The very early inflammatory triquetral lesion by MRI - is this the first sign in Rheumatoid Arthritis?

INTRODUCTION/AIM: Rheumatoid Arthritis (RA) an autoimmune, chronic, and disabling disease if untreated, affects wrist joints, with a diagnostic delay of up to 2 years. Triquetral bone allows rotational movement that pivots over the rest wrist bones, and maintains physiological loads during mobility. Magnetic Resonance Imaging (MRI) is the most sensitive (96%) method for diagnosis, evidencing lesions as early as in the initial RA stages. Our aim was to determine the most frequently affected structures in the hand-wrist joint by MRI using the OMERACT-RAMRIS Score (2003) in three different RA stages, including clinically suspicious arthralgia (CSA) that haven't reported before. METHODS: We performed an exploratory, transverse, observational, descriptive study in 60 patients enrolled and classified by rheumatologists as: CSA, early rheumatoid arthritis (ERA), and established RA, prior to performing a dominant hand-wrist MRI for evaluation and descriptive analysis by an expert radiologist. RESULTS: Female predominance 83% (50), with a mean age 42+13.5 years; A total of 1,731 hand-wrist bone and joint sites were evaluated using EULAR-OMERACT Atlas (2005), identifying 56% (964 sites) with typical RA lesions: synovitis, erosions, and bone marrow edema (BME or osteitis); synovitis was the most frequent with 46% (445 site-lesion), and triquetral synovitis the most frequent each clinical group: CSA 87% (20/23), ERA 91% (20/22), and RA 93% (14/15). CONCLUSION: Synovitis and triquetral synovitis were the most prevalent lesion in three-studied phases. This could suggest the triquetrum as the first morphological site to be affected by RA; so it's assessment should be considered in the RA evaluation when it´s clinically suspected.

Effect of collagen supplementation on osteoarthritis symptoms: a meta-analysis of randomized placebo-controlled trials.

PURPOSE: Osteoarthritis (OA) is one of the most common causes of disability and a prevalent chronic disease. The use of collagen is growing due to the satisfactory results in the treatment of OA. However, the possible beneficial effects of collagen for the treatment of OA are currently controversial. The aim of the present meta-analysis was to evaluate the effect of collagen-based supplements on OA symptoms. METHODS: PubMed-Medline, Scopus, and Google Scholar databases were searched for randomized placebo-controlled trials evaluating the effect of orally administered collagen on OA symptoms using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale and/or the Visual Analog Scale (VAS). Meta-analysis was conducted using a random-effects model and a generic inverse variance method. Heterogeneity was tested using the I2 statistic index. RESULTS: Collagen treatment showed a significant reduction in the score of total WOMAC index (WMD - 8.00; 95% CI - 13.04, - 2.95; p = 0.002). After subgroup analysis of the WOMAC subscores, the collagen supplementation revealed a significant decrease in the stiffness subscore (WMD - 0.41; 95% CI - 0.74, - 0.08; p = 0.01), whereas the pain (WMD - 0.22; 95% CI - 1.58, 1.13; p = 0.75) and functional limitation (WMD - 0.62; 95% CI - 5.77, 4.52; p = 0.81) subscores did not have significant differences. Finally, a significant reduction was found in the VAS score after collagen administration (WMD - 16.57; 95% CI - 26.24, - 6.89; p < 0.001). CONCLUSION: The results of this meta-analysis showed that collagen is effective in improving OA symptoms by the decrease of both total WOMAC index and VAS score.