Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis

Abstract

Objective. To explore the presence of changes resembling rheumatoid arthritis erosions and synovitis in metacarpophalangeal (MCP) and wrist joints of healthy individuals on magnetic resonance imaging (MRI) and to compare the MRI findings with conventional radiographic, clinical, and biochemical findings.Methods. Twenty-eight healthy individuals were studied. Contrast-enhanced MRI and conventional radiography of the dominant wrist and second through fifth MCP joints were performed, coupled with standard clinical assessments and biochemical analyses. MR images were evaluated according to the latest OMER-ACT (Outcome Measures in Rheumatology Clinical Trials) recommendations with respect to synovitis, erosions, and bone marrow edema.Results. Conventional radiography revealed erosion-like changes in 1 of 224 MCP joint bones (0.4%) and in 1 of 420 wrist joint bones (0.2%). MRI depicted low-grade erosion-like changes in 5 of 224 MCP joint bones (2.2%) and in 7 of 420 wrist joint bones (1.7%), but postcontrast enhancement within the lesion was detected in only 8.3% of these. MRI depicted low-grade synovitis-like changes in 10 of 112 MCP joints (8.9%) and in 8 of 84 assessed wrist areas (9.5%), while only minimal early synovial enhancement was detected by dynamic MRI. Three subjects had elevated serum levels of C-reactive protein, and these subjects displayed 44.5% of the synovitis-like changes and 41.7% of the erosion-like changes. Bone marrow edema-like changes were not found in any joints.Conclusion. Changes resembling mild synovitis or small bone erosions are occasionally found in the MCP and wrist joints of healthy controls. Signs of synovitis on dynamic MRI, enhancement within bone erosion-like changes, and signs of bone marrow edema appear rarely or are absent in healthy controls. These signs may thus prove to be very specific in the distinction between arthritic and normal joints.Conventional radiography is the standard reference method for assessing destructive skeletal changes in rheumatoid arthritis (RA) and is part of the American College of Rheumatology (formerly, the American Rheumatism Association) 1987 revised criteria for the classification of RA (1). Magnetic resonance imaging (MRI) is more sensitive for the detection of synovitis and bone erosions in RA than are conventional radiography and clinical assessment (2-4). However, the specificity of the MRI findings in this context remains to be established.A review of the literature describing erosions, synovitis, and bone marrow edema in wrist and metacarpophalangeal (MCP) joints on MRI revealed that very few studies have assessed the prevalence of these findings in healthy persons (Table 1). To our knowledge, only one reported study had the primary aim of describing signs of arthritis in healthy persons. Investigators in that study only examined signs of synovitis in wrist joints (5).Studies involving healthy controls are often perSupported by the Danish Rheumatism Association.

The smallest detectable difference and sensitivity to change of magnetic resonance imaging and radiographic scoring of structural joint damage in rheumatoid arthritis finger, wrist, and toe joints: A comparison of the omeract rheumatoid arthritis magnetic resonance imaging score applied to different joint combinations and the sharp/van der heijde radiographic score

“…Consistent with previously published data (27), small bone changes resembling erosions were observed in some healthy controls. However, none of them had score changes above the SDD and no control subjects had destructive joint changes seen on radiography.…”

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

“…These criteria are based on 4 main domains: joint involvement (detected by clinical examination, ultrasonography, or MRI), serology (anti-CCP and RF), acute-phase reactants (CRP level and erythrocyte sedimentation rate), and duration of synovitis. The findings of the present study, in which we demonstrated that changes revealed on MRI of the joints of healthy subjects resembled pathologic features of the RA joint, are in accordance with the results from other MRI studies of healthy subjects (18,19), and thus these findings underscore the need for establishment of a threshold to indicate which types and grades of MRI findings should be used to designate a "positive" result on MRI. Our study was planned, powered, and designed with the ACR 1987 criteria for RA as the standard reference.…”

Ultrasonography of the metacarpophalangeal joints in healthy subjects using an 18 MHz transducer.

“…The authors explained the difference between MRI and US by the visualization by MRI of the subchondral cysts that were interpreted as erosions. Ejbjerg et al [28] detected low grade erosion-like changes in 2.2% of MCP examined by MRI in 28 normal subjects, especially in the second and the fifth MCP joints. All the lesions were small, without increased signal intensity on postcontrast images.…”