Bone edema scored on magnetic resonance imaging scans of the dominant carpus at presentation predicts radiographic joint damage of the hands and feet six years later in patients with rheumatoid arthritis

Abstract

Objective. Magnetic resonance imaging (MRI) is capable of revealing synovitis and tendinitis in early rheumatoid arthritis (RA), as well as bone edema and erosion. These features are visible before radiographic joint damage occurs. We sought to examine whether MRI of one body region (the wrist) can be used to predict whole-body radiography scores reflecting joint damage at 6 years.Methods. We conducted a 6-year prospective study of a cohort of patients who fulfilled the criteria for RA at presentation, using clinical parameters, radiographs, and MRI scans of the dominant wrist. Of the 42 patients enrolled at baseline, full MRI, radiographic, and clinical data were available for 31 at 6-year followup. MRI scans were scored by 2 radiologists, using a validated scoring system. Radiographs of the hands and feet were graded using the modified Sharp scoring method. MRI and radiography scores obtained at baseline and 6 years were compared, and baseline MRI scores were examined for their ability to predict radiographic outcome at 6 years.Results. At 6 years, the total Sharp score correlated significantly with the total MRI score and the MRI erosion score (r ‫؍‬ 0.81, P < 0.0001 and r ‫؍‬ 0.79, P < 0.0001, respectively). The 6-year Sharp score also correlated with the baseline total MRI and MRI erosion scores (r ‫؍‬ 0.56, P < 0.0001 and r ‫؍‬ 0.33, P ‫؍‬ 0.03, respectively). MRI synovitis and bone edema scores remained constant for the group as a whole over 6 years, but bone erosion scores progressed (P ‫؍‬ 0.0001), consistent with radiographic deterioration. Erosions on 6-year MRI scans were frequently preceded by MRI bone edema at baseline (odds ratio 6.5, 95% confidence interval 2.78-18.1). Regression models indicated that the baseline MRI bone edema score was predictive of the 6-year total Sharp score (P ‫؍‬ 0.01), as was the C-reactive protein (CRP) level (P ‫؍‬ 0.0002). Neither shared epitope status nor swollen or tender joint counts predicted radiographic outcome in this cohort. A model incorporating baseline MRI scores for erosion, bone edema, synovitis, and tendinitis plus the CRP level and the erythrocyte sedimentation rate explained 59% of the variance in the 6-year total Sharp score (R 2 ‫؍‬ 0.59, adjusted R 2 ‫؍‬ 0.44). Conclusion. MRI scans performed at the first presentation of RA can be used to help predict future radiographic damage, allowing disease-modifying therapy to be targeted to patients with aggressive disease.

Bone edema on magnetic resonance imaging is an independent predictor of rheumatoid arthritis development in patients with early undifferentiated arthritis

“…Our finding that bone edema is the most important MRI predictor of the subsequent disease course in UA is consistent with the fact that several studies in patients with early RA have shown that bone edema revealed on MRI is the most important predictor for future progression of erosions (20)(21)(22)(23). Bone edema thus seems to be a very important predictive feature in both RA and pre-RA.…”

A Systematic Literature Review Analysis of Ultrasound Joint Count and Scoring Systems to Assess Synovitis in Rheumatoid Arthritis According to the OMERACT Filter

“…Independent of the metric properties of a proposed joint score, validation is still necessary, and the choice and number of joints included remains a crucial issue. Candidate target joints to be included in a global ultrasound score may also be derived from clinical disease activity indices (i.e., Disease Activity Score 28), or based on other predictive studies, for example MRI studies (i.e., wrist) 37 and prediction of structural damage, or clinical prediction of severity. Considering the composition of available reduced global ultrasound scores, we found that the second and third MCP joints and the wrist were always included, regardless of how the joint score was developed.…”

Extremity magnetic resonance imaging in rheumatoid arthritis: Report of the american college of rheumatology extremity magnetic resonance imaging task force

“…McQueen and colleagues have studied an inception cohort of 42 patients with early RA, from presentation (median of 4 months from symptom onset) to 6 years of followup, using clinical assessments of disease activity and function as well as radiography and highfield MRI scanning of the dominant wrist (9,12). At baseline, 45% of these patients had erosions seen on MRI compared with 15% with erosions seen on radiographs, and by year 1, 75% exhibited erosions on MRI, although erosions were seen on radiographs in only 21% of patients.…”

“…Using a sitespecific analysis of MR scans performed in the cohort described above, investigators in McQueen's group showed that baseline MRI-detected bone marrow edema at a specific carpal bone was highly likely to be associated with MRI erosion at that site after 1 year and 6 years (odds ratio 6.5 [95% confidence interval 2.78-18.1]) and the baseline MRI bone marrow edema score was predictive of the 6-year total Sharp score (12,18). A model incorporating baseline MRI scores for erosion, bone marrow edema, synovitis, and tendinitis, plus the C-reactive protein (CRP) level and the erythrocyte sedimentation rate, explained 59% of the variance in the 6-year total Sharp score (R 2 0.59, adjusted R 2 0.44) (12). Synovitis as seen on MRI can be scored by a validated method and was a predictor of the MRI erosion score at 6 years (R 2 0.15, P ϭ 0.03), but not of the total modified Sharp score in the same cohort.…”

“…Over the last decade, a number of reports have described the efficacy of MRI in patients with RA, demonstrating the ability to document erosions and synovitis with a greater sensitivity than conventional radiography (9)(10)(11)(12). These studies have shown that bone and soft tissue abnormalities that are seen on MRI often progress to radiographic erosive disease.…”