Diagnostic value of high-frequency ultrasound and magnetic resonance imaging in early rheumatoid arthritis

Abstract

Abstract. Early diagnosis and management improve the outcome of patients with rheumatoid arthritis (RA). The present study explored the application of high-frequency ultrasound (US) and magnetic resonance imaging (MRI) in the detection of early RA. Thirty-nine patients (20 males and 19 females) diagnosed with early RA were enrolled in the study. A total of 1,248 positions, including 858 hand joints and 390 tendons, were examined by high-frequency US and MRI to evaluate the presence of bone erosion, bone marrow edema (BME), synovial proliferation, joint effusion, tendinitis and tendon sheath edema. The imaging results of the above abnormalities, detected by US, were compared with those identified using MRI. No statistically significant overall changes were observed between high-frequency US and MRI in detecting bone erosion [44 (5.1%) vs. 35 (4.1%), respectively; P>0.05], tendinitis [18 (4.6%) vs. 14 (1.5%), respectively; P>0.05] and tendon sheath edema [37 (9.5%) vs. 30 (7.7%), respectively; P>0.05]. Significant differences were observed between high-frequency US and MRI with regards to the detection of synovial proliferation [132 (15.4%) vs. 66 (7.7%), respectively; P<0.05] and joint effusion [89 (10.4%) vs. 52 (6.1%), respectively; P<0.05]. In addition, significant differences were identified between the detection of BME using MRI compared with high-frequency US (5.5 vs. 0%, respectively; P<0.05). MRI and high-frequency US of the dominant hand and wrist joints were comparably sensitive to bone erosion, tendinitis and tendon sheath edema. However, MRI was more sensitive in detecting bone marrow edema in early RA, while US was more sensitive in the evaluation of joint effusion and synovial proliferation. In conclusion, US and MRI are promising for the detection and diagnosis of inflammatory activity in patients with RA.

Ultrasonography of Hands and Wrists in the Diagnosis of Complications of Chikungunya Fever

“…These investigators observed that 10% of patients had tenosynovitis, and another 10% had joint effusions. Unlike our study, in which no bone erosions were observed by ultrasound, Wang et al observed bone erosions in ultrasound in 5% of RA patients. Another study comparing ultrasound and MRI in the evaluation of early untreated arthritis showed that the predominant ultrasound findings were metacarpophalangeal synovitis (43%), interphalangeal synovitis (53%), and wrist synovitis (63%), thereby demonstrating a similar pattern to that found in CHIKF .…”

“…This finding is similar to some studies, but very different from those found in other series . The predominance of CHIKF in females is also seen in other rheumatological diseases, such as lupus and RA . Also noteworthy is the potential for chronification of the lesions present in our series, given that at least two risk factors cited in the literature (age greater than 45 and female gender) were present in our patients; the third factor, the presence of pre‐existing rheumatological conditions, was standardized as an exclusion criterion in our study …”

“…In the initial phase, and in comparison with RA, CHIKF shows more intense and rapid synovial impairment, but without bone erosions. Patients in our series who were in the subacute/chronic phase of the disease had more synovitis and tenosynovitis than the patients with RA evaluated by Wang et al using ultrasound and MRI. These investigators observed that 10% of patients had tenosynovitis, and another 10% had joint effusions.…”

“…9,38,39 The predominance of CHIKF in females is also seen in other rheumatological diseases, such as lupus and RA. 40,41 Also noteworthy is the potential for chronification of the lesions present in our series, given that at least two risk factors cited in the literature (age greater than 45 and female gender) were present in our patients; the third factor, the presence of pre-existing rheumatological conditions, was standardized as an exclusion criterion in our study. 15,16 All of the reported symptoms have been described in the literature as being associated with arboviral infection, especially chronic joint pain, in the case of CHIKF.…”

Early Undifferentiated Arthritis: A Developing Country Perspective from Nepal

“…8,9,10 Also, more sensitive imaging tests like high-frequency ultrasonography with power-doppler uptake and extremity magnetic resonance imaging have shown to identify the cases of inflammatory arthritis early before it is clinically apparent. 11,12…”