The investigation of dynamic contrast-enhanced MRI, serum angiogenic factor levels and VEGF gene expression in the evaluation of disease activity in rheumatoid arthritis

Objective: In this study via determining the levels of simultaneous serum angiogenesis markers levels and gene expression levels of VEGF in peripheral blood we aimed to evaluate their relationship between both with conventional indices of the RA disease activation (clinical, laboratory and radiological), and with dynamic contrast-enhanced MR imaging parameters.Materials and methods: simultaneous serum angiogenesis markers (VEGF, ang-1, ang-2, Tie-2) and VEGF gene expression levels were studied in 40 patients with RA and 20 healthy controls and dynamic contrast-enhanced wrist MR imaging was performed to 40 patients with RA and 7 control. REE and REt values were calculated from the signal time curve values obtained from the analysis of images. In 40 patients with RA both wrist and foot direct AP radiographs were scored according to modified Sharp van der Heijde scoring system. Disease activity were evaluated with clinical and laboratory parameters.In clinical assessment, duration of morning stiffness, patient pain assessment (VAS), physician and patient global assessment (VAS) were recorded. The number of tender joints and swollen joints were determined. DAS 28, and Ritchie scores were calculated for the disease activity. HAQ was used for functional evaluation. Anti-CCP, RF, ESR and HsCRP analysis in the laboratory was performed.Results: In our study in patients with RA, serum levels of VEGF and VEGF gene expression, dynamic contrast-enhanced MR imaging parameters REE and REt values were significantly higher than in controls. The subgroup analysis according to duration of disease only the level of serum VEGF during the late disease, was significantly higher compared to early disease. According to the DAS28 sub-group analysis, between the patients with moderate and high activity the only significant difference was found for the value of REE. Although it is not statistically significant, the value of VEGF in patients with high activity was found higher. In the late disease the significant correlation was observed between serum VEGF levels and REE. REE and REt parameters were significantly higher in patients with no medical treatment. There are significant correlations among the laboratory parameters between anti-CCP and Ang-1 among the clinical parameters of disease activity, between DAS 28, HAQ, Ritchie score and REE and REt, in the late disease between the serum VEGF levels and SVH total and erosion score.Conclusions and recommendations: Our results show that the usefulness of serum VGEF, VEGF gene expression levels and dynamic contrast-enhanced MRI REE and REt parameters to reflect neovascularization in patients with RA. Determining the correlation between the clinical activity parameters DAS 28, HAQ, Ritchie score and dynamic MR imaging parameters REE and REt and the significant higher occurance of REE value in patients with high activity, the higher REE and REt values in patients not receiving treatment than under medical treatment support the usefulness of dynamic contrast-enhanced MR in evaluation of the effects of disease activity. Showing increase of VEGF from angiogenesis markers in correlation with disease duration, detection of higher levels in late disease, the correlations between VEGF and SVH total and erosion score, between ang-1 and anti-CCP suggest that in addition to determining the disease activity angiogenesis markers can be a parameter for prediction of erosive and destructive changes and assessment of disease progression.