The value of different involvement patterns of the knee "synovio-entheseal complex" in the differential diagnosis of spondyloarthritis, rheumatoid arthritis, and osteoarthritis: an MRI-based study.

OBJECTIVES: To explore the different involvement patterns of the knee "synovio-entheseal complex (SEC)" on MRI in patients with spondyloarthritis (SPA), rheumatoid arthritis (RA), and osteoarthritis (OA). METHODS: This study retrospectively included 120 patients (male:female, 55:65) with a mean age of 39.20 years diagnosed with SPA (n = 40), RA (n = 40), and OA (n = 40) at the First Central Hospital of Tianjin between January 2020 and May 2022. Six knee entheses were assessed by two musculoskeletal radiologists according to the SEC definition. Bone marrow lesions associated with entheses include bone marrow edema (BME) and bone erosion (BE), which were classified as entheseal or peri-entheseal based on their relationship to the entheses. Three groups (OA, RA, and SPA) were established to characterize the location of enthesitis and the different SEC involvement patterns. Inter-group and intra-group differences were analyzed using the ANOVA or chi-square tests, and the inter-class correlation coefficient (ICC) test was used to determine inter-reader agreement. RESULTS: The study contained a total of 720 entheses. The SEC-based analysis revealed different involvement patterns in three groups. The OA group had the most abnormal signals in tendons/ligaments (p = 0.002). The RA group had considerably greater synovitis (p = 0.002). The majority of peri-entheseal BE was identified in the OA and RA groups (p = 0.003). Furthermore, entheseal BME in the SPA group was significantly different from those in the other two groups (p < 0.001). CONCLUSIONS: SEC involvement patterns differed in SPA, RA, and OA, which is important for differential diagnosis. SEC should be used as a whole evaluation method in clinical practice. KEY POINTS: • The "synovio-entheseal complex (SEC)" explained differences and characteristic alterations in the knee joint in patients with spondyloarthritis (SPA), rheumatoid arthritis (RA), and osteoarthritis (OA). • The various SEC involvement patterns are crucial for differentiating SPA, RA, and OA. • When "knee pain" is the only symptom, a detailed identification of characteristic alterations in the knee joint of SPA patients may help timely treatment and delay the structural damage.

Improved Zn bioavailability by its enhanced colocalization and speciation with S in wheat grain tissues after N addition.

Zinc bioavailability with the presence of other elements in wheat grains might be affected by fertilizers. A long-term field experiment was conducted to examine effects of N fertilizer on Zn bioavailability in wheat grain tissues, with changes in the concentrations, distribution, and speciation of Zn as well as P and sulfur S via synchrotron-based technology. Results showed that addition of N fertilizer was associated with changes in Zn concentrations and distributions in grain tissues, especially in the crease region and endosperm. Simultaneously, N addition enhanced Zn-S colocalization in the crease region and endosperm and lowered the P/Zn ratio and Zn-P colocalization. Addition of N fertilizer with P increased Zn-cysteine (9.2%) and decreased Zn-phytate (47.3%) in the crease region, leading to potentially higher grain Zn bioavailability. Thus, addition of N fertilizer improved concentrations and bioavailability of Zn, by coordinating the relationships among Zn, P and S within wheat grains.

Synchrotron X-ray Fluorescence Technique Identifies Contribution of Node Iron and Zinc Accumulations to the Grain of Wheat.

Increasing iron (Fe) and zinc (Zn) concentrations in crop grains with high yield is an effective measure to ensure food supply and alleviate mineral malnutrition in humans. Micronutrient concentrations in grains depend on not only their availability in soils but also their uptake in roots and translocation to shoots and grains. In this three-year field study, we investigated genotypic variation in Fe and Zn uptake and translocation within six wheat cultivars and examined in detail Fe and Zn distributions in various tissues of two cultivars with similar high yield but different grain Fe and Zn concentrations using synchrotron micro-X-ray fluorescence. Results revealed that root Fe and Zn concentrations were 11 and 44% greater in high-nutrient (HN) than in low-nutrient (LN) concentration cultivar. Although both cultivars accumulated similar amounts of Fe in shoots, HN cultivar had greater accumulation of Fe in grain and greater accumulation of Zn in both shoots and grain. Grain Zn concentration was positively correlated with shoot Zn accumulation, and grain Fe concentration was positively correlated with the ability to translocate Fe from leaves/stem to grains. In the first nodes of shoots, HN cultivar had 482% greater Fe and 36% greater Zn concentrations in the enlarged vascular bundle (EVB) than LN cultivar. In top nodes, HN cultivar had 225 and 116% greater Fe and Zn concentrations in the transit vascular bundle and 77 and 71% greater in the EVB when compared to LN cultivar. HN cultivar also had a greater ability to allocate Fe and Zn to the grain than LN cultivar. In conclusion, HN cultivar had greater capacity of Fe and Zn acquirement by roots and translocation and partitioning from shoots into grains. Screening wheat cultivars for larger Fe and Zn concentrations in shoot nodes could be a novel strategy for breeding crops with greater grain Fe and Zn concentrations.

