***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Aim To monitor joint inflammation and destruction in rheumatoid arthritis ( RA ) patients receiving adalimumab/methotrexate combination therapy using MRI and ultrasonography . To assess the predictive value of MRI and ultrasonography for erosive progression on CT and compare MRI/ultrasonography/radiography for erosion detection/monitoring . Methods Fifty-two erosive biological-naive RA patients were followed with repeated MRI/ultrasonography/radiography ( 0/6/12 months ) and clinical /biochemical assessment s during adalimumab/methotrexate combination therapy . Results No overall erosion progression or repair was observed at 6 or 12 months ( Wilcoxon ; p>0.05 ) , but erosion progressors and regressors were observed using the smallest detectable change cut-off . Scores of MRI synovitis , grey-scale synovitis ( GSS ) and power Doppler ultrasonography decreased after 6 and 12 months ( p<0.05 ) , as did DAS28 , HAQ and tender and swollen joint counts ( p<0.001 ) . Patients with progression on CT had higher baseline MRI bone oedema scores . The RR for CT progression in bones with versus without baseline MRI bone oedema was 3.8 ( 95 % CI 1.5 to 9.3 ) and time-integrated MRI bone oedema , power Doppler and GSS scores were higher in bones/joints with CT progression ( Mann – Whitney ; p<0.05 ) . With CT as the reference method , sensitivities/specificities for erosion in metacarpophalangeal joints were 68%/92 % , 44%/95 % and 26%/98 % for MRI , ultrasonography and radiography , respectively . Median intraobserver correlation coefficient was 0.95 ( range 0.44–0.99 ) . Conclusion During adalimumab/methotrexate combination therapy , no overall erosive progression or repair occurred , whereas repair of individual erosions was documented on MRI , and MRI and ultrasonography synovitis decreased . Inflammation on MRI and ultrasonography , especially MRI bone oedema , was predictive for erosive progression on CT , at bone/joint level and MRI bone oedema also at patient level Objective Erosive osteoarthritis is usually considered as an inflammatory subset of osteoarthritis ( OA ) . However , an inflammatory component is now recognised in all subsets of OA , so this subgroup of erosive or inflammatory OA is more difficult to conceptualise . The aim of this study was to compare routine CR and MRI to investigate erosion numbers and morphology to determine whether h and OA in general is a more erosive disease than previously recognised . Design and methods Fifteen patients with clinical ( OA ) of the small joints of the h and underwent MRI of one of the affected proximal interphalangeal ( PIP ) or distal interphalangeal ( DIP ) joints .  Conventional radiographs ( CR ) of the h and were also obtained . The MR images were review ed by two observers for the presence of central and marginal erosions . The site and morphology of any erosions was recorded . CR images of the same h and joint were scored independently for central and marginal erosions by the same observers . Results There was 100 % agreement between the observers for scoring erosions on CR . Agreement for the MRI scores was also excellent ( kappa = 0.84 ) . MRI detected 37 erosions , of which only 9 were seen on CR . The increase in sensitivity using MRI was much greater for marginal erosions ( 1 detected on CR , 19 on MRI ) than for central erosions ( 8 on CR , 18 on MRI ) . Using MRI 80 % of joints examined showed 1 or more erosions compared with 40 % using CR . If only marginal erosions were considered 80 % of joints were still considered erosive by MRI criteria , but only 1 showed evidence of erosion on CR . Morphologically central erosions appeared to represent areas of subchondral collapse and pressure atrophy . In contrast , marginal erosions resembled those seen in inflammatory arthritides . Conclusion Erosions , and particularly marginal erosions typical of those seen in inflammatory arthritis , are a more common feature of small joint OA than conventional radiographs have previously indicated Sixty-seven patients with symptomatic knee osteoarthritis ( OA ) ( 26 male , 42 female , mean age 62.7 years ) have been followed prospect ively for a mean of 67.3 months ( range 60 - 72 months ) .  