Magnetic resonance imaging, radiography, and scintigraphy of the finger joints: one year follow up of patients with early arthritis

Abstract

Objectives-To evaluate synovial membrane hypertrophy, tenosynovitis, and erosion development of the 2nd to 5th metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints by magnetic resonance imaging in a group of patients with rheumatoid arthritis (RA) or suspected RA followed up for one year. Additionally, to compare the results with radiography, bone scintigraphy, and clinical findings. Patients and methods-Fifty five patients were examined at baseline, of whom 34 were followed up for one year. Twenty one patients already fulfilled the American College of Rheumatology (ACR) criteria for RA at baseline, five fulfilled the criteria only after one year's follow up, whereas eight maintained the original diagnosis of early unclassified polyarthritis. The following MRI variables were assessed at baseline and one year: synovial membrane hypertrophy score, number of erosions, and tenosynovitis score. Results-MRI detected progression of erosions earlier and more often than did radiography of the same joints; at baseline the MRI to radiography ratio was 28:4. Erosions were exclusively found in patients with RA at baseline or fulfilling the ACR criteria at one year. At one year follow up, scores of MR synovial membrane hypertrophy, tenosynovitis, and scintigraphic tracer accumulation had not changed significantly from baseline; in contrast, swollen and tender joint counts had declined significantly (p<0.05). Conclusions-MRI detected more erosions than radiography. MR synovial membrane hypertrophy and scintigraphy scores did not parallel the changes seen over time in clinically assessed swollen and tender joint counts. Although joint disease activity may be assessed as quiescent by conventional clinical methods, a more detailed evaluation by MRI may show that a pathological condition is still present within the synovium.

New radiographic bone erosions in the wrists of patients with rheumatoid arthritis are detectable with magnetic resonance imaging a median of two years earlier

“…This illustrates that the information on joint destruction provided by CR is associated with a considerable delay. In accordance with results of earlier studies (6)(7)(8)12), we observed that the sensitivity of MRI with respect to visualization of bone erosions was superior to that of CR. Furthermore, MRI detected erosive progression in more bones than did CR (i.e., MRI was more sensitive to change).…”

“…Several studies of patients with RA have shown that magnetic resonance imaging (MRI) detects more bone erosions than does CR (6)(7)(8). Due to the lack of long-term MRI followup studies, however, the time advantage offered by MRI compared with CR is unknown.…”

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

“…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)(3)(4). However, the specificity of the MRI findings in this context remains to be established.…”

Targeting the inflamed synovium: The quest for specificity

“…Until recently, imaging of the rheumatoid joint relied on radiologic (x-ray) measurement of cartilage and bone destruction which, while indicative of damage, often provides only limited information about the level of active synovial inflammation. Conventional whole-body bone scintigraphy relies on uptake of radioactive isotopes to regions of bone hyperemia and lacks sensitivity to disease activity over time (3). Although there have been exciting advances recently in the radiologic quantification of the inflamed synovium with the use of power Doppler ultrasound (4) and magnetic resonance imaging (5), the development of an imaging technology that could assess synovitis in multiple joints with simultaneous sensitivity to short-term changes would be a significant advance.…”