th9 cells in synovial tissue from patients with PsA were also studied. Results Subclinical gut inflammation in PsA patients was characterized by a clear Th17 and Th22, but not Th1, polarized immune response. Unlike AS and CD, a strong and significant up-regulation of IL-9 was observed in PsA gut, especially among infiltrating mononuclear cells, high endothelial venules, and Paneth cells. IL-9-positive mononuclear cells were demonstrated to be in large part Th9 cells. IL-9 overexpression was accompanied by significant Paneth cell hyperplasia. Paneth cells strongly overexpressed IL-9R, and stimulation of epithelial cells, isolated from PsA patients, with IL-9 resulted in overexpression of α-defensin 5 and IL-23p19. Peripheral and synovial expansion of α4β7+ Th9 cells was also observed in patients with PsA. Increased expression of IL-9 and IL-9R was also found in synovial tissue. Conclusion Strong IL-9/Th9 polarization seems to be the predominant immunologic signature in patients in PsA.

We describe the impact of α4-β1/7 blockade with natalizumab, a recombinant humanised immunoglobulin (Ig) G4κ monoclonal antibody (mAb) targeted to the α4 subunit of the α4β1 and α4β7 integrins, on the gut and spine inflammation in a patient with ankylosing spondylitis (AS) who developed multiple sclerosis after treatment with tumour necrosis factor (TNF)-blocking agents. A 45-year-old man with human leucocyte antigen (HLA)-B27-positive AS was admitted in January 2007. He had been diagnosed with AS 4 years earlier based on the presence of inflammatory back pain, peripheral arthritis, radiographic bilateral grade 2 sacroiliitis, HLA-B27 positivity. At that time, he had evidence of chronic intestinal inflammation upon histological evaluation of the gut. He was treated with adalimumab for 2 years, achieving a good clinical response. In March 2009, MRI of the brain was performed for the occurrence of …

Objective. To investigate the expression and tis- sue distribution of Th9-related cytokines in patients with psoriatic arthritis (PsA). Methods. Quantitative gene expression analysis of Th1, Th17, and Th9 cytokines was performed in intestinal biopsy samples obtained from patients with PsA, HLA2B272positive patients with ankylosing spondylitis (AS), patients with Crohn’s disease (CD), and healthy controls. Expression and tissue distribu- tion of interleukin-23 (IL-23), IL-17, IL-22, IL-9, and IL-9 receptor (IL-9R) were evaluated by immunohisto- chemistry and confocal microscopy. Flow cytometry was used to study the frequency of Th9 cells among periph- eral blood, lamina propria, and synovial fluid mononuclear cells. The functional relevance of IL-9R expression on epithelial cells was assessed in functional in vitro studies. Th9 cells in synovial tissue from patients with PsA were also studied. Results. Subclinical gut inflammation in PsA patients was characterized by a clear Th17 and Th22, but not Th1, polarized immune response. Unlike AS and CD, a strong and significant up-regulation of IL-9 was observed in PsA gut, especially among infiltrating mononuclear cells, high endothelial venules, and Pan- eth cells. IL-92positive mononuclear cells were demon- strated to be in large part Th9 cells. IL-9 overexpression was accompanied by significant Paneth cell hyperplasia. Paneth cells strongly overexpressed IL-9R, and stimula- tion of epithelial cells, isolated from PsA patients, with IL-9 resulted in overexpression of a-defensin 5 and IL-23p19. Peripheral and synovial expansion of a4b71 Th9 cells was also observed in patients with PsA. Increased expression of IL-9 and IL-9R was also found in synovial tissue. Conclusion. Strong IL-9/Th9 polarization seems to be the predominant immunologic signature in patients in PsA.

Background Subclinical gut inflammation has been demonstrated in patients with psoriatic arthritis (PsA) suggesting a role for the gut in the pathogenesis of inflammation in these patients. A key role for the IL-23, IL-17, IL-22 and IL-9 in the pathogenesis of psoriasis and psoriatic arthritis has been suggested, the immunologic abnormalities underlying subclinical gut inflammation in PsA are still undefined however. Objectives This study was undertaken to investigate the expression and tissue distribution of IL-23 and of Th17,Th22 and Th9 related molecules in the subclinical gut inflammation of patients with PsA. Methods Gut inflammation was assessed accordingly to De Vos et al (1). Quantitative gene expression analysis of Th1, IL-23/Th17, Th22 and Th9 responses was performed in intestinal biopsy samples obtained from 22 patients with PsA (12 with non-radiographic psoriatic axial SpA, 5 of them displaying HLA-27 positivity), 10 patients with HLA-27 positive-ankylosing spondylitis (AS), 10 patients with Crohn9s disease (CD) and 20 healthy controls. IL-23, IL-17, IL-22 and IL-9 tissue distribution was also evaluated by immunohistochemistry. Results Chronic ileal inflammation was observed in 15 PsA patients with no difference regarding axial or peripheral disease. The terminal ileum of PsA patients was characterized by a complex immunological signature. IL-23p19 m-RNA was not significantly over-expressed compared to controls but a clear Th17 and Th22 polarized immune response was demonstrable, at levels comparable to those observed in CD. Differently from CD and similarly to AS, Th1 cytokines were not significantly over-expressed in PsA. Conversely, a strong IL-23p19 and IL-22 expression in the absence of Th17 polarization was confirmed in AS gut. Unlike AS and CD, a strong and significant up-regulation of IL-9 immunologically characterized the gut of PsA patients. In particular, IL-9 immune-reactivity was observed among infiltrating mononuclear cells, high endothelial venules and Paneth cells. IL-9 mononuclear cells were demonstrated to be in large part Th9 cells. IL-9 over-expression was accompanied by significant Paneth cells hyperplasia. Conclusions The strong IL-9/Th9 polarization seems to be the predominant immunological signature of subclinical gut inflammation in PsA. Our findings indicate however a complex immune-regulation occurring in the gut of PsA patients where Th17 and Th22 polarization seems also to occur. References De Vos M, Cuvelier C, Mielants H et al. Ileocolonscopy in seronegative SPondiloarthropathy. Gastroenterology 1989 Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.5174