MRI and ultrasound of the hands and wrists in rheumatoid arthritis. I. Imaging findings

Abstract

The management of patients with rheumatoid arthritis (RA) has rapidly evolved with the development of newer diseasemodifying drugs and the recognition that long-term damage can be mitigated by an earlier and more-informed use of these medications. Historically, radiographs were the mainstay of imaging in RA patients, but radiographic joint narrowing and erosions are late and insensitive findings in the disease. MRI (with intravenous contrast agent) and ultrasound (with power Doppler interrogation) of the hands and wrists are able to demonstrate erosions earlier and with greater sensitivity than radiographs. More importantly, these imaging studies also depict synovitis and active soft-tissue inflammation, which represents a precursor to structural damage. Additionally, MRI can show inflammation within the bones (osteitis), which is proving to be the most important prognosticator of an aggressive disease course. Part I of this review discusses the imaging techniques, pitfalls, definitions, and comparative studies of MRI and ultrasound for identifying and quantifying erosions, synovitis, and osteitis. Part II will demonstrate how these imaging findings influence the clinical management of RA patients throughout their disease course, from presentation through clinical remission.

The Use of Oral Analgesics and Pain Self-Efficacy Are Independent Predictors of the Quality of Life of Individuals with Rheumatoid Arthritis

“…Multiple previous studies have reported clinical and imaging remission in patients with RA, but few studies have focused on functional remission [4,30]. In the present study, we investigated important factors associated with QOL in patients with RA, and our findings suggest that the disease duration, PDQ, PSEQ, PCS, use of oral steroids, and use of oral analgesics play important roles in achieving functional remission.…”

Anterior chest wall in SAPHO syndrome: magnetic resonance imaging findings

“…However, synovitis of the ACW has been rarely reported [ 29 ]. In our study, 90.1% of patients showed effusion in the joint cavities, although some of the manifestation may be physiological effusions, which should be proved by enhanced MRI [ 30 , 31 ]. In addition, the sternal angle, which is in the vicinity of the second SCoJ (containing an interarticular ligament and two synovial membranes) and contains the manubriosternal joint (containing dorsal and ventral ligaments and classified as a synovial joint in ~ 30% patients [ 20 ]), was the third-most frequently involved site.…”

“…Second, the non-contrast-enhanced MRI could not show all the involved veins, such as subclavian veins. The sensitivity and specificity for identifying synovitis and tenosynovitis are also lower using T2-weighted sequences alone compared with contrast-enhanced images [ 30 ]. Third, there was no computed tomography serving as a reference to accurately assess ossification of the costal cartilage and ligaments.…”

Reasons for discordances between ultrasonography and magnetic resonance imaging in the evaluation of the ankle, hindfoot and heel of the patients with rheumatoid arthritis

“…Only the use of contrast-enhanced MRI can make the distinction -the inflamed synovium enhances after contrast injection [26]. However, gadolinium administration raises the cost and duration of the MRI examination and adds considerable discomfort to the patients [29]. It was demonstrated that US and MRI are useful and reliable imaging techniques in identifying tenosynovitis [5,12].…”

“…Bone marrow edema or osteitis (inflammation of the subchondral trabecular bone), findings specific for inflammatory arthropathy, denotes a severe and aggressive disease phenotype, and predicts the structural damage progression of the disease [29,36]. MRI is the only imaging technique capable of visualizing this abnormality.…”