Evaluation of Magnetic Resonance Imaging–Detected Tenosynovitis in the Hand and Wrist in Early Arthritis

Abstract

Objective. Magnetic resonance imaging (MRI) is a sensitive method to detect inflammation in rheumatoid arthritis (RA), visualizing synovitis, bone marrow edema, and tenosynovitis. The prevalence of MRIdetected tenosynovitis and its diagnostic value in early arthritis are unclear. This study was undertaken to identify the frequency of MRI-detectable tenosynovitis at the metacarpophalangeal (MCP) and wrist joints in early arthritis and the association of these with RA and the severity of RA.Methods. A total of 178 patients with early arthritis underwent unilateral 1.5T extremity MRI at baseline. The MCP and wrist joints were scored using the Rheumatoid Arthritis Magnetic Resonance Imaging Scoring system and Haavardsholm's tenosynovitis score. Sixty-nine patients fulfilled the American College of Rheumatology/European League Against Rheumatism 2010 classification criteria for RA during the first year and were compared with the non-RA patients.Among the RA patients, comparisons were made with regard to anti-citrullinated protein antibody (ACPA) positivity and radiographic progression during year 1.Results. Of all patients, 65% had MRI-detected tenosynovitis. RA patients had tenosynovitis more often than non-RA patients (75% versus 59%; P ‫؍‬ 0.023). The flexor tendons at MCP5 and the extensor tendons at MCP2 and MCP4 and in extensor compartment I of the wrist were more frequently affected in RA patients than in other patients (odds ratios 2.8 [95% confidence interval (95% CI) 1.2-7.0], 9.1 [95% CI 1.9-42.8], 14.2 [95% CI 1.7-115.9], and 4.0 [95% CI 1.4-11.1], respectively). These associations were independent of local MRI synovitis. Specificities were all >82%. Within the group of RA patients, tenosynovitis scores were not associated with ACPA positivity or radiographic progression.Conclusion. MRI-detected tenosynovitis is commonly seen in early arthritis. The flexor tendons at MCP5, the extensor tendons at MCP2 and MCP4, and the first extensor compartment of the wrist are more often affected in RA, independent of local synovitis.Magnetic resonance imaging (MRI) of hand, wrist, and foot joints is increasingly used in early arthritis and rheumatoid arthritis (RA), though mainly for research purposes. The advantage of MRI is its ability to sensitively depict both local inflammation and structural damage (1,2). For MRI of the hands and wrists, a validated scoring system (Rheumatoid Arthritis Magnetic Resonance Imaging Scoring [RAMRIS]) has been developed (3). Bone marrow edema, or osteitis, which cannot be detected by physical examination or ultrasound, is a potent predictor of future erosions in RA (4,5).In addition to the RAMRIS method, which allows scoring of erosions, bone marrow edema, and synovitis in the metacarpophalangeal (MCP) and wrist

Ultrasound findings predict progression to inflammatory arthritis in anti-CCP antibody-positive patients without clinical synovitis

“…In a recent study, however, MRI-detected tenosynovitis was noted to be a common finding in early arthritis 25. Further investigations in this regard may be warranted.…”

2016 update of the EULAR recommendations for the management of early arthritis

“…MRI-detected bone marrow oedema and osteitis are independent predictors of radiographic progression in early RA,23 24 but data are limited in early arthritis. Finally, two recent studies have shown that hand flexor or extensor tenosynovitis on US36 or MRI25 may be a specific—although not very sensitive—marker for RA classification.…”

Diagnosis, prognosis and classification of early arthritis: results of a systematic review informing the 2016 update of the EULAR recommendations for the management of early arthritis

“…The included studies evaluated mainly MRI (three studies35 49 50) (see online supplementary materials S5). Other imaging modalities were US (one study51) and bone densitometry (BMD) performed on hand X-rays (one study52).…”