H and radiographs  were obtained at entry and at follow-up .  Scintigraphic images of the h and s  were obtained at entry , and the predictive value of scan abnormalities for subsequent radiographic change was examined . Forty-six of 203 scan-positive joints at entry showed radiographic change , compared with 41 of 2075 scan-negative joints ( P < 0.0001 ) . The thumb base was more often involved than other joints and scintigraphy was a better predictor of change at this site than at other joints in the h and . This study confirms the predictive value of scintigraphy in h and OA and suggests that thumb base and interphalangeal joint OA behave differently OBJECTIVES The primary objective was to compare the clinical , radiologic , laboratory , and scintigraphic features in 28 patients with erosive h and osteoarthritis and in 24 with non-erosive h and osteoarthritis . Other objectives were to evaluate clinical , radiographic , and scintigraphic progression in the two groups over a two-year period and to estimate the value of bone scintigraphy for predicting clinical and radiographic progression . METHOD Prospect i ve two-year study of 52 patients with h and osteoarthritis , of whom 28 had at least three subchondral erosions and 24 patients had no erosions . RESULTS The group with erosive disease had higher serum immunoglobulin G levels ( 14.53 + /- 3.79 mg/L vs. 12.03 + /- 4.01 mg/L ; P < 0.05 ) and a higher radiographic index ( 91.81 + /- 3.67 vs. 25.88 + /- 12.81 ; P < 0.001 ) , whereas the group with non-erosive disease had a higher rate of paresthesia ( 66.7 % vs. 39.3 % ; P < 0.05 ) and higher values for the erythrocyte sedimentation rate ( 25.21 + /- 20.86 vs. 13.21 + /- 12.85 ; P < 0.05 ) and serum C-reactive protein level ( 8.82 + /- 6.08 vs. 3.25 + /- 6.92 ; P < 0.01 ) . None of the other study parameters showed any significant differences , and both age and sex distribution were also similar in the two groups . At completion of the two-year follow-up , no changes versus baseline were found in any of the study parameters in the overall study population or in either of the two groups . The baseline scintigraphic index was significantly correlated with the radiographic index at baseline ( r = 0.497 ; P < 0.01 ) and at study completion ( r = 0.550 ; P < 0.001 ) . Joints with a positive baseline scintigram were significantly more likely to show radiographic progression ( 21.09 % , vs 6.68 % in negative joints ; P < 0.001 ) and joint tenderness exacerbation ( 21.22 % vs. 13.73 % ; P < 0.001 ) . CONCLUSION These data suggest that bone scintigraphy may be useful for predicting clinical and radiographic progression of h and osteoarthritis with or without erosions OBJECTIVE To determine the relationship between radiographic progression of joint space narrowing and cartilage loss on  magnetic resonance imaging ( MRI ) in patients with symptomatic knee osteoarthritis ( OA ) , and to investigate the location of MRI-based cartilage loss in the knee and its relation to radiographic progression . METHODS Two hundred twenty-four men and women ( mean age 66 years ) were studied .  Radiographs and MRI of the more symptomatic knee were obtained at baseline and at 15- and 30-month followup . Radiographs of the knee ( with weight-bearing ) were read for joint space narrowing ( scale 0 - 3 ) , with progression defined as any worsening in score . We used a semiquantitative method to score cartilage morphology in all 5 regions of the tibiofemoral joint , and defined cartilage loss as an increase in score ( scale 0 - 4 ) at any region . We examined the relationship between progression of joint space narrowing on radiographic images and cartilage loss on  MRI  , using a generalized estimating equation proportional odds logistic regression , adjusted for baseline cartilage score , age , body mass index , and sex . The medial and lateral compartments were analyzed separately . RESULTS In the medial compartment , 104 knees ( 46 % ) had cartilage loss detected by MRI . The adjusted odds ratio was 3.7 ( 95 % confidence interval 2.2 - 6.3 ) for radiographic progression being predictive of cartilage loss on MRI . However , there was still a substantial proportion of knees ( 80 of 189 [ 42 % ] ) with cartilage loss visible on