Baseline Severity of Sacroiliitis and Extensive Fat Metaplasia Predicts the Progression of Backfill at the Sacroiliac Joint in Patients With Axial Spondyloarthritis.

Objectives: Fat metaplasia in an erosion cavity, also known as backfill, is an essential intermediary in new bone formation in axial spondyloarthritis (axSpA) patients; however, the predictors of backfill progression are unknown. This longitudinal study aimed to assess the predictors of backfill progression in axSpA patients on magnetic resonance imaging (MRI). Methods: Clinical and MRI data were collected at baseline and follow-up in 52 axSpA patients. Backfill progression was defined as the new or increased T1 hyperintensity within the SI joint space. Logistic regression analyses were performed to identify the predictors of the backfill progression. Results: A total of 19 patients had "backfill" at baseline and 30 patients exhibited the backfill progression after follow-up. The mean disease duration and SPARCC scores at baseline were significantly different between patients with and without backfill progression (P<0.001, P=0.003, respectively). Patients with backfill progression had a higher frequency of backfill at baseline, a higher SSS score of fat metaplasia, and a higher SSS score of backfill than those without (P=0.001, P<0.001, and P=0.002, respectively). A higher fat fraction value in the fat metaplasia area at the baseline was more frequent in patients with, than without, backfill progression (P=0.019). In the univariate logistic regression analyses, a higher SPARCC score for inflammation and a higher SSS score for fat metaplasia at baseline were associated with backfill progression. Conclusions: Severity of sacroiliitis and extensive fat metaplasia at baseline are predictors of the backfill progression in axSpA patients.

Evaluation of active inflammation, chronic structural damage, and response to treatment of sacroiliitis in axial spondyloarthritis using the Spondyloarthritis research consortium of Canada scoring system.

BACKGROUND: Axial spondyloarthritis (axSpA) is a chronic inflammatory rheumatic disease affecting the spine and sacroiliac joints. To investigate whether there are differences in inflammatory and chronic structural damages, as assessed by a semiquantitative MRI scoring method, between non-radiographic axial spondyloarthritis (nr-axSpA) and ankylosing spondylitis (AS) patients with active inflammation at baseline, and to evaluate the treatment response in these patients after 3 months of tumor necrosis factor-alpha (TNF-α) inhibitor treatment. METHODS: Fifty-eight axSpA patients with active inflammation were included in the study. The patients were divided into nr-axSpA group and AS group. MRI examinations of the sacroiliac joints were performed before and after treatment. Inflammatory and structural damages in these patients were assessed using the established Spondyloarthritis Research Consortium of Canada (SPARCC) inflammation and sacroiliac joint structural (SSS) scoring methods, which are two MRI-based scoring methods. The SPARCC score, SSS score, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) level were compared between the two groups. RESULTS: At baseline, SPARCC scores for patients in the nr-axSpA and AS groups did not differ significantly (P > 0.05); however, SSS scores for fat metaplasia, erosion, and backfill for patients in the AS group were significantly higher (P < 0.001). Compared with baseline, SPARCC scores were significantly decreased in both groups after treatment (P < 0.001); however, after treatment, no statistically significant difference was found regarding SPARCC scores between the AS and nr-axSpA groups. Compared with baseline, a significant increase in the SSS scores for fat metaplasia and backfill (P < 0.001) and a significant decrease in the SSS scores for erosion (P < 0.001) were observed in all axSpA patients. Changes in the SPARCC score was inversely correlated with the changes in the SSS score for fat metaplasia (r = - 0.634, P < 0.001). Changes in the SSS score for backfill were positively correlated with the changes in the SSS score for fat metaplasia (r = 0.277, P < 0.05) and inversely correlated with those for erosion (r = - 0.443, P < 0.001). CONCLUSION: The SPARCC and SSS scoring systems can be used to assess inflammatory and chronic structural damages as well as treatment responses in patients with axSpA. More severe structural damages were seen in AS patients. TNF-α inhibitor treatment for 3 months could effectively reduce inflammation in axSpA patients.