MRI when no radiographic progression was apparent . Cartilage loss occurred frequently in the central regions of the femur and tibia as well as the posterior femur region , but radiographic progression was less likely to be observed when posterior femur regions showed cartilage loss . Radiographic progression appeared specific ( 91 % ) but not sensitive ( 23 % ) for cartilage loss . Overall findings were similar for the lateral compartment . CONCLUSION While our results provide longitudinal evidence that radiographic progression of joint space narrowing is predictive of cartilage loss assessed on MRI , radiography is not a sensitive measure , and if used alone , will miss a substantial proportion of knees with cartilage loss OBJECTIVE To assess and score the progression of  osteoarthritis ( OA ) of the distal and proximal interphalangeal ( DIP and PIP ) and metacarpophalangeal ( MCP ) joints . METHODS Forty-six patients with OA of the finger joints were followed up for 3 years ; 36 of them were followed up for 5 years . Posteroanterior radiographs of the h and s were obtained at the start of this prospect i ve study and at yearly intervals . The scoring systems used were based on the increased incidence of OA during consecutive years in previously normal joints , the radiologic progression of anatomic lesions in the affected finger joints , and the consecutive pathologic phases recognized in the course of the disease . RESULTS Significant increases both in the numbers of affected DIP , PIP and MCP joints per subject and in the anatomic progression of the disease ( changes in osteophyte growth , loss of joint space , and subchondral cysts or sclerosis ) in the different finger joints of each patient were recorded during the 3 and 5 years of followup . In approximately 40 % of the patients , the classic picture of OA was complicated by erosive changes , which preceded a period in which repair phenomena in the " eroded " finger joints led to the generation of a new subchondral plate covered by cartilaginous tissue . Huge osteophytes were then responsible for the nodular aspect of the affected finger joints . CONCLUSION OA of the finger joints is progressive in nature and passes through predictable phases . The recognition of and the attribution of a score to these respective phases made assessing the progression of OA less time-consuming and led to the same conclusions as when the anatomic progression was scored Background : Osteoarthritis ( OA ) of the h and could be a relevant model to study the progression of OA in structure-modification trials . Various methods are proposed to assess h and OA and its progression radiologically . Objective : To compare intra-reader and inter-reader precision and sensitivity to change of four radiological scoring methods proposed in h and OA . Methods : 2 trained readers scored separately 105 pairs of radiographs ( baseline ; year 1 ) , selected from patients enrolled in a r and omised controlled trial , for inter-reader reliability and sensitivity to change . They scored twice 60 pairs among the 105 for cross-sectional and longitudinal intra-reader reliability . Radiological h and OA assessment used : global , Kellgren – Lawrence ( KL ) , Kallman and Verbruggen scoring methods . Inter- and intra-reader reliabilities were studied using intraclass coefficient ( ICC ) and the Bl and –Altman method . Sensitivity to change was compared by calculating the st and ardised response means . Results : Transversal intra-reader reproducibility ICCs ranged from 0.922 to 0.999 . Verbruggen ranked the highest , followed by the KL and Kallman methods . Inter-rater reliability was higher for the Verbruggen scores , followed by the KL , global and Kallman scores ( ICC 0.706–0.999 ) . Longitudinal intra-reader reliability ( baseline ; year 1 ) was better using the Kallman and KL ( ICC 0.986 and 0.990 ) , followed by the Verbruggen ( 0.941 ) or global methods ( 0.939 ) . St and ardised response 
    Output:
    
Scintigraphy detected fewer pathological joints than CR .
For scintigraphy , scores decreased over time while CR showed progression of h and OA .
MRI and US seem to be the most promising c and i date s for early detection of h and OA and for future use in clinical trials .